Cost of Illness Research at ERS
Foodborne illnesses are caused by ingesting bacteria, fungi, parasites, viruses, toxins, or other harmful substances in contaminated food. Cost of foodborne illness estimates are used by policymakers, industry, and the public to gain a more complete understanding of the impacts of foodborne illnesses on the public.
Economic Research Service (ERS) researchers:
- conduct economic analysis of the benefits of improved food safety,
- conduct research to improve estimation methodologies, and
- provide estimates of the cost of foodborne illnesses.
History of ERS Cost of Illness Estimates
ERS researchers conducted some of the earliest studies on the economic cost of foodborne illnesses and have since updated and expanded this research. Each set of ERS estimates has worked to incorporate advances in research on the incidence and health consequences of foodborne illnesses and advances in the economic methodologies for valuing health outcomes. This work has been published in ERS reports and data products, as well as in peer-reviewed scientific journals.
ERS produced its first comprehensive cost estimates for 16 foodborne bacterial pathogens in 1989 (Roberts, 1989). These initial estimates reflected the limited information that was then available about the incidence of foodborne illness. These estimates used cost-of-illness (COI) methodology (expenditures on medical care, lost wages resulting from nonfatal illnesses, and lost wages from premature deaths).
In 1996, ERS updated the cost estimates for:
- six bacterial pathogens (Campylobacter, Clostridium perfringens, Escherichia coli O157:H7 (now called STEC), Listeria monocytogenes, non-typhoidal Salmonella, and Staphylococcus aureus) (Buzby et al., 1996); and
- one foodborne parasite (Toxoplasma gondii) (Buzby & Roberts, 1996).
ERS continued to use the COI methodology for nonfatal illnesses but adopted two different health valuation methodologies for premature deaths: the individualized human capital approach and the willingness-to-pay (WTP) approach.
In 1999, ERS prepared a Salmonella cost estimate in collaboration with the U.S. Centers for Disease Control and Prevention’s (CDC) FoodNet Foodborne Diseases Active Surveillance Network. The estimate used new sources of data on medical costs and productivity losses, including FoodNet surveillance data and a large commercial medical claims database (Frenzen et al., 1999).
In 2000, ERS used new CDC disease incidence estimates (Mead et al. (1999) to update the cost of illness estimates for four pathogens (Campylobacter, Salmonella, E. coli O157:H7 (also called STEC O157), and Listeria monocytogenes). The COI methodology was used for nonfatal illnesses, and the WTP approach was used for premature deaths (Crutchfield & Roberts, 2000).
In 2003, ERS introduced the Foodborne Illness Cost Calculator, an interactive online version of the updated ERS cost estimates for selected foodborne pathogens. The Cost Calculator initially included the Salmonella cost estimate, and later added the 2005 STEC O157 estimate. The Cost Calculator provided detailed information about the assumptions underlying each estimate and allowed users to make alternative assumptions and re-estimate the costs.
In 2005, the cost estimate for STEC O157 was updated in collaboration with FoodNet, using FoodNet surveillance data and a case-control study of STEC O157 patients. Unlike other estimates (which valued lives lost), this research estimated reduced life expectancy and valued each year of lost life by annuitizing the value of statistical life (VSL) estimate.
In 2014, ERS replaced the Cost Calculator with a new Cost Estimates of Foodborne Illnesses data product. This data product added cost estimates for 11 pathogens to the 4 pathogens already included in the ERS Cost Calculator, based on research published by Hoffmann et al. (2012). The 2014 estimates used 2013 dollars as the base year and used CDC’s 2011 foodborne disease incidence estimates by Scallan et al. (2011a and 2011b.). The 2014 estimates followed U.S. Environmental Protection Agency guidance on the use of the VSL and did not annuitize the VSL. The rationale for this methodological shift is described in Hoffmann and Anekwe (2013). Hoffmann et al. (2015) provided pathogen-specific graphics and disease descriptions designed to help inform food safety education efforts. In 2021, ERS updated these estimates to 2018 dollars for inflation and income growth (Hoffmann & Ahn, 2021). These versions of the ERS Cost of Foodborne Illness estimates remain available in the Archived Versions section of the data product’s Overview page.
