title: Childhood lead exposure in France: benefit estimation and partial cost-benefit analysis of lead hazard control.
abstract: BACKGROUND
  Lead exposure remains a public health concern due to its serious adverse effects, such as cognitive and behavioral impairment: children younger than six years of age being the most vulnerable population. In Europe, the lead-related economic impacts have not been examined in detail. We estimate the annual costs in France due to childhood exposure and, through a cost benefit analysis (CBA), aim to assess the expected social and economic benefits of exposure abatement.
  
  
  METHODS
  Monetary benefits were assessed in terms of avoided national costs. We used results from a 2008 survey on blood-lead (B-Pb) concentrations in French children aged one to six years old. Given the absence of a threshold concentration being established, we performed a sensitivity analysis assuming different hypothetical threshold values for toxicity above 15 μg/L, 24 μg/L and 100 μg/L. Adverse health outcomes of lead exposure were translated into social burden and economic costs based on literature data from literature. Direct health benefits, social benefits and intangible avoided costs were included. Costs of pollutant exposure control were partially estimated in regard to homes lead-based paint decontamination, investments aiming at reducing industrial lead emissions and removal of all lead drinking water pipes.
  
  
  RESULTS
  The following overall annual benefits for the three hypothetical thresholds values in 2008 are: €22.72 billion, €10.72 billion and €0.44 billion, respectively. Costs from abatement ranged from €0.9 billion to 2.95 billion/year. Finally, from a partial CBA of lead control in soils and dust the estimates of total net benefits were € 3.78 billion, € 1.88 billion and €0.25 billion respectively for the three hypothesized B-Pb effect values.
  
  
  CONCLUSIONS
  Prevention of childhood lead exposure has a high social benefit, due to reduction of B-Pb concentrations to levels below 15 μg/L or 24 μg/L, respectively. Reducing only exposures above 100 μg/L B-Pb has little economic impact due to the small number of children who now exhibit such high exposure levels. Prudent public policies would help avoiding future medical interventions, limit the need for special education and increase future productivity, and hence lifetime income for children exposed to lead.
authors: EHESP School of Public Health, CS 74312 - 35043 Rennes Cedex, France. celine.pichery@ehesp.fr
authors: Céline
authors: C
authors: Pichery
authors: Martine
authors: M
authors: Bellanger
authors: Denis
authors: D
authors: Zmirou-Navier
authors: Philippe
authors: P
authors: Glorennec
authors: Philippe
authors: P
authors: Hartemann
authors: Philippe
authors: P
authors: Grandjean
references: Neurotoxicol Teratol. 2001 Nov-Dec;23(6):511-8
references: 11792521
references: Acta Paediatr Scand. 1990 Mar;79(3):352-60
references: 2333751
references: Arch Pediatr Adolesc Med. 2009 Sep;163(9):844-9
references: 19736339
references: Health Policy. 1995 Sep;33(3):219-31
references: 10145123
references: Am J Public Health. 2004 Nov;94(11):1854-63
references: 15514220
references: Med Decis Making. 2002 Nov-Dec;22(6):482-92
references: 12458978
references: Curr Opin Pediatr. 2008 Apr;20(2):172-7
references: 18332714
references: Environ Health Perspect. 2009 Jul;117(7):1162-7
references: 19654928
references: Environ Res. 1994 Jul;66(1):105-24
references: 8013434
references: Rev Epidemiol Sante Publique. 2006 Apr;54(2):117-25
references: 16830966
references: Circulation. 2006 Sep 26;114(13):1388-94
references: 16982939
references: Environ Health Perspect. 2009 Jul;117(7):1021-2
references: 19654907
references: Environ Res. 2008 Mar;106(3):410-9
references: 17961540
references: J Urban Health. 2006 Jan;83(1):111-28
references: 16736359
references: Neurotoxicol Teratol. 1997 Nov-Dec;19(6):417-28
references: 9392777
references: Environ Int. 2007 Oct;33(7):937-45
references: 17573113
references: Environ Health Perspect. 2002 Jun;110(6):563-9
references: 12055046
references: Neurotoxicol Teratol. 2002 Nov-Dec;24(6):711-7
references: 12460653
references: Environ Res. 2007 Jul;104(3):315-36
references: 17451672
references: Environ Health Perspect. 2002 Jul;110(7):721-8
references: 12117650
references: Annu Rev Med. 2004;55:209-22
references: 14746518
references: Risk Anal. 2004 Oct;24(5):1121-41
references: 15563283
references: Environ Res. 1995 Jul;70(1):1-6
references: 8603652
references: Environ Health Perspect. 2008 Oct;116(10):1285-93
references: 18941567
references: Rev Epidemiol Sante Publique. 2002 Jun;50(3):297-305
references: 12122346
references: PLoS Med. 2008 May 27;5(5):e101
references: 18507497
references: Environ Health Perspect. 2005 Jul;113(7):894-9
references: 16002379