Health economic impacts and cost-effectiveness of aflatoxin-reduction strategies in Africa: case studies in biocontrol and post-harvest interventions

Abstract

Advances in health economics have proven useful in evaluating the cost-effectiveness of interventions, where the benefit usually takes the form of improved health outcomes rather than market outcomes. The paper performs health-based cost-effectiveness analyses of two potential aflatoxin control strategies in Africa: (1) pre-harvest biocontrol, using atoxigenic strains of Aspergillus flavus competitively to exclude toxigenic strains from colonizing maize in Nigeria; and (2) post-harvest interventions in a package to reduce aflatoxin accumulation in groundnuts in Guinea. It is described how health benefits gained from each intervention, in terms of fewer aflatoxin-induced hepatocellular carcinoma cases, can be compared with the costs of implementing the interventions. It is found that both interventions would be extremely cost-effective if applied widely in African agriculture. That is, the monetized value of lives saved and quality of life gained by reducing aflatoxin-induced hepatocellular carcinoma far exceeds the cost of either biocontrol or the post-harvest intervention package to achieve those health benefits. The estimated cost-effectiveness ratio (CER; gross domestic product multiplied by disability-adjusted life years saved per unit cost) for biocontrol in Nigerian maize ranged from 5.10 to 24.8; while the estimated CER for the post-harvest intervention package in Guinean groundnuts ranged from 0.21 to 2.08. Any intervention with a CER > 1 is considered by the World Health Organization (WHO) to be ‘very cost-effective’, while an intervention with a CER > 0.33 is considered ‘cost-effective’. Aside from cost-effectiveness, public health interventions must be readily accepted by the public, and must have financial and infrastructural support to be feasible in the parts of the world where they are most needed.

Keywords:

• health significance
• risk assessment–modelling
• aflatoxins
• peanuts
• cereals

Acknowledgements

The authors thank Ranajit Bandyopadhyay, Deepak Bhatnagar, Bruce Campbell, Sara Henry, John Pitt, Mark Roberts, Gordon Shephard, and Christopher Wild for their support and helpful comments. Work for this publication was funded by a US Department of Agriculture (US$A) Special Cooperative Agreement and a National Institutes of Health Early Career Award (Grant Number KL2 RR024153) from the National Center for Research Resources (NCRR) and National Institutes of Health (NIH) Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not represent the official view of US$A, NCRR or NIH.