OBJECTIVES: To compare the clinical and economic burden of community acquired pneumonia (CAP) with invasive pneumococcal diseases (IPD) in children less than 10 years of age, based on cost-effectiveness studies from 7 countries. METHODS: The clinical and economic burden of IPD and CAP hospitalisations in children less than 10 years of age over 1 year was modelled based on published cost-effectiveness studies of pneumococcal vaccines in UK, Canada, Czech Republic, Sweden, Turkey, Saudi Arabia and Taiwan. Only direct medical costs were taken into account. The costs were converted in 2005 PPP adjusted international dollars (I$). RESULTS: Model projections indicate that hospitalised CAP is more prevalent than hospitalised IPD in children. The IPD case fatality ratio was found to be higher than for CAP in all 7 countries evaluated. The projected total number of deaths related to CAP was, however, estimated to be higher than for those of IPD in all countries except in Canada and Sweden. The total estimated direct medical costs of CAP compared with IPD were found to be on average 8.2 times higher in Europe and North America and 37.8 times higher in Middle East and Asia Pacific regions. The total CAP economic burden per year in children in the included studies was estimated at: 57Mio I$ in UK; 65Mio I$ in Canada; 8.6Mio I$ in Czech Republic; 10.7Mio I$ in Sweden; 3Mio I$ in Turkey; 5.7Mio I$ in Saudi Arabia and 30.3Mio I$ in Taiwan. CONCLUSIONS: Model projections indicate that the mortality burden of CAP was found to be higher than for IPD in the majority of countries studied. The total economic burden of CAP in children is on average 8.2-37.8 times higher than for IPD across 7 countries.