Background: Streptococcus pneumoniae (Spn) is the most common cause of Community-acquired pneumonia (CAP) and invasive pneunmococcal diseases (IPD) in the elderly population. Objectives: The objective of the analysis was to estimate the economic burden of disease caused by Spn in Italy by considering people aged > 65 years. Methods: A cost of illness analysis was performed from the Italian National Health Service (NHS) perspective. Therefore, only direct medical costs were taken into account. The main cost drivers were as follows: diagnosis, visits to GPs, drugs, hospitalizations. Regarding epidemiological and economic data input, incidence rates were taken from the national literature and unit costs (€2010) from national tariffs. The literature search, conducted between July 2000 and July 2011, was performed by consulting PubMed e Ovid. Search terms used were as follows:” Streptococcus pneumoniae”, “invasive pneunmococcal diseases”, “Community-acquired pneumonia”, “cost”, “economic”. Results: The current analysis showed that hospitalization represents the main cost driver. Regarding visits to GPs, annual average cost was €53.9 per patient (€1.267.458 population). Regarding diagnosis, annual average cost was €52,82 per patient (€1.242.062 population). Regarding drugs, antibiotic prescription absorbs a significant amount of resources (€2.257.440 annually/patient). Furthermore, the overall hospitalization costs due to Spn was €175.837.848 annually. Discussion: The analysis showed that the total cost due to Spn diseases was more than €180 million annually. Nevertheless, this value does not consider costs related to sequelae due to IPD and CAP, because of a lack of data at national level. Therefore, it would be necessary to conduct further analyses with the aim to investigate also these costs in order to give a comprehensive picture of the costs related to Spn diseases. Implications for the health system/professionals/patients/ society: Considering the high costs due to streptococcal diseases it would be necessary to consider the implementation of vaccination strategies in the elderly population.