Health Outcomes

• Multiple, Reproductive outcomes

Health Outcome List:

• Reproductive outcomes (fibroids, endometriosis)

Environmental Agents

List of Environmental Agents:

• Pesticides (diphenyldichloroethene (DDE))
• hormonal mimics (phthalates)

Source of Environmental Agents:

• Not available

Economic Evaluation / Methods and Source

Type:

• Cost analysis (CA)

Cost Measures:

• Direct medical costs per patient
• lost work time or economic productivity associated with disease treatment for fibroids and endometriosis (e.g., costs per case for surgical/radiologic interventions for myomas (fibroids))

Potential Cost Measures:

• Costs related to health damages for fibroids and endometriosis resulting from fetal or periconceptional exposures
• costs related to infertility, gynecological disorders, gravid diseases, or other later onset adulthood diseases (e.g., cancer, autoimmune disorders, gestational diabetes, etc.)
• costs for female reproductive health following exposure to other EDCs (e.g., PAHs)

Benefits Measures:

• Not available

Potential Benefits Measures:

• Not available

Location:

• European Union

Models Used:

• Not available

Models References:

• Not available

Methods Used:

• Researchers applied a conservative approach via an expert panel to calculate the associated combined health care and economic costs attributable to specific EDC exposures within the European Union in 2010. They — 1) selected two exposure-outcome relationships (DDE-attributable fibroids and phthalate-attributable endometriosis) based on the availability of well-conducted observational human studies to assess the effects of the EDCs; 2) evaluated epidemiologic evidence for probability of causation using the Intergovernmental Panel on Climate Change weight-of-evidence characterization; 3) organized reference levels and biomarker data from carefully identified studies within peer-reviewed literature to represent European exposure and approximate burden of disease that occurred in 2010; and 4) estimated cost-of-illness for fibroids and endometriosis using multiple peer-reviewed sources.

Sources Used:

• Birth weight and prenatal exposure to polychlorinated biphenyls (PCBs) and dichlorodiphenyldichloroethylene (DDE): a meta-analysis within 12 European Birth Cohorts (Govarts et al., 2012); First steps toward harmonized human biomonitoring in Europe: demonstration project to perform human biomonitoring on a European scale (Den Hond et al., 2015); Persistent organic pollutants (POPs) and fibroids: results from the ENDO study (Trabert et al., 2015); Bisphenol A and Phthalates and Endometriosis: The Endometriosis: Natural History, Diagnosis and Outcomes Study (Buck Louis et al., 2013); Rate, type, and cost of invasive interventions for uterine myomas in Germany, France, and England (Fernandez et al., 2009); What is the societal burden of endometriosis-associated symptoms? A prospective Belgian study (Klein et al., 2014); Additional sources cited in publication

Economic Citation / Fundings

Citation:

• Hunt PA, Sathyanarayana S, Fowler PA, and Trasande L. Female reproductive disorders, diseases, and costs of exposure to endocrine disrupting chemicals in the European Union. J Clin Endocrinol Metab. 2016. 101; 4.
• Pubmed
• DOI

NIEHS Funding:

• Not available

Other Funding:

• Endocrine Society; John Merck Fund; The Broad Reach Foundation; Oak Foundation