<p>Community acquired pneumonia, especially pneumococcal pneumonia, is a common cause of hospitalization and death in developed countries and is a significant economic burden. Our aim was to assess the epidemiologic and economic burdens of pneumococcal pneumonia (J13 and J18 diagnosis) in Slovakia from 2014 to 2019. We performed a retrospective, prevalence-based cost-of-illness analysis from the third-party payer and societal perspectives. Direct costs consisted of the cost of medications, laboratory investigations, diagnostic procedures, and inpatient stay, while indirect costs consisted of the cost of absenteeism, disability, and loss of productivity due to premature death. Our study showed that the estimated incidence of pneumococcal pneumonia in Slovakia decreased by 19% in the 6-year study period, with 314 cases per 100,000 persons in 2019. The total mean cost per patient with pneumococcal pneumonia in 2019 was €8409, with direct costs of €1047 and indirect costs of €7361. During the period under review, the proportion of healthcare costs in the total cost was constant and accounted for 12–15%. Hospitalization was the main driver of direct costs, accounting for more than 70% of costs, while productivity lost due to premature death made up 98% of annual indirect costs. We found that the economic burden of pneumococcal pneumonia is substantial in Slovakia, with a total annual cost of risen from €134 million in 2015 (0,17% of Slovak GDP) to €145 million in 2019 (0,15% of Slovak GDP). Our cost estimates can be used by health policymakers to assess the cost–benefit ratio of immunization programs and make resource allocation decisions.</p>