The cost-effectiveness of banning highly hazardous pesticides to prevent suicides due to pesticide self-ingestion across 14 countries: a model-based economic evaluation

Y Y Lee*, D Chisholm, M Eddleston, D Gunnell, A Fleischmann, F Konradsen, M Y Bertram, C Mihalopoulos, R Brown, D F Santomauro, J Schess, M van Ommeren

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background: Reducing suicides is a key Sustainable Development Goal target for improving global health. Highly hazardous pesticides (HHPs) are among the leading causes of death by suicide in low-and-middle-income countries. National bans of acutely-toxic HHPs have led to significant reductions in pesticide suicides across several countries. This study evaluated the cost effectiveness of implementing national HHP bans to reduce the burden of pesticide suicides.

Methods: A model was developed using WHO-CHOICE methods to estimate pesticide attributable suicide rates over a 100-year time horizon from 2017. The impact of implementing a national HHP ban was compared to a ‘null’ comparator. Costs were estimated in 2017 international dollars (I$). Health impacts were measured in Healthy Life Years Gained (HLYGs). The analysis involved 14 countries spanning low-to-high-income settings. Cost-effectiveness ratios (I$ per HLYG) were reported across two country income groups.

Findings: Banning HHPs across 14 countries could result in up to 28,000 fewer suicide deaths each year (95%UI:24,000–32,000) at an annual cost of $0·007 per capita (95%UI:0·006–0·008). National bans are cost-effective in countries where a high proportion of suicides are attributable to pesticide self-poisoning. The cost-effectiveness ratio was $94 per HLYG (95%UI:73–123)in low and lower middle-income countries and $237 per HLYG (95%UI:191–303) in upper middle- and high-income countries.

Interpretation: National HHP bans are a potentially cost-effective and affordable intervention for reducing suicide deaths in countries with a high burden of pesticide suicides. However, study findings are limited by imperfect data and assumptions that could be improved upon by future studies.
Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalThe Lancet Global Health
Volume0
Early online date17 Dec 2020
DOIs
Publication statusE-pub ahead of print - 17 Dec 2020

Keywords

  • pesticides/poisoning
  • suicide/economics
  • suicide/prevention and control
  • suicide/statistics and numerical data
  • commerce/legislation and jurisprudence
  • economic evaluation
  • models
  • economic
  • cost-utility analysis
  • cost-effectiveness analysis
  • humans

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