Health Outcomes

• Multiple

Health Outcome List:

• Neurological outcomes (cognitive deficits, intellectual disability, neurotoxicity, childhood behavioral disorders, attention deficit hyperactivity disorder (ADHD), autism)
• Respiratory outcomes (asthma, chronic obstructive pulmonary disease (COPD)
• Lower respiratory infections)
• Infectious disease outcomes (lower respiratory infections)
• Reproductive outcomes – male (low testosterone, male infertility)
• Reproductive outcomes – female (fibroids, endometriosis)
• Birth outcomes (preterm birth, cryptorchidism)
• Cardiovascular outcomes (ischemic heart disease, stroke)
• Cancer outcomes (testicular cancer, lung cancer, other cancers)
• Metabolic outcomes (childhood obesity, adult obesity, adult diabetes)
• Mortality (early mortality)

Environmental Agents

List of Environmental Agents:

• Air pollutants
• Brominated compounds (polybrominated diphenyl ethers (PBDEs))
• Hormonal mimics (phthalates, bisphenol A (BPA))
• Metals (lead (Pb), methylmercury)
• Pesticides (organophosphate pesticides, dichlorodiphenyl trichloroethane (DDE))

Source of Environmental Agents:

• Not available

Economic Evaluation / Methods and Source

Type:

• Cost utility analysis (CUA), Cost benefit analysis (CBA)

Cost Measures:

• Disability adjusted life years (DALYs) and costs calculated assuming a societal perspective where all costs borne by society are relevant

Potential Cost Measures:

• More comprehensive assessment of costs such as dysfunctions and other outcomes less serious than mortality and diagnosed morbidity

Benefits Measures:

• Not available

Potential Benefits Measures:

• Not available

Location:

• United States
• European Union (EU)
• Organization for Economic Cooperation and Development (OECD) states

Models Used:

• Not available

Models References:

• Not available

Methods Used:

• This review and analysis article estimated costs and Burden of Disease (BoD) based on a review of published studies that estimated costs calculations for exposures to several environmental chemicals and health outcomes, and studies that provided sufficient dose-response data for the authors to perform a cost analysis. The authors stated that previous estimates of BoD used stringent criteria that leave gaps in evaluating environmental exposures and related outcomes. The authors — 1) performed a literature search to identify publications where sufficient data were available to determine dose-dependent adverse effects or where cost estimates of disease burden were calculated; 2) determined the monetary value of a daily adjusted life-year (DALY) and quality-adjusted life year (QALY) based on a median value of life year (VOLY) of $52,320 in 2010 dollars and adjusted by gross national income (GNI); 3) used the monetary value to quantify costs borne by society (i.e., costs borne by the health care system, individuals, households, employers, and insurers, as available) for studies with dose responses; 4) combined cost estimates from these data and published DALY estimates in studies with cost estimates for consideration in calculating the BoD for different health outcomes; and 4) used attributable risk valuations from the World Health Organization to calculate environmental exposure-attributable fractions of global health burdens for eight health outcomes and associated costs as a third approach to assessing the environmental BoD.

Sources Used:

• Value of a life year (Desaigues et al., 2007); published studies cited in the paper for dose response data and health burden cost data; World Health Organization (WHO) environmental attributable risk factors (Pruss-Usteun et al., 2017); attributable risk valuations from the World Health Organization (Pruss-Ustun et al., 2008); additional sources cited in the publication

Economic Citation / Fundings

Citation:

• Grandjean P, Bellanger M. Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation. Environmental Health. 2017. 16; 1.
• Pubmed
• DOI

NIEHS Funding:

• ES009797

Other Funding:

• Not available