The urban-to-rural cost ratio is 1.17 (95% UR, 1.09–1.27) per 100,000 under fives. In interventions two (randomly increasing all three vaccines to 90% coverage) and three (increasing all three vaccines to at least 90% coverage in each region), states with low coverage rates in intervention Selleck Lapatinib one achieve the greatest additional reductions in burden (Fig. 3 and Fig. 4, row 1). For example, Uttar Pradesh has the second lowest coverage in intervention one, and it averts an additional 427 (95% UR, 275–580) rotavirus-related DALYs per 100,000 under-fives per year in intervention two and 548 (95% UR, 372–724) per 100,000 in intervention three. Approximately 665,000 DALYs

are averted for all five diseases in Uttar Pradesh in intervention three. The intervention costs incremental to the baseline in intervention two for all five diseases are $137,926 (95% UR, $120,787–$155,065) per 100,000 under-fives in Uttar Pradesh ($41 million for its entire population) and above $30,000 in all other states. In intervention three, the cost incremental to the baseline is above $100,000 in nine states, including Uttar Pradesh, where the cost is $186,454 (95% UR, $167,960–$204,948) per 100,000; the cost for all under-fives in Uttar Pradesh is approximately $53 million (Fig.

4, row 2). The urban-to-rural cost ratio is 0.88 (95% UR, 0.54–1.41) in intervention two and 0.75 (95% UR, 0.47–1.17) in intervention three (Fig. HKI-272 cost 2). Most of the OOP expenditure averted results from the reduced rotavirus burden (Fig. 2 and Fig. 5, row 3): $232,354 (95% UR, $224,029–$240,678) averted per 100,000 under-fives in intervention one, with an additional $49,489 (95% UR, $40,861–$58,118) and $56,295 (95% UR, $47,599–$64,991) averted in interventions two and three, respectively. The OOP averted for DPT (approximately 1800) and measles (approximately 5500) is highest in intervention three (Fig. 4, row these 3?). The urban-to-rural ratio

of OOP expenditure averted decreases from intervention one through intervention three (Fig. 1, row 4; e.g., the rotavirus ratio decreases from 0.70 to 0.48). The interventions are cost saving in all states that have sufficient data. If we exclude OOP expenditure averted and only consider the intervention costs, the incremental dollars per DALY averted in intervention one is $70.89 (95% UR, 95% UR, $61.51–$80.28) with respect to the baseline. For interventions two and three, the incremental dollars per DALY averted are $30.47 (95% UR, −$4.36–$65.28) and $36.97 (95% UR, $7.96–$65.97) with respect to intervention one. Excluding OOP expenditure averted, the dollars per DALY averted are below $110 in all states (with sufficient sample size) in all interventions. The value of intervening is highest for rotavirus. In intervention one, the money-metric value of insurance for rotavirus ranges from $521 (95% UR, $280–$761) per 100,000 under-fives in Delhi to $6756 (95% UR, $6318–$7196) in Bihar (Fig. 5).