Cost-effectiveness of lowering the aflatoxin tolerance level.

The cost-effectiveness of adopting aflatoxin tolerance levels of 15, 10 and 5 ppb for peanuts and peanut products was assessed. Estimates of the annual cost to manufacturers of monitoring and controlling peanut aflatoxin levels at the current 20-ppb action level, and estimates of the projected increase in costs of establishing lower tolerances were elicited from producers by questionnaire. Exposures to peanut products were derived from the HANES I survey and from peanut production statistics. The risk of liver cancer at each tolerance level was estimated using both epidemiological and extrapolated experimental data assuming that exposure would be reduced in direct proportion to the decrease in the tolerance. It was found that the 15-ppb tolerance would cost $60,000 per cancer death averted (range $20,000-$1,700,000) and is therefore relatively cost-effective. The marginal costs per life saved for both the 10-ppb and 5-ppb levels were found to be $1.7 million (range $0.6 million-$11.4 million) and $1.6 million (range +0.6 million-$31.1 million), respectively. Conclusions on the optimal regulatory approach should be guided by comparisons of these figures with corresponding cost-effectiveness ratios for alternative regulatory uses of national resources in the interests of public health.