In 2025, ERS updated the Cost Estimates of Foodborne Illnesses data product using information published by Hoffmann et al. (2025). This update: 1) expanded the scope to provide an estimate of the cost of all foodborne illness caused by pathogens in the United States; 2) updated health outcome modeling for all pathogens to reflect the most recent scientific literature available, with particular attention given to chronic health outcomes; and 3) updated cost estimates using the latest available hospitalization and outpatient data and available literature on cost of chronic outcomes. Several separate studies were conducted to inform this update, including several systematic reviews of chronic outcomes from foodborne infectious illness, a methodological study on estimation of hospitalization costs for foodborne infections, a study estimating outpatient costs of foodborne illnesses, and a separate study on the cost of sepsis caused by foodborne infections. The 2025 update used 2023 U.S. dollars as the base year, the same valuation methods used in the 2014 estimates, and the same 2011 CDC incidence estimates, the latest available estimates for all 31 pathogens at the time.
The Documentation page provides an explanation of the methods used in developing the 2025 estimates and instructions for updating estimates annually for price inflation and real income growth.
Please note, this data product refers to the 2014, 2021, and 2025 ERS cost of foodborne illness estimates. These are the dates these estimates were posted to the ERS website. All sets of estimates are based on journal articles that were published before the estimates were posted in the data product and contain cost estimates for a time period that is earlier than the journal article publication date.
Cost of Foodborne Illness Research by Economic Research Service Economists
The following research resources are provided for reference. The findings and conclusions in the publications that are not published by USDA, ERS are those of the author(s) and should not be construed to represent any official USDA or U.S. Government determination or policy.
Hoffmann, S.A. & Scallan Walter, E.J. (2025). Improving cost estimates for risk-based food safety management and policy. Foodborne Pathogens and Disease, 22(1), pp.1–3.
Hoffmann, S., White, A.E., McQueen, R.B., Ahn, J.W., Gunn-Sandell, L.B. & Scallan Walter, E.J. (2025). Economic burden of foodborne illnesses acquired in the United States. Foodborne Pathogens and Disease, 22(1), p.4‒14.
Ahn, J.W., Scallan Walter, E., White, A.E., McQueen, R.B. & Hoffmann, S. (2022). Identifying sepsis from foodborne hospitalization: Incidence and hospitalization cost by pathogen. Clinical Infectious Diseases, 75(5), pp.857–866.
Pogreba-Brown, K., Boyd, K., Schaefer, K., Austhof, E., Armstrong, A., Owusu-Dommey, A., Villa-Zapata, L., Arora, M., McClelland, J.D. & Hoffman, S. (2022). Complications associated with foodborne listeriosis: A scoping review. Foodborne Pathogens and Disease, 19(11), pp.725–743.
Schaefer, K., Austhof, E., Boyd, K., Armstrong, A., Hoffman, S. & Pogreba-Brown, K. (2022). Septicemia due to Listeria monocytogenes infection: A systematic review and meta-analysis. Foodborne Pathogens and Disease, 19(2), pp.104–114.
Whitham, H.K., Gilliland, A.E., Collier, S.A., Scallan Walter, E. & Hoffmann, S. (2022). Direct outpatient health care costs among commercially insured persons for common foodborne pathogens and acute gastroenteritis, 2012–15. Foodborne Pathogens and Disease, 19(8), pp.558–568.
Hoffmann, S., & Ahn, J.W. (2021). Updating economic burden of foodborne diseases estimates for inflation and income growth (ERR-297). U.S. Department of Agriculture, Economic Research Service.
Hoffmann, S., Ashton, L. & Ahn, J.W. (2021). Food safety: A policy history and introduction to avenues for economic research. Applied Economic Perspectives and Policy, 43(2), pp.680–700.
Austhof, E., Boyd, K., Schaefer, K., McFadden, C., Owusu-Dommey, A., Hoffmann, S., Villa-Zapata, L., McClelland, D.J. & Pogreba-Brown, K. (2021). Scoping review of toxoplasma postinfectious sequelae. Foodborne Pathogens and Disease, 18(10), pp.687–701.
