Applying Local Health Cost Data to Better Estimate the Economic Burden of Air Pollution in the United States

Ambient air pollution exposure causes adverse health outcomes and associated economic burdens. The Environmental Benefits Mapping and Analysis Program–Community Edition (BenMAP-CE) is widely used for estimating the health effects and economic value of air quality changes, including in regulatory impact analyses in the United States (US). BenMAP-CE uses healthcare cost data from the Healthcare Cost and Utilization Project (HCUP) in its health valuation functions for hospital admissions and emergency department visits in the US. These cost data currently represent national averages, the use of which obscures cost differences that exist by region, state, or county. We introduce a framework for applying localized healthcare cost data from HCUP to determine whether and where BenMAP-CE may be underestimating or overestimating healthcare costs associated with air pollution exposure. Additionally, we compile health-related costs associated with outpatient care, home health care, and prescription medication costs, which are largely excluded from standard BenMAP-CE estimates, to determine how much the air pollution–related economic burden would increase if these additional health-related costs were included. We also explore the equity implications of such calculations by analyzing costs by patient age group, sex, race/ethnicity, expected payer, and other population characteristics. We apply this expanded set of economic valuation functions to health benefits estimated to occur if proposed and alternative revisions to the primary National Ambient Air Quality Standards for fine particulate matter are met. This work demonstrates the benefits of improving the spatial resolution of health costs for more precise estimation of the true health-related economic burden of air pollution in the US.