Female Reproductive Disorders, Diseases, and Costs of Exposure to Endocrine Disrupting Chemicals in the European Union

Patricia A. Hunt, Sheela Sathyanarayana, Paul A. Fowler, Leonardo Trasande

Research output: Contribution to journalArticle

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Abstract

Context:
A growing body of evidence suggests that endocrine-disrupting chemicals (EDCs) contribute to female reproductive disorders.

Objective:
To calculate the associated combined health care and economic costs attributable to specific EDC exposures within the European Union (EU).

Design:
An expert panel evaluated evidence for probability of causation using the Intergovernmental Panel on Climate Change weight-of-evidence characterization. Exposure-response relationships and reference levels were evaluated, and biomarker data were organized from carefully identified studies from the peer-reviewed literature to represent European exposure and approximate burden of disease as it occurred in 2010. Cost-of-illness estimation used multiple peer-reviewed sources.

Setting, Patients and Participants and Intervention:
Cost estimation was carried out from a societal perspective, ie, including direct costs (eg, treatment costs) and indirect costs such as productivity loss.

Results:
The most robust EDC-related data for female reproductive disorders exist for 1) diphenyldichloroethene-attributable fibroids and 2) phthalate-attributable endometriosis in Europe. In both cases, the strength of epidemiological evidence was rated as low and the toxicological evidence as moderate, with an assigned probability of causation of 20%–39%. Across the EU, attributable cases were estimated to be 56 700 and 145 000 women, respectively, with total combined economic and health care costs potentially reaching €163 million and €1.25 billion.

Conclusions:
EDCs (diphenyldichloroethene and phthalates) may contribute substantially to the most common reproductive disorders in women, endometriosis and fibroids, costing nearly €1.5 billion annually. These estimates represent only EDCs for which there were sufficient epidemiologic studies and those with the highest probability of causation. These public health costs should be considered as the EU contemplates regulatory action on EDCs.
Original languageEnglish
Pages (from-to)1562–1570
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume101
Issue number4
Early online date22 Mar 2016
DOIs
Publication statusPublished - 1 Apr 2016

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Endocrine Disruptors
Cost of Illness
European Union
Health Care Costs
Causality
Costs
Leiomyoma
Endometriosis
Costs and Cost Analysis
Health care
Economics
Climate Change
Toxicology
Epidemiologic Studies
Biomarkers
Public health
Public Health
Climate change
Weights and Measures
Productivity

Cite this

Female Reproductive Disorders, Diseases, and Costs of Exposure to Endocrine Disrupting Chemicals in the European Union. / Hunt, Patricia A.; Sathyanarayana, Sheela; Fowler, Paul A.; Trasande, Leonardo.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 101, No. 4, 01.04.2016, p. 1562–1570.

Research output: Contribution to journalArticle

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abstract = "Context:A growing body of evidence suggests that endocrine-disrupting chemicals (EDCs) contribute to female reproductive disorders.Objective:To calculate the associated combined health care and economic costs attributable to specific EDC exposures within the European Union (EU).Design:An expert panel evaluated evidence for probability of causation using the Intergovernmental Panel on Climate Change weight-of-evidence characterization. Exposure-response relationships and reference levels were evaluated, and biomarker data were organized from carefully identified studies from the peer-reviewed literature to represent European exposure and approximate burden of disease as it occurred in 2010. Cost-of-illness estimation used multiple peer-reviewed sources.Setting, Patients and Participants and Intervention:Cost estimation was carried out from a societal perspective, ie, including direct costs (eg, treatment costs) and indirect costs such as productivity loss.Results:The most robust EDC-related data for female reproductive disorders exist for 1) diphenyldichloroethene-attributable fibroids and 2) phthalate-attributable endometriosis in Europe. In both cases, the strength of epidemiological evidence was rated as low and the toxicological evidence as moderate, with an assigned probability of causation of 20{\%}–39{\%}. Across the EU, attributable cases were estimated to be 56 700 and 145 000 women, respectively, with total combined economic and health care costs potentially reaching €163 million and €1.25 billion.Conclusions:EDCs (diphenyldichloroethene and phthalates) may contribute substantially to the most common reproductive disorders in women, endometriosis and fibroids, costing nearly €1.5 billion annually. These estimates represent only EDCs for which there were sufficient epidemiologic studies and those with the highest probability of causation. These public health costs should be considered as the EU contemplates regulatory action on EDCs.",
author = "Hunt, {Patricia A.} and Sheela Sathyanarayana and Fowler, {Paul A.} and Leonardo Trasande",
note = "Acknowledgments We thank the many helpful discussions with Germaine Buck Louis and her valuable comments on the manuscript. We also thank Charles Persoz, Robert Barouki, and Marion Le Gal of the French National Alliance for Life Sciences and Health and Barbara Demeneix, Lindsey Marshall, Bilal Mughal, and Bolaji Seffou of the UMR 7221 Paris for providing technical and logistical support throughout the project. This work was supported by The Endocrine Society, the John Merck Fund, the Broad Reach Foundation, and the Oak Foundation. Disclosure Summary: The authors have nothing to disclose.",
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T1 - Female Reproductive Disorders, Diseases, and Costs of Exposure to Endocrine Disrupting Chemicals in the European Union

AU - Hunt, Patricia A.

