Research Article Economic Valuation of Selected Illnesses in Environmental Public Health Tracking Ying Zhou, ScD; Tursynbek Nurmagambetov, PhD; Matthew McCord, MSPH; Wan-Hsiang Hsu, PhD ABSTRACT Background: In beneft-cost analysis of public health programs, health outcomes need to be assigned monetary values so that different health endpoints can be compared and improvement in health can be compared with cost of the program. There are 2 major approaches for estimating economic value of illnesses: willingness to pay (WTP) and cost of illness (COI). In this study, we compared these 2 approaches and summarized valuation estimates for 3 health endpoints included in the Centers for Disease Control and Prevention’s National Environmental Public Health Tracking Network—asthma, carbon monoxide (CO) poisoning, and lead poisoning. Method: First, we compared results of WTP and COI estimates reported in the peer-reviewed literature when these 2 methods were applied to the same study participants. Second, we reviewed the availability and summarized valuations using these 2 approaches for 3 health endpoints. Result: For the same study participants, WTP estimates in the literature were higher than COI estimates for minor and moderate cases. For more severe cases, with substantial portion of the costs paid by the third party, COI could exceed WTP. Annual medical cost of asthma based on COI approach ranged from $800 to $3300 and indirect costs ranged from $90 to $1700. WTP to have no asthma symptoms ranged from $580 to $4200 annually. We found no studies estimating WTP to avoid CO or lead poisoning. Cost of a CO poisoning hospitalization ranged from $14 000 to $17 000. For patients who sustained long-term cognitive sequela, lifetime earnings and quality-of-life losses can signifcantly exceed hospitalization costs. For lead poisoning, most studies focused on lead exposure and cognitive ability, and its impact on lifetime earnings. Conclusion: For asthma, more WTP studies are needed, particularly studies designed for conditions that involve third-party payers. For CO poisoning and lead poisoning, WTP studies need to be conducted so that more comprehensive economic valuation estimates can be provided. When COI estimates are used alone, it should be clearly stated that COI does not fully capture the nonmarket cost of illness, such as pain and suffering, which highlights the need for WTP estimates. KEY WORDS: asthma, carbon monoxide poisoning, cost of illness (COI), lead poisoning, willingness to pay (WTP) Author Affliations: Environmental Health Tracking Branch (Dr Zhou) and Air Pollution and Respiratory Health Branch (Dr Nurmagambetov), Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Tracking Network, Environmental Epidemiology Program, Utah Department of Health, Salt Lake City, Utah (Mr McCord); and Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York (Dr Hsu). The authors thank Thomas Largo and Melanie Jetter for valuable inputs. The fndings and conclusions in this article are those of the authors and do not necessarily represent the offcial position of the Centers for Disease Control and Prevention. The authors declare they have no actual or potential competing fnancial interests. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (http://www.JPHMP.com). Correspondence: Ying Zhou, ScD, Environmental Health Tracking Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329 (yzhou2@cdc.gov). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/PHH.0000000000000641 H uman exposures to environmental contam- inants are associated with various adverse health outcomes. Programs, interventions, or policies can be implemented to prevent or reduce human exposure and the corresponding adverse health effects. Beneft-cost analysis, also referred to as cost-beneft analysis, is a systematic process for calcu- lating and comparing benefts and costs of a decision or policy to determine if its benefts outweigh the costs and by how much. For example, the framework and principles of beneft-cost analysis were applied to evaluate the results of the Clean Air Act. 1 In beneft- cost analysis of public health programs, health outcomes need to be assigned monetary values so that different health endpoints can be compared and the improvement in health can be compared with the cost of the program. Assigning an accurate monetary value to health outcomes can be a challenging task. There are 2 commonly used methods—willingness to pay (WTP) and cost of illness (COI). Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. S18 www.JPHMP.com September/October 2017 • Volume 23, Number 5 Supp