Cost-effectiveness of water quality interventions for preventing diarrhoeal disease in developing countries.
Using effectiveness data from a recent systematic review and cost data from programme implementers and World Health Organization (WHO) databases, we conducted a cost-effectiveness analysis to compare non-piped in source- (dug well, borehole and communal stand post) and four types of household- (chlorination, filtration, solar disinfection, flocculation/disinfection) based interventions to improve the microbial quality of water for preventing diarrhoeal disease. Results are reported for two WHO epidemiological sub-regions, Afr-E (sub-Saharan African countries with very high adult and child mortality) and Sear-D (South East Asian countries with high adult and child mortality) at 50% intervention coverage. Measured against international benchmarks, source- and household-based interventions were generally cost effective or highly cost effective even before the estimated saving in health costs that would offset the cost of implementation. Household-based chlorination was the most cost-effective where resources are limited; household filtration yields additional health gains at higher budget levels. Flocculation/disinfection was strongly dominated by all other interventions; solar disinfection was weakly dominated by chlorination. In addition to cost-effectiveness, choices among water quality interventions must be guided by local conditions, user preferences, potential for cost recovery from beneficiaries and other factors.
Clasen
Thomas
T
London School of Hygiene & Tropical Medicine, Keppel St., London, WC1E 7HT, UK. thomas.clasen@lshtm.ac.uk
Haller
Laurence
L
Walker
Damian
D
Bartram
Jamie
J
Cairncross
Sandy
S
D003362:Cost-Benefit Analysis; D003906:Developing Countries; D003967:Diarrhea / Q000517:prevention & control*; D006801:Humans; D017059:Models, Econometric; D018508:Water Purification / Q000191:economics* / Q000379:methods; D014881:Water Supply / Q000191:economics*; D014944:World Health Organization