Carbon monoxide is the leading cause of all unintentional poisoning-related deaths in the United States,54 especially among adults older than 65 years.53 In residential settings, CO accounts for 5% of poisoning deaths not related to a fire.56 While the public health burden of most CO poisoning is small when compared with other housing-related adverse health outcomes, the Centers for Disease Control and Prevention reports non-fire-related CO exposures caused an average of 480 deaths from 2001 to 2002 and more than 15 000 emergency department visits between 2001 and 2003.55 More than 50% of CO poisoning incidents reportedly occur in the home.57 , 58 On the basis of a published estimate of the average societal costs of unintentional death in the home59 and assuming 50% of deaths occurred in the home,58 , 60 residential CO poisoning-related fatalities costs the US society more than $500 million annually. Similarly, assuming the average cost for nonfatal injuries is $17 250,59 and 70% of nonfatal CO poisoning incidents occur in the home,61 morbidity due to residential CO exposures costs approximately $180 million annually in the United States.
Few published studies on societal costs associated with CO morbidity or mortality were identified. This may be because CO poisoning is difficult to accurately diagnose clinically.55 , 62 , 63 Although CO detectors are purported to reduce CO poisoning incidents and deaths,64 only 1 study on the effectiveness and costs and benefits of these devices was identified.53 This CBA demonstrated that installing CO detectors is not sufficiently beneficial to justify the costs in homes with new gas and liquefied petroleum gas appliances in the UK, since these appliances already have a secondary safety system built-in.
The lack of CE studies on CO detectors is surprising, given the number of published economic studies on smoke alarm, a similar low-cost, early-warning intervention.
Published economic evaluations for housing-related health outcomes, including asthma, lead poisoning, and radon-related lung cancer, provide valuable information to guide prevention efforts. Nonetheless, more research focusing on the costs of effective housing-related interventions and the resulting economic impact of these interventions is needed. In addition, formal study is needed to demonstrate the effectiveness of interventions for which only anecdotal arguments have been presented. The resulting information can be used to make more efficient use of limited resources, as well as develop and implement programs that will have greater health impact.
Understanding both the strengths and limitations of economic evaluations will help decision makers interpret findings appropriately. For example, a number of economic evaluations reviewed were conducted from the payer perspective. Such studies may be of particular interest to local public health agencies; however, policy makers at the state and federal levels often take a broader view of cost and consequences. Results from CUA and CBA studies enable policy makers at the highest level (eg, Congress, heads of state health departments) to compare disparate health outcomes and related interventions. More CUA and CBA studies are needed to help policy makers who are responsible for allocating resources aimed at addressing wide-ranging problems.
Because decision makers and practitioners in public health increasingly embrace economic analyses to make informed decisions about how best to allocate limited resources, particular attention should be given to important concepts highlighted in this article. These concepts include (1) the selection of the appropriate analytic method(s) to address the question(s) of interest; (2) the perspective from which the analysis is conducted; (3) the comprehensiveness of important costs and consequences (both benefits and unintended negative outcomes) included in the analysis; and (4) the potential impact of omitted costs and benefits.
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