Dr. Jack Caravanos, clinical professor of environmental public health sciences at New York University College of Global Public Health just had a new article published in the journal of the American Geophysical Union titled, “Cost Effectiveness of Environmental Lead Risk Mitigation in Low and Middle-Income Countries”. The authors reviewed the cost-effectiveness of the remediation of a lead contaminated site in the Dominican Republic that posed a health risk to the surrounding community. They found that the project reduced a significant health burden for an acceptable cost according to thresholds established by the World Health Organization (WHO).
Environmental remediation efforts in low- and middle-income countries (LMICs) have yet to be evaluated for their cost effectiveness. To address this gap, the authors 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, they use environmental data to calculate the resulting disease burden.
The authors also found 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 percent CI: 24.45 – 25.5) in children (0 – 7 years old) and 13.98 μg/dL (95 percent CI: 13.03 – 15) in adults. They calculated 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. The authors used a societal perspective, meaning that they included all costs regardless of by whom they were incurred, and estimate costs in 2009 USD. Lead remediation in LMICs is cost effective according to WHO thresholds. Further research is required to compare the approach detailed here with other public health interventions.