AU - Sathyanarayana, Sheela

AU - Fowler, Paul A.

AU - Trasande, Leonardo

N1 - Acknowledgments We thank the many helpful discussions with Germaine Buck Louis and her valuable comments on the manuscript. We also thank Charles Persoz, Robert Barouki, and Marion Le Gal of the French National Alliance for Life Sciences and Health and Barbara Demeneix, Lindsey Marshall, Bilal Mughal, and Bolaji Seffou of the UMR 7221 Paris for providing technical and logistical support throughout the project. This work was supported by The Endocrine Society, the John Merck Fund, the Broad Reach Foundation, and the Oak Foundation. Disclosure Summary: The authors have nothing to disclose.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Context:A growing body of evidence suggests that endocrine-disrupting chemicals (EDCs) contribute to female reproductive disorders.Objective:To calculate the associated combined health care and economic costs attributable to specific EDC exposures within the European Union (EU).Design:An expert panel evaluated evidence for probability of causation using the Intergovernmental Panel on Climate Change weight-of-evidence characterization. Exposure-response relationships and reference levels were evaluated, and biomarker data were organized from carefully identified studies from the peer-reviewed literature to represent European exposure and approximate burden of disease as it occurred in 2010. Cost-of-illness estimation used multiple peer-reviewed sources.Setting, Patients and Participants and Intervention:Cost estimation was carried out from a societal perspective, ie, including direct costs (eg, treatment costs) and indirect costs such as productivity loss.Results:The most robust EDC-related data for female reproductive disorders exist for 1) diphenyldichloroethene-attributable fibroids and 2) phthalate-attributable endometriosis in Europe. In both cases, the strength of epidemiological evidence was rated as low and the toxicological evidence as moderate, with an assigned probability of causation of 20%–39%. Across the EU, attributable cases were estimated to be 56 700 and 145 000 women, respectively, with total combined economic and health care costs potentially reaching €163 million and €1.25 billion.Conclusions:EDCs (diphenyldichloroethene and phthalates) may contribute substantially to the most common reproductive disorders in women, endometriosis and fibroids, costing nearly €1.5 billion annually. These estimates represent only EDCs for which there were sufficient epidemiologic studies and those with the highest probability of causation. These public health costs should be considered as the EU contemplates regulatory action on EDCs.

AB - Context:A growing body of evidence suggests that endocrine-disrupting chemicals (EDCs) contribute to female reproductive disorders.Objective:To calculate the associated combined health care and economic costs attributable to specific EDC exposures within the European Union (EU).Design:An expert panel evaluated evidence for probability of causation using the Intergovernmental Panel on Climate Change weight-of-evidence characterization. Exposure-response relationships and reference levels were evaluated, and biomarker data were organized from carefully identified studies from the peer-reviewed literature to represent European exposure and approximate burden of disease as it occurred in 2010. Cost-of-illness estimation used multiple peer-reviewed sources.Setting, Patients and Participants and Intervention:Cost estimation was carried out from a societal perspective, ie, including direct costs (eg, treatment costs) and indirect costs such as productivity loss.Results:The most robust EDC-related data for female reproductive disorders exist for 1) diphenyldichloroethene-attributable fibroids and 2) phthalate-attributable endometriosis in Europe. In both cases, the strength of epidemiological evidence was rated as low and the toxicological evidence as moderate, with an assigned probability of causation of 20%–39%. Across the EU, attributable cases were estimated to be 56 700 and 145 000 women, respectively, with total combined economic and health care costs potentially reaching €163 million and €1.25 billion.Conclusions:EDCs (diphenyldichloroethene and phthalates) may contribute substantially to the most common reproductive disorders in women, endometriosis and fibroids, costing nearly €1.5 billion annually. These estimates represent only EDCs for which there were sufficient epidemiologic studies and those with the highest probability of causation. These public health costs should be considered as the EU contemplates regulatory action on EDCs.

U2 - 10.1210/jc.2015-2873

DO - 10.1210/jc.2015-2873

M3 - Article

VL - 101

SP - 1562

EP - 1570

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 4

ER -