The Cost of Illness-Handbook
http://www.epa.gov/oppt/coi/pubs/toc.html
This information gives regulatory analysts a quick and
resource-saving estimate of the lower bound cost of medical care
for a number of environmentally-related illnesses.
Specifically, this web page contains information on the per
capita incremental direct medical costs associated with the
various illnesses linked to environmental pollutants. The U.S.
Environmental Protection Agency developed this information to
provide support for benefits analyses, policy evaluation and
development, and other EPA activities. The site contains cost
data for numerous cancers, developmental diseases and
disabilities, respiratory diseases, acute diseases, and
additional illnesses.
Work on this project began in 1991 and is ongoing. The Agency
welcomes comments and additional data regarding the information
contained in this web page, which can be communicated by
clicking on comments link in the footer.
The handbook was prepared for the Office of Pollution Prevention
and Toxics, under the direction of Nicolaas Bouwes, by Abt
Associates, Cambridge, Massachusetts. Funding for the project
has been provided by the Office of Pollution Prevention and
Toxics, the Office of Water, the Office of Radiation and Indoor
Air, and the Office of Policy, Planning and Evaluation.
Cost of
Illness Information
Economic information is increasingly used when developing worker
& environmental regulations and policies (e.g., California's
worker parity bill uses estimates of the cost of illnesses due
to lax worker protections). Cost of illness (COI) estimates are
used in arguments to insurers for health training and strategies
(e.g., regarding asthma trigger avoidance). Federal dockets for
health-related regulations often include COI information and
many COI values used environmental work are available at
www.epa.gov . The 2001 EPA Cost of Illness Handbook (http://www.epa.gov/oppt/coi/
) includes some cancers, birth defects, etc, and was developed
for use in environmental regulations. Chapter 1discusses key
issues affecting the uncertainty and incompleteness of cost of
illness estimates, and cancer intro chapter identifies issues
specific to those diseases. Caveats: as with any cost estimate,
it is essential to apply inflation factors (from Consumer Price
Index) and to review survival data and current practice
guidelines for
changes.
Reliance on cost of illness information is controversial for
many reasons. COI usually includes only direct medical costs
that substantially underestimate total costs (discussed in
Chapter 1 of the Handbook). COI estimates can be extensively
manipulated by economists to achieve desired results (e.g., OMB
now requires such heavy "discounting" that some serious
illnesses appear to have no costs). More scrutiny and critique
by health professionals is needed in this area, given the role
economic analyses play in federal health protection policies.
Kathleen Burns, Ph.D.
Director, Sciencecorps
Lexington, Massachusetts
www.sciencecorps.org
(Co-author, Cost of Illness Handbook)
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