data were incomplete the Current situation estimate was calculated assuming a

# Data were incomplete the current situation estimate

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data were incomplete, the “Current situation” estimate was calculated assuming a 0.61 conversion factor from PM 10 to PM 2.5 . Scenario 1 is based on the air quality standards of the European Union (Directive 2008/50/EC) [ 23 ]. These seem like a sensible benchmark, since as an accession country, MKD would eventually be required to comply with EU standards. WHO air quality guidelines [ 13 ] recommend an annual average PM 2.5 concentration equal to 10 μ g/m 3 , which we chose for Scenario 2. 2.3. Economic Evaluation of Premature Mortality One approach to value the burden of premature mortality is to multiply the predicted number of deaths by the “value of a statistical life” VSL. The VSL represents society’s collective willingness to pay (WTP) for a small reduction in the annual mortality risk of death. The value of VSL is contextual: in this case, it refers to the value of preventing an anonymous premature death from exposure to air pollution. Various studies have derived VSL values in the European context [ 24 26 ]. A meta-analysis of VSL studies by [ 27 ] recommends for EU-27 a VSL of 3.6 million dollars (2005 prices), with an indicative range of 1.8 to 5.4 million dollars. Ideally, national or regional studies should be used to value economic losses from exposure to ambient air pollution. In the absence of such studies, however, (2) may be used to transfer unit health costs (cost per case of illness or death) from a previous study to the policy location based on the “benefit-transfer” approach proposed by [ 27 ]. The adjustment takes into account differences in income levels between two places, all other socioeconomic conditions being similar ( ceteris paribus ). VSL p = VSL s Y p Y s β (2) Here, Y is the Gross Domestic Product GDP per capita (at purchasing power parity PPP prices), with subscripts p and s indicating policy (Skopje) and study (EU-27) locations, respectively. The coefficient β is the income elasticity factor, the marginal change in cost for a marginal change in income. In this study, we assumed β equals one, although other values have also been suggested in the literature [ 27 , 28 ]. Application of (2) to the case of Skopje yields 1.23 million euros (This value would be applied to deaths in year 2012). For all cost adjustments in this work, we assumed \$13,500 and \$34,500, respectively, for Skopje and EU-27 GDP per capita (PPP prices), and a purchase power parity exchange of 0.87 euros (2013) to the US dollar (2005). All costs in this study are stated in constant 2013 prices.
Int. J. Environ. Res. Public Health 2018 , 15 , 626 5 of 11 The VSL varies year-to-year based on income growth and choice of discount rate. In this analysis we assumed a real growth rate (excluding inflation) of 2% per annum, whereas future costs and benefits have been discounted at a rate of 3% per annum. Another approach to valuing premature deaths is to calculate the economic value attributed to the number of years lost, or loss of life expectancy, in the exposed population. For this type of assessment, we use the “value of a life year” (VOLY). Empirical values of VOLY have been determined using WTP studies in which respondents to questionnaires assigned monetary values to small gains in

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• Fall '18
• Noor Shah

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