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Your Environment. Your Health.

Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost utility analysis (CUA), Cost benefit analysis (CBA)
Grandjean P, Bellanger M
Environmental Health
This review and analysis used published studies related to health outcomes attributable to environmental exposure to calculate global burdens of disease (BoD) and associated costs for numerous health outcomes and chemicals (e.g., mercury, pesticides, brominated diethyl ethers, and several endocrine disrupting chemicals). Their analysis shows that functional deficits, especially regarding cognition, greatly add to the total environmental BoD, and that total costs are substantially higher than those previously estimated. The authors’ analysis suggests that the total environmental BoD may exceed 10% of the global gross domestic product, higher than a previous estimate of 5.3%. The authors suggest that future calculations of environmental BoD take a more comprehensive approach to better inform decisions about the scope of disease and dysfunction associated with industrial chemicals.
Populations studied as described in published reports of economic valuation of health burdens from environmental exposures including children and adults

Health Outcomes

  • 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


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

Cost Measured:

  • 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: (Not available)


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

Models Used: (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 Evaluation / Methods and Source


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

NIEHS Funding:

  • ES009797

Other Funding: (Not available)

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