The seven-valent pneumococcal conjugate vaccine (PCV) is the only vaccine to immunize children under two years old against Streptococcus Pneumoniae, a leading cause of meningitis, bacteremia, pneumonia, otitis media, and sinusitis. OBJECTIVE: The purpose of this analysis is to assess the cost-effectiveness of PCV in Canada, the United Kingdom, France, Germany, Italy, and Spain. METHODS: A Markov cohort simulation model was constructed to compare the health and economic outcomes of children vaccinated with PCV versus unvaccinated. Estimated disease-specific incidence and mortality rates for each country, as well as relative risk rates for vaccinated children, were entered into the model. Primary research was used in Canada, Germany, and the United Kingdom to establish incidence rates for the model. Incidence data for other countries was obtained from published studies. Relative risk data for vaccination was obtained from the Northern California Kaiser Permanente Efficacy Study. The following health states were considered in the model: well, meningitis, bacteremia, pneumonia, otitis media, sinusitis, and death. A decision tree model was developed for each health state in each country, to evaluate the direct and indirect cost of illness. Each decision tree model was based on a local clinical management analysis and resource valuation. The Markov model was adapted to accommodate five dosing schedules of PCV, based on the age of initial vaccination. The expected utilization of PCV in all child groups was incorporated in a net budgetary impact analysis. RESULTS: Cost-effectiveness, measured as the incremental cost-per-life-year gained, varied by country. PCV is a cost-effective method of disease prevention when considering the savings in direct and indirect costs and the high efficacy demonstrated in invasive disease. CONCLUSIONS: PCV should be supported by healthcare providers in the six countries because it is the only means of pneumococcal disease prevention in a high-risk population and it is cost-effective.