OBJECTIVE: A general vaccination of newborns with PnC-7 reduces pneumococcal diseases and also the rate of pneumococcal diseases in unvaccinated adults (herd immunity). Usually cohort of patients followed subsequent cycles in a Markov model. In this study, age and class were computed cross sectionally. The objective of this study was to evaluate the annual health outcomes and cost-effectiveness of a general vaccination with PnC-7 in a hypothetical steady state German cohort across all age groups with base year 2003 focusing health care payers' perspective. METHODS: The efficacies of PnC-7 and herd immunity were adjusted to serotype distribution according to two German panels. The model included incidences of pneumococcal diseases, fatality rates, rate of long-term sequelae, age specific German population structure, 3+1 application of PnC-7, and health care expenditures for treatment of pneumococcal diseases. Critical key data were varied in a sensitivity analysis. RESULTS: A vaccination rate PnC-7 of 68% is able to avoid 4,256 invasive pneumococcal diseases, 57,727 pneumococcal pneumonias, 274,332 cases of otitis media, 99 longterm sequelaes and 2,257 deaths resulting in 34,237 life years gained in Germany every year. From health care payer's view the cost savings outweighed the vaccination administration with factor 1.23 and costs of a life-year-saved are 887€. The one-way sensitivity analysis showed the estimations were sensitive to reduction in incidence of otitis media and health care costs, but the vaccination with PnC-7 remained cost saving. On the other hand, the incorporation of an ageing German population, 2+1 application of PnC-7, herd immunity without serotype adjustments or non-discounting of life year gained resulted in conservative cost-effectiveness estimations. CONCLUSIONS: From the German health care payer view, a general vaccination with conjugate vaccine PnC-7 is cost saving.