Most studies of the cost-effectiveness of pneumococcal vaccination show very favorable cost-effectiveness ratios for preventing pneumococcal pneumonia, but they make the controversial assumption that vaccination is equally effective in preventing bacteremic (BPP) and nonbacteremic (NBPP) pneumonia. However, the results of our study showed that, compared with preventing BPP alone, the cost-effectiveness of pneumococcal vaccination increased substantially even when only a small proportion of additional cases of NBPP were prevented.