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https://www.oecd.org/en/publications/economic-valuation-of-chemicals-related-health-effects_b58b7451-en.html
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Title page 1
Contents 7
Preface 4
Foreword 5
Acknowledgements 6
Abbreviations and acronyms 11
Executive summary 12
1. Introduction 14
1.1. The importance of valuing non-fatal health effects 15
1.2. Overview and history of the SWACHE project 15
1.3. Selection of health endpoints covered in the SWACHE project 16
1.4. Implementing surveys in 28 countries 18
1.5. Valuation of morbidity in a consistent manner 19
1.5.1. What does willingness-to-pay capture? 20
1.5.2. Measuring willingness-to-pay through stated-preference surveys 21
1.6. Objectives and contribution of this report 24
References 25
Note 26
2. Recommended values for policy analysis 27
2.1. Average values across countries for the ten health endpoints 28
2.2. Results by health effect 29
2.3. Hypertension 30
2.4. Infertility 31
2.5. Underactive thyroid 32
2.6. Asthma 33
2.7. Miscarriage 35
2.8. Non-fatal cancer 36
2.9. Chronic kidney disease 37
2.10. Very low birth weight 38
2.11. IQ loss in children 39
2.12. Skin sensitisation 40
References 43
Notes 45
3. Drivers of preferences in the valuation of health effects 46
3.1. Drivers of differences in willingness-to-pay among individuals 47
3.1.1. Socio-economic determinants and valuation scenario attributes 47
3.1.2. Example of a psychological and societal determinant 50
3.2. Drivers of differences in willingness-to-pay among countries 52
3.2.1. Country-level income and health system effectiveness, costs and satisfaction 53
3.2.2. Attitudes towards chemicals 55
3.2.3. Perceptions of disease and risk 58
References 59
Notes 61
4. Guidance for use of SWACHE values in cost-benefit analysis 62
4.1. Cost-benefit analysis 63
4.2. Convenience of using WTP and VSC values in CBAs, compared to other metrics 64
4.3. How can SWACHE values be used to calculate benefits? 65
4.4. How can SWACHE values be used in a break-even analysis? 68
4.5. Overview of the use of SWACHE values across institutions 69
References 70
Note 71
5. Applying SWACHE values in other countries and contexts 72
5.1. Applying valuations in other countries 73
5.1.1. Results of the benefit transfer analysis 73
5.1.2. Recommendations 81
5.2. Applying valuations in other contexts 82
References 84
Notes 85
6. Methodological discussion and areas for future research 86
6.1. Ensuring quality of the valuation studies 87
6.2. Validity of benefit transfer analysis approaches 88
6.3. Valuation of multiple health endpoints 88
6.3.1. Valuation of multiple health endpoints 88
6.3.2. Valuation of pre-existing conditions 90
6.3.3. Guidance 91
6.4. Methodological challenges linked to distributional outcomes 91
References 92
Notes 93
Annex A. Recommended values for policy analysis from the surveys and their confidence intervals 94
Annex B. Recommended values for 38 OECD Member countries and South Africa 107
Figure 1.1. Hazard classifications for substances registered under EU REACH 17
Figure 1.2. Health effects assessed across the three rounds of the SWACHE project 18
Figure 1.3. Willingness-to-pay to reduce the risk of developing a disease 21
Figure 1.4. Double-bounded dichotomous choice example from the underactive thyroid survey 23
Figure 1.5. Discrete choice experiment choice card example from the skin sensitisation survey 24
Figure 2.1. Value of a statistical case, by health effect, averaged across countries (USD) 29
Figure 2.2. Values of a statistical case of hypertension by country (USD) 30
Figure 2.3. Values of a statistical case of infertility by country (USD) 31
Figure 2.4. Values of a statistical case of underactive thyroid by country (USD) 32
Figure 2.5. Values of a statistical case of asthma by country (USD) 34
Figure 2.6. Willingness-to-pay per year for one step reduction in asthma severity by country (USD) 35
Figure 2.7. Value of a statistical case of miscarriage by country (USD) 36
