Cost Effectiveness of Environmental Lead Risk Mitigation in Low‐ and Middle‐Income Countries

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.

Health and Economic Consequences of Lead Exposure Associated with Products and Services Provided by the Informal Economy

“…This contrasts with previous studies focused on estimating countrywide and continental impacts of lead exposure in LMICs. 8,37 Importantly, the principles demonstrated in this paper can easily be replicated in other parts of the world to support the informal sector while also improving health and economic wellbeing.…”

Assessment of the Presence of Soil Lead Contamination Near a Former Lead Smelter in Mombasa, Kenya

“…Following IEUBK guidelines, default values for lead from all exposure pathways were used and measured in situ soil concentrations were entered 79. Default ingestion rates were then adjusted upward to account for higher ingestion rates in LMICs (250–400 mg/day) 10,80. Results were also calculated using the default values (85–135 mg/day).…”

“…79 Default ingestion rates were then adjusted upward to account for higher ingestion rates in LMICs (250–400 mg/day). 10 , 80 Results were also calculated using the default values (85–135 mg/day). For adults, the USEPA Adult Lead Methodology was used.…”

Rethinking Aid Allocation: Analysis of Official Development Spending on Modern Pollution Reduction

“…In low-and middle-income countries, Attina and Trasande (2013) found the burden of childhood lead exposure amounts to 1.2% of global GDP for 2011, for a total of $977 billion international dollars 1. Ericson et al (2018) [35] estimated the global burden of lead toxicity from lead-acid battery sites to be large (6 to 16.8 million exposed each year), with a range of 127,248 to 1.6 million DALYs 2. Research conducted for mercury exposure at artisanal small-scale gold mining sites estimated a global burden of disease ranging from 1.22 to 2.39 million DALYs [19].…”

“…the “return on investment”), but also where significant investments are critical to reduce the burden of disease or what solutions are good investments. While there is evidence of the cost-effectiveness of some pollution interventions, for example Ericson, et al (2018) [35] found that lead remediation in low- and middle-income countries is cost-effective according to WHO thresholds, overall comparisons of effectiveness of investments in modern pollution do not exist.…”