Their model included a calculation of the opportunity cost of equity, based on the health improvements that would be forgone in order to select the most equitable selleck solutions. Jehu-Appiah et al. demonstrated the usefulness

of a similar modeling approach to quantify the trade-offs between efficiency and equity in health investment priorities in Ghana [16]. One of the simplest approaches to assessing distributional effects is to explicitly estimate costs and impacts for distinct sub-populations. This may include stratifying by age, sex, socio-economic status and/or geographic regions. Coyle et al. provide a general framework for population stratified cost-effectiveness analysis [17] and Sculpher describes the application of the approach in contexts such as the UK’s NICE evaluation process [18]. We used an existing country-level rotavirus impact and cost-effectiveness model [1] that has been updated with newly available data [5]. Estimates here are for vaccinating a single birth cohort, including outcomes

during their first five years of life. National rotavirus mortality estimates were based on recently published figures [19]. Estimates of inpatient and outpatient visits are also from previously published studies [20]. Vaccine efficacy estimates Selleck Regorafenib were based on region and mortality strata [21], [22] and [23]. Estimates for high mortality countries were based on pooled estimates from recent trials [21] and are described in full detail in Atherly et al. [5]. Efficacy was adjusted for

the expected age at which first and second dose would be received in each country, based on DPT1 and DPT2 coverage from DHS surveys [3] and [24]. This was done by modeling coverage of 1 and 2 doses of vaccine at 0–2, 3–5, 6–8 and 9–11 months. Reported DPT1 and DPT2 coverage among 12–23 month old children was used to estimate the fraction of those that would receive each vaccine at the different age ranges [5]. Vaccination effectiveness was based on the fraction of children at each age with 0, 1, or 2 doses and the expected protection of each, assuming 50% lower efficacy for a single dose in the 2-dose regime. For each age band, the effectiveness was whatever applied to the proportion of rotavirus deaths that would occur during that period. Current SAGE recommendations suggest that children over 8 months or 32 weeks not receive a vaccine in order to avoid potential adverse effects. The model used in this study assumes that children receiving their second DPT dose between 8 and 12 months of age would still receive it [25]. Medical treatment costs were estimated for inpatient and outpatient visits, using cost-estimates from WHO-CHOICE for facility charges and extrapolations of medication and diagnostic costs from published studies, as described elsewhere [1] and [3]. Medical costs were in 2010 US Dollars and presented in more detail elsewhere [5]. All costs and DALY estimates were discounted at 3%.