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Lee YY, Chisholm D, Eddleston M, Gunnell D, Fleischmann A, Konradsen F, Bertram MY, Mihalopoulos C, Brown R, Santomauro DF, Schess J, van Ommeren M. The cost-effectiveness of banning highly hazardous pesticides to prevent suicides due to pesticide self-ingestion across 14 countries: an economic modelling study. Lancet Glob Health 2021; 9:e291-e300. [PMID: 33341152 PMCID: PMC7886657 DOI: 10.1016/s2214-109x(20)30493-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Reducing suicides is a key Sustainable Development Goal target for improving global health. Highly hazardous pesticides are among the leading causes of death by suicide in low-income and middle-income countries. National bans of acutely toxic highly hazardous pesticides have led to substantial reductions in pesticide-attributable suicides across several countries. This study evaluated the cost-effectiveness of implementing national bans of highly hazardous pesticides to reduce the burden of pesticide suicides. METHODS A Markov model was developed to examine the costs and health effects of implementing a national ban of highly hazardous pesticides to prevent suicides due to pesticide self-poisoning, compared with a null comparator. We used WHO cost-effectiveness and strategic planning (WHO-CHOICE) methods to estimate pesticide-attributable suicide rates for 100 years from 2017. Country-specific costs were obtained from the WHO-CHOICE database and denominated in 2017 international dollars (I$), discounted at a 3% annual rate, and health effects were measured in healthy life-years gained (HLYGs). We used a demographic projection model beginning with the country population in the baseline year (2017), split by 1-year age group and sex. Country-specific data on overall suicide rates were obtained for 2017 by age and sex from the Global Burden of Disease Study 2017 Data Resources. The analysis involved 14 countries spanning low-income to high-income settings, and cost-effectiveness ratios were analysed at the country-specific level and aggregated according to country income group and the proportion of suicides due to pesticides. FINDINGS Banning highly hazardous pesticides across the 14 countries studied could result in about 28 000 (95% uncertainty interval [UI] 24 000-32 000) fewer suicide deaths each year at an annual cost of I$0·007 per capita (95% UI 0·006-0·008). In the population-standardised results for the base case analysis, national bans produced cost-effectiveness ratios of $94 per HLYG (95% UI 73-123) across low-income and lower-middle-income countries and $237 per HLYG (95% UI 191-303) across upper-middle-income and high-income countries. Bans were more cost-effective in countries where a high proportion of suicides are attributable to pesticide self-poisoning, reaching a cost-effectiveness ratio of $75 per HLYG (95% UI 58-99) in two countries with proportions of more than 30%. INTERPRETATION National bans of highly hazardous pesticides are a potentially cost-effective and affordable intervention for reducing suicide deaths in countries with a high burden of suicides attributable to pesticides. However, our study findings are limited by imperfect data and assumptions that could be improved upon by future studies. FUNDING WHO.
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Affiliation(s)
- Y Y Lee
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.
| | - D Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - M Eddleston
- Pharmacology, Toxicology and Therapeutics, University and British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK
| | - D Gunnell
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; Population Health Sciences Institute, Bristol Medical School, Bristol, UK; National Institute of Health Research Biomedical Research Centre, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, UK
| | - A Fleischmann
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
| | - F Konradsen
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK; Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Y Bertram
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - C Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - R Brown
- Department of Environment, Climate Change and Health, WHO, Geneva, Switzerland
| | - D F Santomauro
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - J Schess
- Generation Mental Health Association, New York, NY, USA; Ross School of Business, University of Michigan, Ann Arbor, MI, USA
| | - M van Ommeren
- Department of Mental Health and Substance Use, WHO, Geneva, Switzerland
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