Wateska AR, Nowalk MP, Lin CJ, et al. - Researchers sought to estimate the public health impact and cost-effectiveness of employing both the conjugate and polysaccharide pneumococcal vaccines in all adults aged ≥ 65 years. Further, they compared these estimates with those with an alternative strategy (omitting pneumococcal conjugate vaccine in the nonimmunocompromised) and with the newly revised recommendation (giving or omitting conjugate vaccine based on patient–physician shared decision making). They investigated the strategies in hypothetical US 65-year-old population cohorts and segmented these into health states depending on age- and population-specific data in a Markov state-transition model with a lifetime time horizon from a healthcare perspective. A separate examination of Black population cohorts was done given greater illness risk and lower vaccine uptake. Outcomes support providing both vaccines, either routinely or with shared decision making, as most effective in reducing pneumococcal disease incidence compared with no vaccination. However, this costs $765,000–$2.18 million/quality-adjusted life-year gained. The alternative strategy cost $65,700–$226,700/quality-adjusted life year gained (less in black populations) and lessened cases and deaths by 0.3%–0.9% depending on the examined population and scenario. These findings suggest a higher efficacy of using both pneumococcal vaccines but with considerably more expenses. Vaccination strategy with the omission of pneumococcal conjugate vaccination in immunocompetent US seniors appeared to be economically reasonable, especially for black seniors.