Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation
Abstract Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal c...
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| Format: | Article |
| Language: | English |
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BMC
2017-12-01
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| Series: | Environmental Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12940-017-0340-3 |
| _version_ | 1818956669713907712 |
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| author | Philippe Grandjean Martine Bellanger |
| author_facet | Philippe Grandjean Martine Bellanger |
| author_sort | Philippe Grandjean |
| collection | DOAJ |
| description | Abstract Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal criteria, and is hampered by gaps in environmental exposure data, especially from industrializing countries. For these reasons, a recently calculated environmental BoD of 5.18% of the total DALYs is likely underestimated. We combined and extended cost calculations for exposures to environmental chemicals, including neurotoxicants, air pollution, and endocrine disrupting chemicals, where sufficient data were available to determine dose-dependent adverse effects. Environmental exposure information allowed cost estimates for the U.S. and the EU, for OECD countries, though less comprehensive for industrializing countries. As a complement to these health economic estimations, we used attributable risk valuations from expert elicitations to as a third approach to assessing the environmental BoD. For comparison of the different estimates, we used country-specific monetary values of each DALY. The main limitation of DALY calculations is that they are available for few environmental chemicals and primarily based on mortality and impact and duration of clinical morbidity, while less serious conditions are mostly disregarded. Our economic estimates based on available exposure information and dose-response data on environmental risk factors need to be seen in conjunction with other assessments of the total cost for these environmental risk factors, as our estimate overlaps only slightly with the previously estimated environmental DALY costs and crude calculations relying on attributable risks for environmental risk factors. The three approaches complement one another and suggest that environmental chemical exposures contribute costs that may exceed 10% of the global domestic product and that current DALY calculations substantially underestimate the economic costs associated with preventable environmental risk factors. By including toxicological and epidemiological information and data on exposure distributions, more representative results can be obtained from utilizing health economic analyses of the adverse effects associated with environmental chemicals. |
| first_indexed | 2024-12-20T10:57:38Z |
| format | Article |
| id | doaj.art-e227290c53eb4290baa61d679a58fd76 |
| institution | Directory Open Access Journal |
| issn | 1476-069X |
| language | English |
| last_indexed | 2024-12-20T10:57:38Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Environmental Health |
| spelling | doaj.art-e227290c53eb4290baa61d679a58fd762022-12-21T19:43:06ZengBMCEnvironmental Health1476-069X2017-12-0116111310.1186/s12940-017-0340-3Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimationPhilippe Grandjean0Martine Bellanger1Department of Environmental Health, Harvard T.H. Chan School of Public HealthEHESP School of Public HealthAbstract Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal criteria, and is hampered by gaps in environmental exposure data, especially from industrializing countries. For these reasons, a recently calculated environmental BoD of 5.18% of the total DALYs is likely underestimated. We combined and extended cost calculations for exposures to environmental chemicals, including neurotoxicants, air pollution, and endocrine disrupting chemicals, where sufficient data were available to determine dose-dependent adverse effects. Environmental exposure information allowed cost estimates for the U.S. and the EU, for OECD countries, though less comprehensive for industrializing countries. As a complement to these health economic estimations, we used attributable risk valuations from expert elicitations to as a third approach to assessing the environmental BoD. For comparison of the different estimates, we used country-specific monetary values of each DALY. The main limitation of DALY calculations is that they are available for few environmental chemicals and primarily based on mortality and impact and duration of clinical morbidity, while less serious conditions are mostly disregarded. Our economic estimates based on available exposure information and dose-response data on environmental risk factors need to be seen in conjunction with other assessments of the total cost for these environmental risk factors, as our estimate overlaps only slightly with the previously estimated environmental DALY costs and crude calculations relying on attributable risks for environmental risk factors. The three approaches complement one another and suggest that environmental chemical exposures contribute costs that may exceed 10% of the global domestic product and that current DALY calculations substantially underestimate the economic costs associated with preventable environmental risk factors. By including toxicological and epidemiological information and data on exposure distributions, more representative results can be obtained from utilizing health economic analyses of the adverse effects associated with environmental chemicals.http://link.springer.com/article/10.1186/s12940-017-0340-3Attributable riskBurden of illnessLeadMercuryNeurotoxicityPesticides |
| spellingShingle | Philippe Grandjean Martine Bellanger Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation Environmental Health Attributable risk Burden of illness Lead Mercury Neurotoxicity Pesticides |
| title | Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation |
| title_full | Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation |
| title_fullStr | Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation |
| title_full_unstemmed | Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation |
| title_short | Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation |
| title_sort | calculation of the disease burden associated with environmental chemical exposures application of toxicological information in health economic estimation |
| topic | Attributable risk Burden of illness Lead Mercury Neurotoxicity Pesticides |
| url | http://link.springer.com/article/10.1186/s12940-017-0340-3 |
| work_keys_str_mv | AT philippegrandjean calculationofthediseaseburdenassociatedwithenvironmentalchemicalexposuresapplicationoftoxicologicalinformationinhealtheconomicestimation AT martinebellanger calculationofthediseaseburdenassociatedwithenvironmentalchemicalexposuresapplicationoftoxicologicalinformationinhealtheconomicestimation |