Leveraging Systematic Reviews to Explore Disease Burden and Costs of Per- and Polyfluoroalkyl Substance Exposures in the United States

Abstract

Accelerating evidence confirms the contribution of per- and polyfluoroalkyl substances (PFAS) to disease burden and disability across the lifespan. Given that policy makers raise the high cost of remediation and of substituting PFAS with safer alternatives in consumer products as barriers to confronting adverse health outcomes associated with PFAS exposure, it is important to document the costs of inaction even in the presence of uncertainty. We therefore quantified disease burdens and related economic costs due to legacy PFAS exposures in the US in 2018. We leveraged systematic reviews and used meta-analytic inputs whenever possible, identified previously published exposure–response relationships, and calculated PFOA- and PFOS-attributable increases in 13 conditions. These increments were then applied to census data to determine total annual PFOA- and PFOS-attributable cases of disease, from which we calculated economic costs due to medical care and lost productivity using previously published cost-of-illness data. We identified PFAS-attributable disease costs in the US of $5.52 billion across five primary disease endpoints shown to be associated with PFAS exposure in meta-analyses. This estimate represented the lower bound, with sensitivity analyses revealing as much as $62.6 billion in overall costs. While further work is needed to assess probability of causation and establish with greater certainty effects of the broader category of PFAS, the results confirm further that public health and policy interventions are still necessary to reduce exposure to PFOA and PFOS and their endocrine-disrupting effects. This study demonstrates the large potential economic implications of regulatory inaction.

PFAS: forever chemicals—persistent, bioaccumulative and mobile. Reviewing the status and the need for their phase out and remediation of contaminated sites

“…[378]. Obsekov et al calculated health costs of at least US $5.5 billion in 2018 for PFOA and PFOS in a differentiated analysis [379]. Thus, inaction comes at a higher cost in the medium term compared to phase out the PFAS.…”

Presumptive Contamination: A New Approach to PFAS Contamination Based on Likely Sources

“…10 The economic and social impacts of PFAS contamination include health impacts, testing and remediation costs, agricultural and real estate impacts, and burdens on local and state governments. 11,12 An estimated 200 million U.S. residents receive PFAScontaminated drinking water, and state-level testing indicates widespread contamination of environmental media, 13 yet tremendous data gaps exist related to PFAS contamination and human exposure. 2,14 The only federal drinking water testing initiative with PFAS data to date, the Environmental Protection Agency's (EPA) Unregulated Contaminant Monitoring Rule 3 (UCMR3), focused on large drinking water systems, had high reporting thresholds (10−90 ng/L), and excluded private wells.…”

“…Many PFAS are highly mobile in ground and surface water, and contamination of drinking water, air, and other media is a growing concern . The economic and social impacts of PFAS contamination include health impacts, testing and remediation costs, agricultural and real estate impacts, and burdens on local and state governments. , …”

“… 10 The economic and social impacts of PFAS contamination include health impacts, testing and remediation costs, agricultural and real estate impacts, and burdens on local and state governments. 11 , 74 …”

Global plastic treaty should address chemicals

“…Documented health effects include premature births, low birth weight, obesity, diabetes, cardiovascular disease, endometriosis, infertility, and cancers, thus spanning generations (6). In the US alone, associated costs of endocrine-disrupting chemicals amount to USD 300 billion/year (7,8). The total burden on community, ecosystem health, and biodiversity is far greater (9,10).…”