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Your Environment. Your Health.

Female reproductive disorders, diseases, and costs of exposure to endocrine disrupting chemicals in the European Union

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost analysis (CA)
Hunt PA, Sathyanarayana S, Fowler PA, and Trasande L
J Clin Endocrinol Metab
This study estimated the combined economic and health care costs for fibroids and endometriosis that are attributable to two specific EDC exposures (DDE and phthalates), respectively, within the European Union in 2010. The authors concluded that these EDC-attributable cases of fibroids and endometriosis were estimated to be 56,700 and 145,000 women, respectively, with total combined economic and health care costs reaching nearly €1.5 billion annually. These findings suggest that DDE and phthalates may contribute substantially to the most common reproductive disorders in women, fibroids and endometriosis, and these public health costs should be considered as the European Union contemplates on proceeding with regulatory action for EDCs.
Young and adult women (15-54 years)

Health Outcomes

  • 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


  • Cost analysis (CA)

Cost Measured:

  • 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: (Not available)


  • European Union

Models Used: (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 Evaluation / Methods and Source


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

NIEHS Funding: (Not available)

Other Funding:

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