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Your Environment. Your Health.

The hidden economic burden of air pollution-related morbidity: evidence from the Aphekom project

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost-benefit analysis (CBA)
Chanel O, Perez L, Künzli N, Medina S, Aphekom group
Eur J Health Economics
This cost-benefit analysis compared two methods, a standard health impact assessment (HIA) and a comprehensive HIA, to examine the economic burden that could be avoided by reducing exposure to air pollution. The standard HIA method only accounted for about 6.2 percent [€ 0.55 million (95 percent CI 0–0.95)], of the annual hospitalization burden computed with the comprehensive HIA method [€ 8.81 million (95 percent CI 3–14.4)], and for about 0.15 percent of the overall economic burden of air pollution-related chronic diseases [€ 370 million (95 percent CI 106–592)]. Results suggest that morbidity effects impact the health system more directly and strongly than previously believed.
Children (0-17 years), adults (≥65 years)

Health Outcomes

  • Respiratory outcomes (asthma)
  • cardiovascular outcomes (coronary heart disease)

Environmental Agents

List of Environmental Agents:

  • Multiple

Source of Environmental Agents:

  • Traffic-related pollution, ambient air pollution

Economic Evaluation / Methods and Source


  • Cost-benefit analysis (CBA)

Cost Measured:

  • Direct health costs (medical resources consumed, drugs, in-patient and outpatient hospitalizations, emergency room stays, and cost of rehabilitation)
  • indirect costs (loss of productive work by patient or patient’s family)
  • intangible costs for patient and his/her friend and family (grief, fear, pain, unhappiness, loss of well-being, and loss of quality of life)

Potential Cost Measures:

  • Costs of noise-related health impacts
  • costs of asthma attacks, bronchitis episodes, and chronic-disease specific healthcare visits
  • costs of health-related related absenteeism
  • costs related to disease onset due to other air pollution exposures (near road NO2, NO, CO, black carbon, elemental carbon)

Benefits Measures:

  • Reduced chronic diseases due to lower air pollution exposure

Potential Benefits: (Not available)


  • 10 European cities from six countries

Models Used: (Not available)

Methods Used:

  • The authors used a comprehensive health impact exposure (HIA) assessment approach to investigate the full burden of air pollution on asthma in children and coronary heart disease (CHD) in adults over 65 in 10 European cities. The authors — 1) estimated near road traffic-related pollution (NRTP) by combining traffic density information with residential proximity to busy roads; 2) estimated asthma and CHD prevalence and asthma and myocardial infarction hospitalizations using concentration-response functions; 3) used these data to compute current and hypothetical health effects among total city population; 4) assessed direct and indirect costs of health effects with real market prices from cost of illness methods; 5) estimated intangible costs of health effects using willingness to pay; and 6) estimated the economic burden associated with the chronic diseases using annual prevalence costs and cost per exacerbation for OECD countries.

Sources Used:

  • Monetary data from World Bank database: World Development Indicators and Global Development Finance (2010); additional sources cited in publication

Economic Evaluation / Methods and Source


  • Chanel O, Perez L, Künzli N, Medina S, Aphekom group. 2016. The hidden economic burden of air pollution-related morbidity: evidence from the Aphekom project. Eur J Health Economics.
  • Pubmed
  • DOI

NIEHS Funding: (Not available)

Other Funding:

  • Aphekom project co-funded by the European Commission’s Programme on Community Action in the Field of Public Health (2003–2008) under Grant Agreement No. 2007105, and many national and local institutions
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