Dhaliwal, S., Hoffmann, S., White, A., Ahn, J.W., McQueen, R.B. & Scallan Walter, E. (2021). Cost of hospitalizations for leading foodborne pathogens in the United States: Identification by international classification of disease coding and variation by pathogen. Foodborne Pathogens and Disease, 18(11), pp.812–821.
Hoffmann, S. & Scallan Walter, E. (2020). Acute complications and sequelae from foodborne infections: Informing priorities for cost of foodborne illness estimates. Foodborne pathogens and disease, 17(3), pp.172–177.
Hoffmann, S., & Scallan, E. (2017). Epidemiology, cost and risk analysis of foodborne disease, in Foodborne Diseases, C. Dodd, T. Aldsworth, and R. Stein, eds. 3rd edition, Amsterdam, Netherlands: Elsevier.
Hoffmann, S., McCulloch, B., & Batz, M. (2015). Economic burden of major foodborne illnesses acquired in the United States (EIB-140). U.S. Department of Agriculture, Economic Research Service.
Batz, M.B., Hoffmann, S., & Morris, J.G., Jr. (2014). Disease-outcome trees, EQ-5D scores, and estimated annual losses of quality-adjusted life years (QALYs) for 14 foodborne pathogens in the United States. Foodborne Pathogens and Disease 11(5), 395–402.
Anekwe, T.D., & Hoffmann, S. (2013, November). Recent estimates of the cost of foodborne illness are in general agreement. Amber Waves. U.S. Department of Agriculture, Economic Research Service.
Hoffmann, S., & Anekwe, T.D. (2013). Making sense of recent cost-of-foodborne-illness estimates (EIB-118). U.S. Department of Agriculture, Economic Research Service.
Hoffmann, S., Batz, M.B., & Morris, J.G., Jr. (2012). Annual cost of illness and quality-adjusted life year losses in the United States due to 14 foodborne pathogens. Journal of Food Protection 75(7), 1291–1302.
Batz, M.B., Hoffmann, S., & Morris, J.G., Jr. (2012). Ranking the disease burden of 14 pathogens in food sources in the United States using attribution data from outbreak investigations and expert elicitation. Journal of Food Protection 75(7), 1270–77.
Hoffmann, S. (2012). Food safety policy and economics, in Oxford Handbook of Food Consumption and Policy, J. Lusk, J. Rossen, and J. Shogren, eds. Oxford, UK: Oxford University Press.
Buzby, J.C., & Roberts, T. (2009). The economics of enteric infections: Human foodborne disease costs. Gastroenterology 136(6), 1851–62.
Frenzen, P. (2008). Economic cost of Guillain-Barré Syndrome in the United States. Neurology 71(1), 21–7.
Roberts, T. (2007). WTP estimates of the societal costs of U.S. foodborne illness. American Journal of Agricultural Economics 89 (4), 1183–8.
Frenzen, P.D. (2007). Hospital admissions for Guillain-Barré Syndrome in the United States, 1993–2004. Neuroepidemiology 29 (1), 83–8.
Frenzen, P.D. (2007). An online cost calculator for estimating the economic cost of illness due to Shiga Toxin-Producing E. coli (STEC) O157 infections (EIB-28). U.S. Department of Agriculture, Economic Research Service.
Jones, T.F., McMillian, M.B., Scallan, E., Frenzen, P.D., Cronquist, A.B., Thomas, S., & Angulo, F.J. (2007). Population-based estimate of the substantial burden of diarrhoeal disease in the United States FoodNet, 1996–2003. Epidemiology and Infection 135(2), 293–301.
Scallan, E., Jones, T., Cronquist, A., Thomas, S., Frenzen, P.D., Hoefer, D., Medus, C., Angulo, F., & the FoodNet Working Group. (2006). Factors associated with seeking medical care and submitting a stool sample in estimating the burden of foodborne illness. Foodborne Pathogens and Disease 3(4), 432–38.
