Cost Effectiveness of Environmental Lead Risk Mitigation in Low‐ and Middle‐Income Countries. Issue 2 (22nd February 2018)

• Record Type: Journal Article
• Authors: Ericson, Bret; Caravanos, Jack; Depratt, Conrado; Santos, Cynthia; Cabral, Mishelle Gomez; Fuller, Richard; Taylor, Mark Patrick
• Is Part Of: GeoHealth. Volume 2:Issue 2(2018)
• Page Start: 87
• Page End: 101
• Publication Date: 2018-02-22
• Subjects: soil -- lead -- remediation -- low‐ and middle‐income countries -- disability adjust life years; Environmental health -- Periodicals; Electronic journals; Periodicals; 616.98
• DOI: 10.1002/2017GH000109
• Languages: English
• ISSNs: 2471-1403

Abstract

Abstract: Environmental remediation efforts in low‐ and middle‐income countries have yet to be evaluated for their cost effectiveness. To address this gap we calculate a cost per Disability Adjusted Life Year (DALY) averted following the environmental remediation of the former lead smelter and adjoining residential areas in Paraiso de Dios, Haina, the Dominican Republic, executed from 2009 to 2010. The remediation had the effect of lowering surface soil lead concentrations to below 100 mg/kg and measured geometric mean blood lead levels (BLLs) from 20.6 μg/dL to 5.34 ug/dL. Because BLLs for the entire impacted population were not available, we use environmental data to calculate the resulting disease burden. We find that before the intervention 176 people were exposed to elevated environmental lead levels at Paraiso de Dios resulting in mean BLLs of 24.97 (95% CI: 24.45–25.5) in children (0–7 years old) and 13.98 μg/dL (95% CI: 13.03–15) in adults. We calculate that without the intervention these exposures would have resulted in 133 to 1, 096 DALYs and that all of these were averted at a cost of USD 392 to 3, 238, depending on assumptions made. We use a societal perspective, meaning that we include all costs regardless of by whom they were incurred and estimate costs in 2009 USD. Lead remediation in low‐ and middle‐income countries is cost effective according to World Health Organization thresholds. Further research is required to compare the approach detailed here with other public health interventions. Plain Language Summary: We review the cost effectiveness of the remediation of a lead contaminated site in the Dominican Republic that posed a health risk to the surrounding community. We find that the project reduced a significant health burden for an acceptable cost according to thresholds established by the World Health Organization. Pollution poses a credible health risk to a large number of people; thus, it is important to identify cost effective methods of dealing with the worst sites. Key Points: Pollution remediation in low‐ and middle‐income countries has yet to be evaluated for its cost effectiveness We calculate DALYs averted by the lead remediation in Paraiso de Dios, Haina, the Dominican Republic completed in 2010 Pollution remediation is cost effective according to WHO thresholds