title: Economics of "essential use exemptions" for metered-dose inhalers under the Montreal Protocol.
abstract: The Montreal Protocol on Substances that Deplete the Ozone Layer has led to rapid reductions in the use of ozone-depleting substances worldwide. However, the Protocol provides for "essential use exemptions" (EUEs) if there are no "technically and economically feasible" alternatives. An application that might qualify as an "essential use" is CFC-powered medical metered-dose inhalers (MDIs) for the treatment of asthma and chronic obstructive pulmonary disease (COPD), and the US and other nations have applied for exemptions in this case. One concern is that exemptions are necessary to ensure access to medications for low-income uninsureds. We examine the consequences of granting or withholding such exemptions, and conclude that government policies and private-sector programs are available that make it economically feasible to phase out chlorofluorocarbons (CFCs) in this application, thereby furthering the global public health objectives of the Montreal Protocol without compromising the treatment of patients who currently receive medication by means of MDIs.
authors.affiliation: UCSB Washington Program, 1608 Rhode Island Avenue, NW, Washington, DC 20036, USA. decanio@econ.ucsb.edu
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: DeCanio
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Norman
mesh_terms: D000335:Aerosol Propellants / Q000191:economics*; D000397:Air Pollution / Q000191:economics / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D001249:Asthma / Q000188:drug therapy; D017402:Chlorofluorocarbons / Q000191:economics*; D003365:Costs and Cost Analysis; D004777:Environment; D014943:Global Health; D006801:Humans; D007391:International Cooperation / Q000331:legislation & jurisprudence*; D036501:Metered Dose Inhalers / Q000191:economics*; D010126:Ozone; D011634:Public Health; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D014481:United States
chemical_list: D000335:Aerosol Propellants; D017402:Chlorofluorocarbons; D010126:Ozone