Saturday, January 25, 2014

Further Limiting Bisphenol A In Food Uses Could Provide Health And Economic Benefits

Abstract:
There is mounting evidence that bisphenol A (BPA), a chemical used in the production of polycarbonate plastics and the linings of aluminum cans, may have adverse health consequences. The Food and Drug Administration has banned BPA from baby bottles and sippy cups but has deferred further action on other food uses—that is, uses in metal-based food and beverage containers. This article quantifies the potential social costs of childhood obesity and adult coronary heart disease attributable to BPA exposure in the United States in 2008 and models the potential health and economic benefits associated with replacing BPA in all food uses. BPA exposure was estimated to be associated with 12,404 cases of childhood obesity and 33,863 cases of newly incident coronary heart disease, with estimated social costs of $2.98 billion in 2008. Removing BPA from food uses might prevent 6,236 cases of childhood obesity and 22,350 cases of newly incident coronary heart disease per year, with potential annual economic benefits of $1.74 billion (sensitivity analysis: $889 million–$13.8 billion per year). Although more data are needed, these potentially large health and economic benefits could outweigh the costs of using a safer substitute for BPA....
The twelve-year-old children in the two highest quartiles of exposure to BPA were estimated to have BMI Z-scores that were, on average, 0.041 and 0.063 standard deviation units higher than the scores for the remainder of the population. This resulted in 4,879 and 7,525 additional cases of obesity for the third and fourth quartiles, respectively (Exhibit 1). In 2008 dollars, these additional cases resulted in $27.7 million in additional child health care expenditures.

Of the additional 12,404 obese children, 9,427 were estimated to remain obese as adults, with an additional $489 million in associated increased health care expenditures in adulthood and 54,676 QALYs lost. Applying a value of $50,000 to each QALY and adjusting for bringing future costs into the present, the lost QALYs cost an additional $972 million, for a total of $1.49 billion in costs for BPA-attributable childhood obesity. In the sensitivity analyses, the estimated total costs ranged from $443 million to $12.3 billion.

Exhibit 2 presents estimates of health and economic consequences of coronary heart disease attributable to BPA in 2008. The adults ages 40–74 in the three highest quartiles of BPA exposure were estimated to have 15.17 percent, 6.2 percent, and 3.1 percent greater odds of coronary heart disease, respectively, compared with the lowest quartile. There were an estimated 33,863 cases of newly incident coronary heart disease attributable to BPA in the three highest quartiles, with associated costs of $1.50 billion (Exhibit 2). Sensitivity analyses suggested that the cost of BPA-attributable coronary heart disease could range from $935 million to $2.29 billion....

Combining the estimated costs of BPA-attributable childhood obesity and adult coronary heart disease produced a cost of $2.98 billion in 2008. According to the sensitivity analyses, the figure could be between $1.4 billion and $14.6 billion. This represents an annual cost that will accrue each year that exposure to BPA continues unabated in the US population.

In the counterfactual scenarios, urinary BPA was reduced 66–92 percent as a result of eliminating BPA from food uses. In the baseline scenario, 6,236 fewer twelve-year-olds were obese in 2008, and 22,350 cases of newly incident coronary heart disease were prevented (Exhibit 3). The resulting savings were $748 million and $987 million, respectively, with a total economic benefit of $1.74 billion. The lower-bound estimate of the counterfactual scenarios suggested economic benefits of $889 million, while the upper-bound estimate suggested $13.8 billion.

This analysis suggests that $2.98 billion in annual costs are attributable to BPA-associated childhood obesity and adult coronary heart disease. The $1.49 billion in childhood obesity costs are the first environmentally attributable costs of obesity in childhood to be documented, and they can be added to the estimated $76.6 billion in environmentally attributable costs of US childhood disease in 2008.48

It is useful to compare the estimated $1.74 billion annual economic benefit of removing BPA from food uses with the costs of replacing BPA with an alternative that might not produce health consequences similar to those attributable to BPA. One proposed alternative is oleoresin, a mixture of oil and resin extracted from various plants. If an oleoresin lining for an aluminum can costs 2.2 cents more than a BPA lining, as some reports suggest,49 and 100 billion aluminum cans are produced annually,50 then the incremental cost of replacing BPA would be $2.2 billion each year.                   

by Leonardo Trasande, associate professor of pediatrics, environmental medicine, and health policy at the New York University (NYU) School of Medicine, in New York City. He also holds faculty appointments in the Wagner School of Public Service and the Steinhardt School of Culture, Education, and Human Development at NYU, Leonardo.trasande@nyumc.org
Health Affairs www.healthaffairs.org/
January, 2014; doi: 10.1377/hlthaff.2013.0686 Health Aff January 2014 10.1377/hlthaff.2013.0686 
Keywords: Environmental Health, Health Economics, Health Promotion/Disease Prevention, Legal/Regulatory Issues

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