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.
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 language | English |
|---|---|
| Pages (from-to) | 1562–1570 |
| Number of pages | 9 |
| Journal | Journal of Clinical Endocrinology and Metabolism |
| Volume | 101 |
| Issue number | 4 |
| Early online date | 22 Mar 2016 |
| DOIs | |
| Publication status | Published - 1 Apr 2016 |
Bibliographical note
AcknowledgmentsWe 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.
Access to Document
- Accepted Manuscript
This is the author's manuscript of a paper accepted for publication in Journal of Clinical Endocrinology and Metabolism.
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Paul Alfred François Fowler
- School of Medicine, Medical Sciences & Nutrition, Molecular and Cellular Function
- School of Medicine, Medical Sciences & Nutrition, Applied Medicine - Chair in Translational Medical Sciences
- School of Medicine, Medical Sciences & Nutrition, Institute of Medical Sciences
Person: Academic