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Estimating the costs associated with environmental health interventions (EHIs) is as difficult as estimating their benefits. The objective of this chapter is to provide an overview of the main issues associated with costing EHIs. The second section outlines the two approaches: financial and economic analysis to quantify the cost of EHIs. The third section is devoted to examining the differences between partial and general equilibrium analysis. The fourth section provides suggestions on selecting the appropriate time frame for estimating the costs by summarizing indications from existing cost–benefit analysis guidelines.

The objective of this chapter is to provide an overview of the different steps involved in the cost–benefit analysis of environmental health interventions. This chapter helps making the process of conducting a cost–benefit analysis more manageable by dividing the analysis into seven main consecutive steps: (1) specifying the decision problem, (2) quantifying the benefits, (3) assigning monetary values to each benefit, (4) quantifying the costs of the intervention, (5) including considerations of the life span for costs and benefits and reexpressing these as present values, (6) comparing the estimated costs with the benefits, and (7) performing uncertainty analysis to assess the robustness of the study results. The remaining part of this chapter will focus on a brief overview of each step with a special focus on Step 1, which is not covered in the remaining chapters of this book.

Providing a healthy school environment is a priority for child health. The aim of this study is to develop a methodology that allows quantification of the potential economic benefit of reducing indoor exposure to nitrogen dioxide (NO2) in children attending primary schools. Using environmental and health data collected in primary schools in London, this study estimates that, on average, 82 asthma exacerbations per school can be averted each year by reducing outdoor NO2 concentrations. The study expands upon previous analyses in two ways: first it assesses the health benefits of reducing children’s exposure to indoor NO2 while at school, second it considers the children’s perspective in the economic evaluation. Using a willingness to pay approach, the study quantifies that the monetary benefits of reducing children’s indoor NO2 exposure while at school would range between £2.5 k per school if a child’s perspective based on child’s budget is adopted up to £60 k if a parent’s perspective is considered. This study highlights that designers, engineers, policymakers and stakeholders need to consider the reduction of outdoor pollution, and particularly NO2 levels, near primary schools as there may be substantial health and monetary benefits.

Background Cost-benefit analysis is a transparent tool to inform policy makers about the potential effect of regulatory interventions, nevertheless its use to evaluate clean-up interventions in polluted industrial sites is limited. The two industrial areas of Gela and Priolo in Italy were declared "at high risk of environmental crisis" in 1990. Since then little has been done to clean the polluted sites and reduce the health outcomes attributable to pollution exposure. This study, aims to quantify the monetary benefits resulting from clean-up interventions in the contaminated sites of Gela and Priolo. Methods A damage function approach was used to estimate the number of health outcomes attributable to industrial pollution exposure. Extensive one way analyses and probabilistic analyses were conducted to investigate the sensitivity of results to different model assumptions. Results It has been estimated that, on average, 47 cases of premature death, 281 cases of cancer and 2,702 cases of non-cancer hospital admission could be avoided each year by removing environmental exposure in these two areas. Assuming a 20 year cessation lag and a 4% discount rate we calculate that the potential monetary benefit of removing industrial pollution is €3,592 million in Priolo and €6,639 million in Gela. Conclusions Given the annual number of health outcomes attributable to pollution exposure the effective clean-up of Gela and Priolo should be prioritised. This study suggests that clean-up policies costing up to €6,639 million in Gela and €3,592 million in Priolo would be cost beneficial. These two amounts are notably higher than the funds allocated thus far to clean up the two sites, €127.4 million in Gela and €774.5 million in Priolo, implying that further economic investments - even considerable ones - could still prove cost beneficial.

Three decades of illegal practices of waste dumping and consequent environmental abuse have made the Campania region of Southern Italy a unique case in the context of waste-related health outcomes. Scientific evidence is mounting in support of a significant increase in cancer mortality and malformation occurrence in specific areas of the Campania region, where improper waste management and illegal waste trafficking have been repeatedly documented. However, the currently available evidence suffers from limitations mainly due to study design, lack of consideration of confounders and quality of the exposure data. Recent economic studies have shown the economic benefits of reclaiming toxic waste sites in Campania. Future perspectives include the adoption of different study designs, use of biomarkers and a molecular approach. Current knowledge, both scientific and economic, might be of help in orienting the short and long term governmental policy on waste related health outcomes at a regional level.

BACKGROUND: Blood transfusions carry the risk of transmitting infections. This risk has been studied in detail in high-income countries but not in sub-Saharan Africa. This study estimates the risks of acquiring human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) from a single unit of blood in sub-Saharan Africa. STUDY DESIGN AND METHODS: A mathematical model was constructed to quantify transfusion risks across 45 sub-Saharan African countries using three components: the risk of a contaminated unit entering the blood supply, the risk that the unit will be given to a susceptible patient, and the risk that receipt of the unit will lead to infection in the recipient. Variables included prevalence of infection in donors, extent of blood testing, test sensitivity, and susceptibility of recipients. Data from the World Health Organization (WHO) African Region and a systematic review of the literature were used to parameterize the model. Uncertainty in the risk estimates was quantified using probabilistic sensitivity analysis. RESULTS: The median overall risks of becoming infected with HIV, HBV, and HCV from a blood transfusion in sub-Saharan Africa were 1, 4.3, and 2.5 infections per 1000 units, respectively. If annual transfusion requirements projected by the WHO were met, transfusions alone would be responsible for 28,595 HBV infections, 16,625 HCV infections, and 6650 HIV infections every year. Sensitivity analysis suggests that the true risks may be even higher. CONCLUSIONS: This study is the first to systematically quantify the risks of transfusion-transmitted infections across sub-Saharan Africa. Although the results are limited by the quality and quantity of available data, these may be the most reliable estimates at this time.