Wateska AR, Nowalk MP, Lin CJ, et al. - Both 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13) were included in recently revised vaccination recommendations for US adults, aged 65 years and older, with PCV13 now recommended for immunocompetent older people based on shared decision making. Researchers here investigated the public health impact and cost-effectiveness of this recommendation or of pneumococcal vaccine uptake improvement interventions. They used Markov decision analysis on a hypothetical 65-year-old general and black population cohorts. The intervention comprised current pneumococcal vaccination recommendations for US older people, an alternative policy eliminating PCV13 in immunocompetent older people, and vaccine uptake improvement programs. The outcomes suggest that relative to an alternative strategy omitting PCV13 in the immunocompetent, current pneumococcal vaccination recommendations for US older people are economically unfavorable. In black population analyses, the alternative recommendation with an uptake improvement program may be economically feasible and could be worth holding as a population-wide recommendation if reducing racial disparities is a priority.