The productivity gains of health technology are typically neglected in normal economic evaluations from the standpoint of a health payer, risking undervaluation. From a societal standpoint, the study conducts a productivity-based cost-benefit analysis and estimate the indirect costs of adult pneumococcal disease, vaccination benefits from the adult 13-valent pneumococcal conjugate vaccine (PCV13 Adult), and rates of return to PCV13 Adult for a range of hypothetical vaccination costs. Indirect costs from death or incapacity equal the estimated present discounted worth of lifetime losses in the infected individual’s paid and unpaid labour, as well as the paid work of caretakers. Vaccination benefits include the avoidance of indirect expenditures. Rates of return are calculated by dividing vaccination benefits by vaccination expenses, minus one.

The study simulates the impacts of comorbidities using scalar multiplication of general population factors. Indirect expenses for inpatient community-acquired pneumonia (CAP), bacteremia, and meningitis – but not for outpatient CAP – approach or exceed Turkish per capita GDP. For any hypothetical expenses less than this, the rate of return is positive. The findings are sensitive to herd effects from paediatric immunisation as well as vaccine effectiveness rates. The rate of return compares favourably with comparable global development interventions with well-established strong investment arguments for a wide range of potential immunisation costs.