There has been an increasing interest in the economic health cost from smoke exposure from wildfires in the past 20 years, particularly in the north-western USA that is reflected in an emergent literature. In this review, we provide an overview and discussion of studies since 2006 on the health impacts of wildfire smoke and of approaches for the estimation of the associated economic cost. We focus on the choice of key variables such as cost estimators for determining the economic impact of mortality and morbidity effects. In addition, we provide an in-depth discussion and guidance on the functioning, advantages and challenges of BenMAP-CE, freely available software of the US Environmental Protection Agency (EPA) that has been used in a growing number of studies to assess cost from wildfire smoke. We highlight what generates differences in outcomes between relevant studies and make suggestions for increasing the comparability between studies. All studies, however, demonstrate highly significant health cost from smoke exposure, in the millions or billions of US dollars, often driven by increases in mortality. The results indicate the need to take health cost into account for a comprehensive analysis of wildfire impacts.