Estimating the government health-care costs of treating pesticide poisoned and pesticide self-poisoned patients in Sri Lanka

ABSTRACT

Background: Pesticide self-poisoning as a method of suicide is a major global health problem.

Objectives: To estimate the cost and per patient cost of treating pesticide self-poisoning at different hospital levels in a Sri Lankan district, and to examine the distribution of cost components. Another objective was to investigate changes in total cost of treatment of pesticide poisoning for all causes at different administrative levels in Sri Lanka in 2005 and 2015.

Methods: The economic framework was a costing analysis, adopting a government perspective. Cost data were collected prospectively over a 4-month period in 2016 for patients admitted for pesticide self-poisoning to six hospitals in the Anuradhapura District. Assumption-based scenario analyses were run to determine changes in total pesticide poisoning treatment costs.

Results: We included 67 self-poisoned patients in the study. The total cost of treatment was US$ 5,714 at an average treatment cost of US$ 85.3 (9.7–286.6) per patient (across all hospital levels). Hospital costs constituted 67% of the total cost for treating self-poisoning cases and patient-specific costs accounted for 29%. Direct cost of patient hospital transfer constituted the smallest share of costs (4%) but accounted for almost half of the total costs at primary level. The estimated total cost of treating all causes of pesticide poisoning in Sri Lanka was US$ 2.5 million or 0.19% of the total government health expenditure (GHE) in 2015.

Conclusion: Our findings indicate that the average per patient cost of pesticide self-poisoning treatment has increased while the total cost of pesticide poisoning treatment as a percentage of the total GHE in Sri Lanka has declined over the past decade. A continuous focus on banning the most hazardous pesticides available would likely further drive down the cost of pesticide self-poisoning and pesticide poisoning to the government.

KEYWORDS:

• Cost analysis
• suicide and self-harm
• pesticide self-poisoning
• treatment costs
• government costs
• lower-middle income country
• Sri Lanka

Responsible Editor Jennifer Stewart Williams, Umeå University, Sweden

Responsible Editor Jennifer Stewart Williams, Umeå University, Sweden

Acknowledgments

The authors thank Mala Ranawake for advice and support, and the staff at South Asian Clinical Toxicology Research Collaboration for administrative support.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethical approval was granted for the safe storage project from the University of Peradeniya, Sri Lanka, in March 2008. An amendment for the present study was granted from Rajarata University of Sri Lanka in November 2013.

Paper context

Pesticide self-poisoning is a commonly used method of suicide in Sri Lanka, and treatment costs add to the government health expenditures. Costing studies can be used to investigate the cost of illness and the potential for cost-savings. This study contributes to new estimates on treating pesticide self-poisoning cases in Sri Lanka at different hospital levels. Furthermore, the study investigates treatment costs over the past decade in light of Sri Lanka’s regulatory strategies that target the most hazardous pesticides.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the Wellcome Trust [GR090958] and a stipend grant from the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. The funding sources played no role in the design, data collection, analysis, interpretation, writing, and submission of the study.

Notes on contributors

Hannah Ahrensberg

LBM and FK conceived the concept and rationale of the study. LBM, ME, KSH, MP, SJ, and FK contributed to the design of the study. MW, VA, and SR organised and collected data from hospitals. HA, LBM, and FK analysed and interpreted the data. HA drafted the first version of the manuscript, while LBM redrafted the manuscript with input from all authors. All authors have read and approved the final manuscript.