Frenzen, P.D., Drake, A., Angulo, F.J., & the FoodNet Working Group. (2005). Economic cost of illness due to Escherichia coli O157 infections in the United States. Journal of Food Protection 68(12), 2623–30.
Frenzen, P.D. (2004). Deaths due to unknown foodborne agents. Emerging Infectious Diseases 10(9):1536.
Frenzen, P.D. (2003). Mortality due to gastroenteritis of unknown etiology in the United States. Journal of Infectious Diseases 187, 441–52.
Snowdon, J.A., Buzby, J.C., Roberts, T., Cliver, D., & Riemann, H. (2002). Epidemiology, cost, and risk of foodborne disease. Foodborne Diseases: 31–51.
Buzby, J.C. (2002). Older adults at risk of complications from microbial foodborne illness. Food Review 25(2), 30–5.
Kuchler, F. (2001). Valuing the health benefits of food safety: A proceedings (MP-1570). U.S. Department of Agriculture, Economic Research Service.
Crutchfield, S.R. & Roberts, T. (2000). Food safety efforts accelerate in the 1990's. Food Review 23(3), 44–9.
Frenzen, P.D., Riggs, L., Buzby, J.C., Breuer, T., Roberts, T., Voetsch, D., Reddy, S., & the FoodNet Working Group. (1999). Salmonella cost estimate updated using FoodNet data. Food Review 22(2), 10–15.
Buzby, J.C., Allos, B.M., & Roberts, T. (1997). The economic burden of Campylobacter-associated Guillain-Barré Syndrome. Journal of Infectious Diseases 176 (supplement 2), S192–S197.
Buzby, J.C., Roberts, T., & Allos, B.M. (1997). Estimated annual costs of Campylobacter-associated Guillain-Barré Syndrome (AER-756). U.S. Department of Agriculture, Economic Research Service.
Buzby, J.C., Roberts, T., Jordan Lin, C.T., & MacDonald, J.M. (1996). Bacterial foodborne disease: Medical costs and productivity losses (AER-741). U.S. Department of Agriculture, Economic Research Service.
Buzby, J.C., & Roberts, T. (1996). ERS updates U.S. foodborne disease costs for seven pathogens. Food Review 19(3).
Roberts, T., & Marks, S. (1995). Valuation by the cost of illness method: The social costs of Escherichia Coli O157: H7 foodborne disease. Valuing Food Safety and Nutrition.
Roberts, T., Murrell, K.D., & Marks, S. (1994). Economic losses caused by foodborne parasitic diseases. Parasitology Today 10(11), 419–23.
Roberts, T., & Smallwood, D. (1991). Data needs to address economic issues in food safety. American Journal of Agricultural Economics 73(3), 933–42.
Roberts, T., & Frenkel, J.K. (1990). Estimating income losses and other preventable costs caused by Congenital Toxoplasmosis in people in the United States. Journal of the American Veterinary Medical Association 196(2), 249–56.
Roberts, T. (1989). Human illness costs of foodborne bacteria. American Journal of Agricultural Economics 71(2), 468–74.
Roberts, T. (1986). A retrospective assessment of human health protection benefits from removal of Tuberculous Beef. Journal of Food Protection 49(4), 293–8.
Other Government Foodborne Illnesses Research References
Mead, P. S., Slutsker, L., Dietz, V., McCaig, L. F., Bresee, J. S., Shapiro, C., Griffen, P.M., & Tauxe, R. V. (1999). Food-related illness and death in the United States. Emerging Infectious Diseases, 5(5), 607–625.
Scallan, E., Hoekstra, R.M., Angulo, F.J., Tauxe, R.V., Widdowson, M.A., Roy, S.L., Jones, J.L. & Griffin, P.M. (2011a). Foodborne illness acquired in the United States—major pathogens. Emerging Infectious Diseases, 17(1), p.7.
Scallan, E., Griffin, P.M., Angulo, F.J., Tauxe, R.V. & Hoekstra, R.M. (2011b). Foodborne illness acquired in the United States—unspecified agents. Emerging Infectious Diseases, 17(1), p.16.