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

Figures & data

Table 1. Health-care levels and types of government hospitals in Sri Lanka [16,17].

Level of health-care	Characteristics	Type of hospital	Notes
Primary health-care	Provides non-specialist inpatient and outpatient care	Primary medical care units
		Divisional hospital	Type A, B, C
Secondary health-care	Provides health-care in different specialities^a	Base hospital– Type A– Type B	Type B hospitals have fewer basic specialities than type A
Tertiary health-care	Provides specialised health-care in four main specialities	District General hospital (DGH)Provincial General hospital (PGH)	DGH health-care also includes some sub specialitiesPGH has more facilities than DGH
		Teaching hospital	Provides health-care in the main sub specialities, and is used for teaching purposes
		National hospital	Main hospital in Sri Lanka, also provides health-care in many sub specialities.

^aSpecialities include medicine, surgery, paediatric, obstetrics, and gynaecology.

Table 2. Input parameters collected to estimate the cost of treating pesticide self-poisoning in Anuradhapura District, Sri Lanka.

Input parameters	Baseline estimate	Data sources
Patient-specific cost
- Medical prescriptions, medical devices, laboratory tests	Varies according to poison type and hospital level	Present study
Hospital cost at primary and secondary level
- Personnel costs	Varies according to type	Present study
- Capital costs, incl. medical equipment and ambulances	Varies according to type	Present study
- Operational cost of capital cost, incl. buildings	5% of total capital cost	[19]
- Overhead	Varies according to type	Present study
- Consumables	Varies according to type	Present study
- Buildings
◦ Construction price	LKR 5,000/6,500 per m^2	Present study
◦ Lifetime of building	60 years	[20,21]
Hospital cost at tertiary level
- Cost per bed day	US$ 77.65	[22]
Transfer cost (fuel cost)	US$ 1.4 per litre	Present study

Table 3. Characteristics of pesticide self-poisoned patients admitted to six hospitals in Anuradhapura District, Sri Lanka, from 1 March to 31 July 2016.

Variable		n (%)
Patients		67 (100)
Mean age (SD)		36.15 (15.6)
Gender
- Female		27 (40.3)
- Male		40 (59.7)
Poison type	Chemical group
Insecticide		48 (71.6)
	- Carbamate	16 (23.9)
	- Organophosphate	21 (31.3)
	- Other	11 (16.4)
Herbicide		19 (28.4)
Average length of stay per poison type (h)
Insecticide		31 h 38 min
	- Carbamate	25 h 34 min
	- Organophosphate	23 h 14 min
	- Other	56 h 27 min
Herbicide		15 h 28 min
Total length of stay in average (h)		27 h 2 min
Patients transferred		40 (58.8)

Table 4. Average treatment costs by poison type and hospital level for pesticide self-poisoned patients in Anuradhapura District, Sri Lanka, from 1 March to 31 July in 2016.

	Hospital level
Pesticide type	Primary level (USD, 2015)	Secondary level (USD, 2015)	Tertiary level (USD, 2015)	All hospitals levels (USD, 2015)
Insecticide	10.0 (18)^a	46.2 (20)	347.8 (10)	95.50 (48)
Carbamate	11.5 (6)	27.9 (5)	341.9 (5)	119.9 (16)
Organosphosphate	9.0 (9)	59.5 (7)	353.7 (5)	107.9 (21)
Other	10.0 (3)	46.0 (8)	- (0)	36.2 (11)
Herbicide	8.7 (7)	66.9 (8)	133.7 (4)	59.5 (19)
All pesticide types	9.7 (25)	52.1 (28)	286.6 (14)	85.3 (67)

^aNumber of patients in parenthesis.

Figure 1. Cost profile. (a) 67 Self-poisoned patients admitted to six different hospitals in the Anuradhapura District from 1 March to 31 July 2016. (b) 53 Self-poisoned patients admitted to five different hospitals in the Anuradhapura District (tertiary level not included) from 1 March to 31 July 2016.

Table 5. Total cost of pesticide poisoning treatment for all patients in Sri Lanka, 2005/2015.

Scenario^a	Level	Total cost (US$) 2005^b	Total cost (US$) 2015
Base-case	Sri Lanka	-	2,533,772
	North Central Province	-	421,747
	Anuradhapura District	-	295,420
Scenario 1^c	Sri Lanka	998,928	1,369,760
	North Central Province	140,801	215,267
	Anuradhapura District	104,886	148,165
Scenario 2^d	Sri Lanka	864,828	690,723
	North Central Province	136,332	114,971
	Anuradhapura District	97,838	80,533
Scenario 3^e	Sri Lanka	874,905	695,786
	North Central Province	136,332	115,814
	Anuradhapura District	97,838	81,124

^aAll types of pesticide poisoning (self-poisoning, accidental, and occupational).

^bAdjusted for inflation.

^cRegistered cases were grouped into two different pesticide categories (organophosphate/carbamate cases, and other pesticide cases) using a ‘distribution key’; the cost of transfer was excluded; and an average cost estimate obtained from this study was used for each pesticide category across all hospital levels.

^dRegistered cases were grouped into two different pesticide categories (organophosphate/carbamate cases, and other pesticide cases) using a ‘distribution key’; the cost of transfer was included; and a cost estimate obtained from this study was used for each pesticide category by hospital level.

^eRegistered cases were grouped into three different pesticide categories (organophosphate, carbamate, and other pesticides) using a ‘distribution key’; the cost of transfer was included; and a cost estimate obtained from this study was used for each pesticide category by hospital level.

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