OBJECTIVES Acute otitis media (AOM) is a prevalent pediatric condition, affecting approximately 80% of children by three years of age. Routine immunization programs include 7-valent Pneumococcal conjugate vaccine (PCV-7), associated with a reduction of AOM events caused by Streptococcus pneumoniae. The objective of this study was to compare the costs and effects of PCV-7 with PHiD-CV, a newly approved in Canada Pneumococcal non-typeable Haemophilus influenzae Protein D-conjugate vaccine employing an active protein D-carrier associated with reduction of nontypeable Haemophilus Influenzae (NTHi) AOM. METHODS A steady-state, population-based model with a one-year time horizon was developed, and calibrated with Canadian epidemiologic and demographic data, to investigate the costs and effects associated with AOM episodes across the Canadian population. A 4-dose schedule for PHiD-CV vaccination was compared with a 4-dose schedule for PCV-7 vaccination. The base-case included herd-protection for invasive pneumococcal disease and serotype 6A cross protection. A healthcare system perspective was taken with the assumption of 100% vaccination coverage. RESULTS Compared with PCV-7, vaccination with PHiD-CV could prevent an additional 170,951 ambulatory visits for AOM, 144,454 antibiotic prescriptions for AOM, and 9,830 hospitalizations for myringotomy per year. With PCV-7 the total direct costs associated with AOM are $119.8 million of which $16.9 million could be off-set by implementation of routine vaccination with PHiD-CV. CONCLUSIONS Based on the base-case analysis, inclusion of PHiD-CV in routine immunization programs across Canada would be cost-saving to the healthcare system compared with PCV-7. PHiD-CV offers substantial benefits in terms of reduced ambulatory visits, antibiotic prescriptions and hospitalizations for AOM, a highly prevalent childhood condition.