22 Accounting for Health Impacts of Climate Change Table 6: Cost of Treating Diarrheal Diseases in Nepal Year Description Total number of patients 2000 2001 2002 2003 2004 2005 2006 2007 2008 7,036,459 7,846,667 8,642,852 9,576,761 9,800,451 9,552,307 9,699,858 8,797,639 12,137,059 Number of patients with diarrheal disease 550,392 608,347 625,150 724,386 787,094 785,336 739,915 680,819 1,398,106 Number of patients treated with ORS 486,148 540,769 552,508 641,228 697,260 693,831 649,171 602,516 977,337 Number of patients treated with IV fluid 31,6900 29,541 27,543 27,368 24,431 22,843 14,285 10,074 10,573 Number of patients treated with zinc and ORSa – – – – – – – – 438,578 Total treatment cost of zinc and ORS treatment (NRs thousand) – – – – – – – – 23,200 Total treatment cost of ORS treatment (NRs thousand) 8,751 9,734 9,945 11,542 12,551 12,507 11,685 10,845 17,592 Total treatment cost of IV fluid (NRs thousand) 9,507 8,862 8,263 8,210 7,329 6,853 4,286 3,022 3,172 18,258 18,596 18,208 19,753 19,880 19,360 15,971 13,867 43,964 Total cost of all treatments (NRs thousand) – = no data available, IV = intravenous, NRs = Nepal rupees (NRs70 = $1), ORS = oral rehydration solution. a Zinc tablets were not used before 2008. Source: Pradhan, B. 2010. Key Sector Analysis: Health Adaptation in Nepal. Mimeo. Kathmandu. The above approaches to estimate the impacts of climate change have been used in a number of studies.13 Accounting solely for the direct medical costs, the cost of treating diarrheal diseases in Nepal was estimated to be NRs18 (approximately $0.25) for oral rehydration solution treatment and NRs300 (approximately $4.0) for intravenous fluid treatment. Using these numbers, the total cost of treating diarrheal diseases was estimated to reach in excess of $600,000 in 2008 (Table 6). Contingent Valuation Methodology Applying the contingent valuation methodology (CVM) involves surveys that ask how much people are willing to pay for specific environmental goods or services in a specific but hypothetical situation where changes are brought to the goods or services.14 It is “contingent” because the scenarios presented to the 13 See for example: Ebi (2008), Hubler et al. (2008), Markandya and Chiabai (2009), McMichael et al. (2003), and Van Rensburg and Blignault (2002). 14 For more detailed information on good practices related to this methodology, see Gunatilake et al. (2007).