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Your Environment. Your Health.

An analysis of the cost-effectiveness of arsenic mitigation technologies: Implications for public policy

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost effectiveness analysis (CEA)
Singh SK
International Journal of Sustainable Built Environment
This study presented a cost-effectiveness analysis for three government-sponsored arsenic mitigation technologies – arsenic treatment (ATU) units, new hand pump (NHP) units, and new tube wells with stand post (NTWSP) units – in Bihar, India. The authors analyzed costs and benefits for each technology to calculate the CER and incremental cost effectiveness ratio (ICER). Results showed that NTWSP and NHP were the most cost-effective technologies, and ATU the least cost-effective but most dominant technology used. The authors concluded that NHP may be the most efficient arsenic mitigation intervention in areas where the population is scarce and illiterate, and NTWSP in regions having higher rates of literacy and arsenic awareness within the community. The authors suggest that socioeconomic, demographic, and sociobehavioral factors of arsenic-affected communities, as well as awareness of arsenic contamination and its associated health risks, be taken into consideration when designing or implementing any arsenic mitigation policies.
Households and residents in Bihar, India that would use arsenic mitigation devices (ages not specified)

Health Outcomes

  • Not available

Environmental Agents

List of Environmental Agents:

  • Metals (arsenic)

Source of Environmental Agents:

  • Naturally occurring in drinking water

Economic Evaluation / Methods and Source


  • Cost effectiveness analysis (CEA)

Cost Measured:

  • Total cost of arsenic mitigation interventions (unit cost, operation and maintenance cost, provision for semi-skilled worker and per-unit cost for worker)

Potential Cost Measures:

  • Variables such as socioeconomic, demographic, sociobehavioral factors of the affected communities and levels of awareness of arsenic in the affected communities

Benefits Measures:

  • Number of persons benefitting from using the units, per unit population
  • Lives saved
  • Reduced burden of arsenic-induced health risks and outcomes

Potential Benefits: (Not available)


  • State of Bihar in India

Models Used: (Not available)

Methods Used:

  • The authors performed a cost-effectiveness analysis for three arsenic mitigation technologies to be implemented in the state of Bihar in India. The authors — 1) obtained cost values for installation and maintenance of the mitigation devices; 2) defined assumptions made for the analysis; 3) applied an 8% discount rate to account for the future costs to be expressed as present value; 4) calculated the cost-effectiveness ratio (CER) by dividing costs of the intervention by the effectiveness (defined by the authors as the number of people covered by the intervention), expressed as dollars per life covered/saved; 5) calculated the incremental CER to rank interventions by their effectiveness rather than their cost; 6) performed residual analysis to account for a range in maximum life span for the intervention units; 7) performed sensitivity analysis to analyze effects of uncertainty in the calculations and the robustness of the estimates; and 8) calculated the total numbers of arsenic mitigation intervention units required in each of arsenic-affected districts.

Sources Used:

  • Cost data and per unit population covered by implemented interventions (Central Ground Water Board, National Institute of Hydrology, Government of India, 2010); cost-effectiveness and cost-benefit analysis (Cellini and Kee, 2010); WHO Guide to Cost-Effectiveness Analysis (Edejer et al., 2002); additional sources cited in the publication

Economic Evaluation / Methods and Source


  • Singh SK. 2017. An analysis of the cost-effectiveness of arsenic mitigation technologies: Implications for public policy. International Journal of Sustainable Built Environment.
  • Pubmed: (Not available)
  • DOI

NIEHS Funding: (Not available)

Other Funding: (Not available)

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