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The cost-effectiveness of banning highly hazardous pesticides to prevent suicides due to pesticide self-ingestion across 14 countries: an economic modelling study

Lee, YY, Chisholm, D, Eddleston, M, Gunnell, D, Fleischmann, A, Konradsen, F, Bertram, MY, Mihalopoulos, C, Brown, R, Santomauro, DF, Schess, J and van Ommeren, M 2020, The cost-effectiveness of banning highly hazardous pesticides to prevent suicides due to pesticide self-ingestion across 14 countries: an economic modelling study, The Lancet Global Health, vol. 9, no. 3, pp. e291-e300, doi: 10.1016/s2214-109x(20)30493-9.

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Title The cost-effectiveness of banning highly hazardous pesticides to prevent suicides due to pesticide self-ingestion across 14 countries: an economic modelling study
Author(s) Lee, YY
Chisholm, D
Eddleston, M
Gunnell, D
Fleischmann, A
Konradsen, F
Bertram, MY
Mihalopoulos, CORCID iD for Mihalopoulos, C orcid.org/0000-0002-7127-9462
Brown, R
Santomauro, DF
Schess, J
van Ommeren, M
Journal name The Lancet Global Health
Volume number 9
Issue number 3
Start page e291
End page e300
Total pages 10
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2020-12-17
ISSN 2214-109X
2214-109X
Summary 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.
Language eng
DOI 10.1016/s2214-109x(20)30493-9
Indigenous content off
Field of Research 0605 Microbiology
1117 Public Health and Health Services
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2020, The Author(s)
Free to Read? Yes
Use Rights Creative Commons Attribution 3.0 IGO licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30146686

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.