Report

Health-Related Costs from Foodborne Illness in the United States

Quick Summary

The report ranks states according to their total costs related to foodborne illness and cost per case for an individual, which is $1,850 on average nationwide. The ten states with the highest costs per case are: Hawaii, Florida, Connecticut, Pennsylvania, South Carolina, the District of Columbia, Mississippi, New York, Massachusetts and New Jersey.

Foodborne illness is a serious public-health problem in the United States. In 1999, the Centers for Disease Control and Prevention (CDC) estimated that approximately 76 million new cases of food-related illness (resulting in 5,000 deaths and 325,000 hospitalizations) occur in the United States each year [1]. More recent data on sporadic illnesses and outbreaks suggests that this problem is not going away [2, 3].

At the same time, the aggregate economic cost of health losses associated with foodborne illnesses has not been sufficiently examined. The few studies that provide cost estimates are incomplete and/or based on limiting assumptions [4]. For example, most cost estimates include only a few, if any, of the long-term health outcomes associated with acute foodborne illnesses [5]. The derivation of an accurate cost-of-illness measure for foodborne illness is important as a guide to policymakers who seek to allocate scarce resources to programs designed to improve the health of Americans. The Government Accountability Office (GAO) reports that, in 1999, the same year of the CDC estimate, the federal government spent $1 billion on food safety efforts, while state governments spent another $300 million [6]. Without a good measure of the scope of the problem these funds are targeted towards, it is impossible to determine whether such expenditures—which are even more substantial a decade later—are reasonable.

In this study, I use the Scharff et al. (2009) enhanced food-safety, cost-of-illness model to provide a more complete estimate of the aggregate health costs from foodborne illness in the United States [7]. This approach is an improvement over past studies because it takes into account illnesses from all pathogens identified by Mead et. al. (1999); includes measures for health losses that are not included in many past studies; and presents uncertainty using confidence intervals and a sensitivity analysis. The methodology follows principles used by economists at the Food and Drug Administration (FDA) and the U.S. Department of Agriculture (USDA), the two primary food-safety agencies in the United States.

The primary objective of this study is to provide policymakers with measures of the economic burden of foodborne illnesses, both at the aggregate level and at the pathogen-specific level. The derivation of a measure for the aggregate health costs of foodborne illness is useful as a means of evaluating the importance of this problem relative to other pressing health problems. I do not include every cost associated with foodborne illness. Instead, I focus on costs of acute foodborne illnesses and a few long-term health-related costs. Costs to industry from reputation externalities and recalls are significant, but are not covered here. Nevertheless, my best estimate for the cost of foodborne illness in the U.S. is $152 billion a year. This suggests that foodborne illness continues to be a significant problem in the United States. Below, I present estimates of the cost of foodborne illness, both at the aggregate and pathogen-specific levels. I also examine how this cost of illness is distributed across the states. More detail about the methodology used can be found in Appendix B.

References

1. Mead, P.S., et al., Food-Related Illness and Death in the United States. Emerging Infectious Diseases, 1999. 5(5): p. 607-625.
2. Centers for Disease Control and Prevention. Outbreak Surveillance Data. 2009 [cited May 5, 2009]; Available from: http://www.cdc.gov/foodsafety/outbreaks/index.html.
3. Centers for Disease Control and Prevention. FoodNet Reports. 2009 [cited May 5, 2009]; Available from: http://www.cdc.gov/foodnet/data/reports.html.
4. Buzby, J.C. and T. Roberts, The Economics of Enteric Infections: Human Foodborne Disease Costs. Gastroenterology, 2009. 136: p. 1851-1862.
5. Roberts, T., et al., The Long-Term Health Outcomes of Selected Foodborne Pathogens. 2009, Center for Foodborne Illness Research and Prevention. p. 28.
6. General Accounting Office, Food Safety: Overview of Federal and State Expenditures. 2001.
7. Scharff, R.L., J. McDowell, and L. Medeiros, The Economic Cost of Foodborne Illness in Ohio. Journal of Food Protection, 2009. 72(1): p. 128-136.
8. Fox, J.A., et al., Experimental auctions to measure willingness to pay for food safety, in Valuing Food Safety and Nutrition, J.A. Caswell, Editor. 1995, Westview Press: Boulder.
9. Hammitt, J.K. and K. Haninger, Willingness to Pay for Food Safety: Sensitivity to Duration and Severity of Illness. American Journal of Agricultural Economics, 2007. 89(5): p. 1170-1175.
10. Roberts, T., WTP Estimates of the Societal Costs of U.S. Food-Borne Illness. American Journal of Agricultural Economics, 2007. 89(5): p. 1183-1188.
11. Viscusi, W.K. and J.E. Aldy, The Value of a Statistical Life: A Critical Review of Market Estimates Throughout the World. Journal of Risk and Uncertainty, 2004. 27(1): p. 5-76.
12. Buzby, J.C., et al., Bacterial Foodborne Disease: Medical Costs and Productivity Losses, U. S. Department of Agriculture, Editor. 1996, Economic Research Service. p. 100.
13. Centers for Disease Control and Prevention, National Notifiable Diseases Surveillance System. 2009.
14. Census Bureau, Statistical Abstract of the United States: 2009 2009.
15. Allos, B.M. and M.J. Blaser, Campylobacter jejuni and the expanding spectrum of related infections. Clinical Infectious Diseases, 1995. 20: p. 1092-1099.
16. Frenzen, P., Economic cost of Guillain-Barré syndrome in the United States. Neurology, 2008. 71(1): p. 21-27.
17. Havelaar, A.H., Health Burden in the Netherlands due to infection with thermophilic Campylobacter spp. Epidemiology and Infection, 2000. 125(3): p. 505-522.
18. Bureau of Labor Statistics, Consumer Price Index -All Urban Consumers. 2009.
19. Frenzen, P.D., A. Drake, and F.J. Angulo, Economic Cost of Illness Due to Escherichia coli O 157 Infections in the United States. Journal of Food Protection, 2005. 68(12): p. 2623-2630.
20. Townes, J.M., et al., Reactive arthritis following culture-confirmed infections with bacterial enteric pathogens in Minnesota and Oregon: a population-based study. Annals of the Rheumatic Diseases, 2008. 67(12): p. 1689-1696.
21. Hawkins, M., et al., The Burden of Diarrheal Illness in FoodNet, 2000-2001, in Conference on Emerging Infectious Diseases. 2002: Atlanta, GA.
22. Practice Management Information Corporation, Medical Fees in the United States. 2009, Los Angeles: PMIC.
23. American Medical Association, Outpatient Services CPT. 2007, Chicago, IL: American Medical Association.
24. Cohen, M.L., et al., An Assessment of Patient-Related Economic Costs in an Outbreak of Salmonellosis. New England Journal of Medicine, 1978. 299(9): p. 459-460.
25. Frenzen, P., Foodborne Illness Cost Calculator: STEC O157. 2007, Economic Research Service.
26. Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project. 2009.
27. Hay, J., Hospital Cost Drivers: An Evaluation of State-Level Data. 2002, University of Southern California: Los Angeles. p. 41.
28. Bureau of Labor Statistics, Employer Costs for Employee Compensation. 2009.
29. Department of Health and Human Services. Family, Work and Child Care. 2002 [cited 2009; Available from: http://www.cdc.gov/foodsafety/outbreaks/index.html