Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 20:912:168913.
doi: 10.1016/j.scitotenv.2023.168913. Epub 2023 Nov 30.

Cost-effectiveness analysis of insecticide ban aimed at preventing Parkinson's disease in Central California

Shiwen Li  1 , Roch A Nianogo  1 , Yuyuan Lin  1 , Hanwen Wang  1 , Yu Yu  2 , Kimberly C Paul  3 , Beate Ritz  4
Affiliations

Cost-effectiveness analysis of insecticide ban aimed at preventing Parkinson's disease in Central California

Shiwen Li et al. Sci Total Environ. .

Abstract

Background: Our study assessed whether banning specific insecticides to reduce the PD burden in three Central California (CA) counties is cost-effective.

Method: We applied a cost-effectiveness analysis using a cohort-based Markov model to estimate the impact and costs of banning seven insecticides that were previously associated with PD in these counties as well as mixture exposures to some of these pesticides. We relied for our estimations on the cohort of 65- and 66-year-olds living in these counties who were unaffected by PD at baseline in 2020 and projected their incidence, costs, and reduction in quality-adjusted-life-years (QALY) loss due to developing PD over a 20-year period. We included a shiny app for modeling different scenarios (https://sherlockli.shinyapps.io/pesticide_pd_economics_part_2/).

Results: According to our scenarios, banning insecticides to reduce the occurrence of PD in three Central CA counties was cost-effective relative to not banning insecticides. In the worst-case scenario of exposure to a single pesticide, methomyl, versus none would result in an estimated 205 (95 % CI: 75, 348) additional PD cases or 12 % (95 % CI: 4 %, 20 %) increase in PD cases over a 20-year period based on residential proximity to pesticide applications. The increase in PD cases due to methomyl would increase health-related costs by $72.0 million (95 % CI: $5.5 million, $187.4 million). Each additional PD patient due to methomyl exposure would incur $109,327 (95 % CI, $5554, $347,757) in costs per QALY loss due to PD. Exposure to methomyl based on workplace proximity to pesticide applications generated similar estimates. The highest PD burden and associated costs would be incurred from exposure to multiple pesticides simultaneously.

Conclusion: Our study provides an assessment of the cost-effectiveness of banning specific insecticides to reduce PD burden in terms of health-related QALYs and related costs. This information may help policymakers and stakeholders to make decisions concerning the regulation of pesticides.

Keywords: Cost-effectiveness analysis; Markov model; Parkinson's disease; Pesticide.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1.
Fig. 1.
Markov model employed for the cost effectiveness analysis.
Fig. 2.
Fig. 2.
Additional Parkinson’s disease cases in each pesticide exposure scenario of ambient residential and workplace proximity to pesticide applications. A) Residential proximity to pesticide application and B) workplace proximity to pesticide application.
Fig. 3.
Fig. 3.
Incremental cost effectiveness ratios for each insecticide exposure scenarios (reference: no ambient pesticide exposure at the residence).
Fig. 4.
Fig. 4.
Incremental cost effectiveness ratios for each insecticide exposure scenarios (reference: no ambient pesticide exposure at the workplace).
See this image and copyright information in PMC

References

    1. Afentou N, Jarl J, Gerdtham U-G, Saha S, 2019. Economic evaluation of interventions in Parkinson’s disease: a systematic literature review. Mov. Disord. Clin. Pract. 6, 282–290. 10.1002/mdc3.12755. - DOI - PMC - PubMed
    1. Attema AE, Brouwer WBF, Claxton K, 2018. Discounting in economic evaluations. Pharmacoeconomics 36, 745–758. 10.1007/s40273-018-0672-z. - DOI - PMC - PubMed
    1. Barbeau A, Roy M, Bernier G, Campanella G, Paris S, 1987. Ecogenetics of Parkinson’s disease: prevalence and environmental aspects in rural areas. Can. J. Neurol. Sci. J. Can. Sci. Neurol. 14, 36–41. 10.1017/s0317167100026147. - DOI - PubMed
    1. Böcker T, Britz W, Finger R, 2018. Modelling the effects of a glyphosate ban on weed management in silage maize production. Ecol. Econ. 145, 182–193. 10.1016/j.ecolecon.2017.08.027. - DOI
    1. Böcker T, Möhring N, Finger R, 2019. Herbicide free agriculture? A bio-economic modelling application to Swiss wheat production. Agric. Syst. 173, 378–392. 10.1016/j.agsy.2019.03.001. - DOI