Incidence and Cost of Otitis Media in High-income and Low- and Middle-income Countries

BACKGROUND: The estimated global incidence of acute otitis media (AOM) is >700 million episodes per year, with direct costs of billions of United States Dollars. This economic burden warrants continued investment in vaccine development against otopathogens. To aid in these decisions, an updated estimate of the incidence and costs of AOM and common sequelae is provided. METHODS: A structured search using PubMed and Google Scholar that included English-language articles published from January 2000 to April 2024 was conducted using keywords and Boolean operators. Costs were adjusted to 2025 United States Dollars using the consumer price index inflation calculator provided by the US Bureau of Labor Statistics. RESULTS: The US incidence of AOM is reported as 2- to 4-fold higher than most other high-income countries, and 3- to 6-fold higher than low- and middle-income countries (LMICs). However, studies of the point prevalence of AOM sequelae, such as chronic suppurative otitis media and acquired hearing loss, are higher in LMICs. The direct cost per AOM episode in the United States ranges from $397 to $718, for other high-income countries from $224 to $878 and for LMICs from $31 to $227. When indirect costs are incorporated, the economic burden of AOM in children under 5 years is estimated at $51-$68 billion/year. CONCLUSIONS: The worldwide incidence of AOM may be higher than prior estimates suggest. The reported frequency of AOM complications in LMICs, especially chronic suppurative otitis media and acquired deafness, is inconsistent with the reported low incidence rates. Costs per episode vary widely but represent a much larger economic burden than previously reported, supporting investment to prevent this infectious disease.