Figure 2.8. Values of a statistical case of non-fatal cancer by country (USD) 37
Figure 2.9. Values of a statistical case of chronic kidney disease by country (USD) 38
Figure 2.10. Values of a statistical case of very low birth weight by country (USD) 39
Figure 2.11. Willingness-to-pay per year to avoid one IQ point loss in children by country (USD) 40
Figure 2.12. Willingness-to-pay estimates per year to avoid a skin sensitisation case involving a two-week severe flare-up visible... 41
Figure 2.13. Values of a statistical case to avoid a skin sensitisation case involving a two-week severe flare-up visible on the face for... 42
Figure 3.1. Relationship between bid acceptance and bid amounts by country in the hypertension study 49
Figure 3.2. Mean willingness-to-pay values for a one step reduction in adult and childhood asthma severity 51
Figure 3.3. Positive and negative fixed effects by country across implemented surveys 53
Figure 3.4. Relationship between the medical cost burden and the value of a statistical case estimates in the hypertension study 54
Figure 3.5. Awareness of the risks posed by harmful chemicals by country 56
Figure 3.6. Satisfaction with the level of governmental regulation of chemicals by country 57
Figure 3.7. Relationship between perceived chemical regulatory stringency and the willingness-to-pay estimates in the IQ loss in children study 58
Figure 4.1. Cost-benefit analysis in the context of health valuation 63
Figure 4.2. Steps of a cost-benefit analysis in the context of morbidity valuation 67
Figure 5.1. Methodology of the recommended benefit function transfer 73
Figure 5.2. Willingness-to-pay estimates over one year to avoid one IQ point loss in children by country (USD), for OECD countries... 75
Figure 5.3. Values of a statistical case of hypertension by country (USD), for OECD countries and South Africa 75
Figure 5.4. Values of a statistical case of underactive thyroid by country (USD), for OECD countries and South Africa 76
Figure 5.5. Values of a statistical case of non-fatal cancer by country (USD), for OECD countries and South Africa 76
Figure 5.6. Values of a statistical case of chronic kidney disease by country (USD), for OECD countries and South Africa 77
Figure 5.7. Willingness-to-pay estimates over one year for one step reduction in adult asthma by country (USD), for OECD countries... 77
Figure 5.8. Willingness-to-pay estimates over one year for one step reduction in childhood asthma by country (USD), for OECD countries... 78
Figure 5.9. Values of a statistical case of infertility by country (USD), for OECD countries and South Africa 78
Figure 5.10. Values of a statistical case of very low birth weight by country (USD), for OECD countries and South Africa 79
Figure 5.11. Values of a statistical case of miscarriage by country (USD), for OECD countries and South Africa 79
Figure 5.12. Willingness-to-pay estimates over one year to avoid a skin sensitisation case involving a two-week severe flare-up visible... 80
Figure 5.13. Values of a statistical case to avoid a skin sensitisation case involving a two-week severe flare-up visible on the face for... 80
Figure 5.14. Values of a statistical case of adult asthma by country (USD), for OECD countries and South Africa 81
Figure 5.15. Values of a statistical case of childhood asthma by country (USD), for OECD countries and South Africa 81
Figure 5.16. Presentation of underactive thyroid symptoms in the survey 83
Figure 6.1. Classification of substances into four hazard classes 89
Figure 6.2. Valuation of comorbidity 90
Boxes 10
Box 1.1. Valuation concepts and methods in brief 21
Box 1.2. Contingent valuation method in the underactive thyroid survey 22
Box 1.3. Discrete choice experiment in the skin sensitisation survey 23
Box 4.1. Disability-adjusted life years (DALYs) and Quality-adjusted life years (QALYs) 64
Figure A.1. Scenario-specific estimates for skin sensitisation 103
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