OBJECTIVES: Since mid-2001, a heptavalent pneumococcal conjugate vaccine (PCV-7) against 7 common pneumococcal serotypes has been available in Canada. The purpose of this study is to build upon existing economic evaluations and use recent herd immunity evidence to estimate the real-world clinical and economic effectiveness of PCV-7 in Canada. METHODS: A systematic literature review was completed using Medline and Canadian health care publications including: Canadian Journal of Infectious Disease and Canadian Communicable Disease Report. The search terms included: pneumococcal, costs, cost-effectiveness, herd immunity, and incidence. Clinical and economic impacts of adult pneumococcal disease were determined based on epidemiologic and cost data available from the United States and Canada. RESULTS: Three pharmacoeconomic evaluations of PCV-7 in Canada have each found that routine immunization would help Canada avoid substantial morbidity and mortality, and associated health care costs and productivity losses. Using recent effectiveness data, the reduction in adult pneumococcal disease is estimated to save an additional $40 million from a Canadian health care perspective; suggesting the vaccine is cost-saving. CONCLUSIONS: Herd immunity resulting from a universal childhood PCV-7 program will have a substantial clinical and economic impact on populations greater than 20 years of age, thereby making PCV-7 a cost-saving intervention for the Canadian health care system.