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Black RE, Laxminarayan R, Temmerman M, et al., editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Apr 5. doi: 10.1596/978-1-4648-0348-2_ch9

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Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2).

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Table 9.1Cost-Effectiveness and Unit Cost of Interventions for Diarrheal Diseases

InterventionRegionCost-effectiveness (US$/DALY averted)Unit cost (US$)
Oral rehydration solution (versus no ORS)AFR-E< 2002.20/diarrhea episode
Prophylactic zinc with ORS (versus ORS alone)AFR-E and SEA-D< 1000.61/diarrhea episode
Rotavirus vaccine (versus no vaccine)Low-income countries< 200 at 5/dose
(less at 0.20/dose)
5/dose for two doses (Gavi price); Gavi-eligible countries pay 0.20/dose for two doses
Clean water (at household: chlorination or solar disinfection versus untreated water)AFR-E and SEA-D<2000.07/person/year SEA-D
0.13/person/year AFR-E (in 2000 U.S. dollars)
Improved rural water and sanitation (versus unimproved)AFR-E and SEA-D<2,00028/household (well); 52/household (latrine)
Piped water and sewer connection (versus no connections)AFR-E
SEA-D
<2,000
<3,000
136/household (water); 160/household (sewer)
Cholera vaccine (versus no vaccine)High-endemicity countries2,000–10,0001.33/person
Behavior changeLow-income countriesLarge variationLarge variation
RUTF added to standard rations (versus standard rations)AFR-E> 10,000 considering only benefits for diarrhea527/child/year

See Horton and Levin 2016, chapter 17, on cost-effectiveness in this volume.

Note: AFR-E = high-mortality Africa (WHO subregion); DALY = disability adjusted life year; Gavi, the Vaccine Alliance; ORS = oral rehydration solution; RUTF = ready-to-use therapeutic foods; SEA-D = high-mortality South-East Asia (WHO subregion). Costs and cost per DALY averted are higher in other regions. Interventions costing less than US$240 per DALY in 2012 would be very cost-effective even in the poorest low-income country; those costing less than US$720 would be cost-effective even in the poorest low-income country (Burundi’s per capita gross national income was US$240 in 2012) (World Bank 2014). All costs converted to 2012 U.S. dollars (except as noted otherwise).

From: Chapter 9, Diarrheal Diseases

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