Self-Harm in India: Cost-Effectiveness Analysis of a Proposed Pesticide Ban

Authors: Aditi Nigam, Neha Raykar , Dan Chisholm

Abstract:

India reported an estimated 187,000 suicide deaths in 2010, which amounts to 3 percent of total surveyed deaths in individuals aged 15 years or older; about half of all suicide deaths were mainly due to ingestion of pesticides. Public health interventions that restrict access to pesticides, either through their safe storage or through a ban on their use, may significantly reduce suicide deaths in India. In this paper, we use the example of Sri Lanka’s ban on pesticides in the 1990s to evaluate the cost-effectiveness of suicide prevention through a population-wide pesticide ban in India. The money metric value of insurance is determined to show the cost implications to the government of a ban for each income quintile in a population of one million. This is relevant because there is a lack of evidence on the impact of policies on the prevention of self-harm in India.

Our results show that by considering the mortality implications of a pesticide ban, we can avert $751 to $895 per DALY per year. If we consider both the mortality and morbidity implications of a pesticide ban, we can avert at least $136 to $140 per DALY per year. Using the money metric value of insurance as a measure of financial protection, we see that the lowest income quintile has an annual insurance value of $1,675 while the highest income quintile has an annual insurance value of $259. This indicates that a pesticide ban will have a greater effect for the poor than the rich.