Upgrading to cleaner household stoves and reducing chronic obstructive pulmonary disease among women in rural China - A cost-benefit analysis

Exposure to fine particles ≤ 2.5 μm in aerodynamic diameter (PM2.5) from incomplete combustion of solid fuels in household stoves is recognized as a major contributor to global ill health. Still there are few attempts to estimate the economic costs and health benefits of interventions to reduce exposure. The objective of this paper is to estimate costs and health benefits to women of possible interventions to replace current biomass stoves in Guizhou Province, southwest China, with cleaner burning stoves. Prevalence of chronic obstructive pulmonary disease (COPD) was measured in women ≥ 30 y living in households using biomass as fuel. In a sub-sample of households indoor PM2.5 concentrations were measured. Reduced exposure from replacing stoves in individual homes and at the community level was estimated using information about stoves, concentration levels, and time-activity patterns. Annual avoided new cases of COPD were estimated. The economic value of avoided cases was compared to intervention costs. Probabilistic cost-benefit analysis was performed using Monte-Carlo simulation and the impact of uncertainty in single parameters was explored. The mean reduction in annual average PM2.5 exposure is estimated at 127-294 μg/m3, which corresponds to a 41-77% reduction. Annually 0.6-3.2 new cases of COPD among women may be avoided per 1000 households. The present value net benefit is 1766-22,500 Yuan (Yuan/USD ≈ 0.16) per household and mean benefit/cost-ratios (B/C) are 3.3-14.7. We conclude that policy interventions to increase access to cleaner burning stoves may bring large net benefits to rural women and their families, and to society.