The attributable annual health costs of U.S. occupational lead poisoning

Figures & data

Table 1 Cost components of illness/injury

	At work	At service delivery site		At home
		Inpatient (includes both general & specialty)	Outpatient (includes both general & specialty)
Direct medical costs	Health unit, including staff, treatment, equipment, supplies & services; co-workers & supervisors	Hospitalization		Trained & untrained care providers, including transportation
	Transportation, (ambulance or driver, transport & parking)	Treatment & tests	Treatment & tests
	Out of pocket expenditures (copays & deductibles, phone calls, record keeping, etc.)	Specialist provider services	Medical & specialist provider visits
		Transportation (ambulance or driver, transport & parking)	Transportation (ambulance or driver, transport & parking)
		Pharmaceuticals (prescribed & over the counter)	Pharmaceuticals (prescribed & over the counter)	Pharmaceuticals (prescribed & over the counter)
		Specialized consumer goods (e.g. pillows, clothing, food, etc.)	Specialized consumer goods (e.g. pillows, clothing, food, etc.)	Specialized consumer goods (e.g. pillows, clothing, food, etc.)
		Out of pocket expenditures (copays & deductibles, phone calls, record keeping, etc.)	Out of pocket expenditures (copays & deductibles, phone calls, record keeping, etc.)	Out of pocket expenditures (copays & deductibles, phone calls, record keeping, etc.)
		Costs to family & friends	Costs to family & friends	Costs to family & friends
Indirect costs	Lost work (costs to employer & employee), includes absenteeism & presenteeism	Time loss associated with inpatient care	Time loss associated with outpatient care	Lost home production
	Impositions on supervisor, colleagues, etc.			Lost leisure
	Avoidance activities			Avoidance activities
	Decreased future earnings, including e.g. moving from full- to part-time work			Specialized consumer goods (pillows, clothing, food, etc.)
	Specialized consumer goods (chair, clothing, food, etc.)			Costs to family & friends
	Costs to co-workers

Table 2 Monetized annual health endpoint unit estimates, with sources noted

System	Subcomponent	Delineated Medical Costs (yr$)	Source	Comprehensiveness	Adjustment (Source)	Out of Pocket (source)^2	Total medical unit costs (2014$)
Cardiovascular	Hypertension	$550 (2010$)	AHA 14^67	Restricted diagnoses, Medicare expenditures	Voigt 14 (×2.5)^68	10.3% (half of MEPS 12)^41	$1700
	Myocardial infarct	$38501 (1996$)	NBER^71; Afana^70; Ben-Joseph^69	Only first 90 days insurer expenditure & Medicare	×1.5 to acct for rest of yr; ×1.5 to acct for insurer exp vs. all med	$7500 (midpt of CDC 11^99 & ACS 13)^114	$116000
Neurologic	Muscular pain	$3578 (1996$)	Yelin 01^47	Only expenditures	×1.5 to acct for exp vs. all med	7.5% (MEPS 12)^41	$11000
	Ocular disorder	$3105 plus 2 days informal care (2002$); $345 + $2193 (2003$)	Frick 07^48; Javitt 07^32	Javitt is Medicare, no part D	×1.5 to acct for Medicare exp vs. all med + 12% for Part D	18.9% (MEPS 12)^41	$7000
	Depression – mild	$1000 (2003$)	Luppa 07^51	Also increases general medical costs	+ $2120 (Welch 09)^50	18% (MEPS 12)^41	$4000
	Depression – severe	$2500 (2003$)	Luppa 07^51	Also increases general medical costs	+ $20574 (Welch 09)^50; added $4,800 for informal care	18% (MEPS 12)^41	$25000
	Nervous syst disorder	$10349 (2002$);$11167 (02$)	Huse 05^32; Noyes 06^54			$3345 (02$, Noyes 06)^54	$22000
	Panic disorder	$1658 (2009$)	Shirneshan 13^52			18% (MEPS 12)^41	$2200
	Dementia	$29000 (2010$)	Avg of Hurd 13^55; Alzheimers Assoc 14^56	Excl informal care	Added $4,800 for informal care	21% (Alz Assoc)^56	$63000
Reproductive	Fertility damages male	$19500 (2003$)	Meng 05^115	Excl live delivery		$5338 (13$,Wu 14)^60	$35000
	Fertility damages fem	^a	Unit costs fr Neumann 94^58 (92$), Goldfarb 96 (92$)^59, Pratt 04 (03$)^116	Excl live delivery	Assume 15% live delivery	$5338 (13$,Wu 14)^60	$101000
	Preterm birth	$103938 (05$)	Behrman & Butler 07^61			14.6% (MEPS 12)^41	$161000
Kidney disease	ESRD	$79916 (10$)	2012 USRDS^63	Medicare expenditures	X 1.5 to acct for just expenditures; added $4,800 for informal care	midpoint of 15% (Cubanski 39) and 5.4% (MEPS 12)	$144000
	Chronic kidney disease	$13395 (10$)	2012 USRDS^63 for those 50–64	Medicare expenditures	X 1.5 to acct for just expenditures	5.4% (MEPS 12)^41	$23500
Carcinogenicity	Lung cancer	$38569 (96$), $80979 (2006$)	EPA 97,^65 Cipriano 11^33	Medicare exp, coinsurance & deduct/copay; no pharma	+ 16% pharma (Van Houtven 04)^66	5.4% (MEPS 12),^41 15% (Cipriano 11)^33	$115400
Mortality	Value of a statistical life	$7.4 mil (06$)	EPA 14^30				NA
Anemia as comorbidity		Avg cost of illness in this analysis $56000		Anemia can double the cost (Smith,^74 Nissenson^75)			$56000

Note:

Used unit treatment costs from Neumann⁵⁸, Goldfarb⁵⁹ and Pratt¹¹⁶, plus excess medical estimates from Behrman & Butler⁶¹.

Sources: Refs. [114–116].

^a Neumann 1994 $55–212,000 (92$), plus NICU costs $10–100,000 (92$), 12% success rate.

Table 3 Monetized unit estimates of annual indirect costs and total annual (medical and indirect) costs (2014$)

System	Subcomponent	Estimated unit medical costs	Estimation basis of indirect costs	Estimated unit indirect costs	Total unit costs
Cardiovascular	Hypertension	$1,700	Direct = indirect	$1,700	$3,400
	Myocardial infarct	$116,000	Direct = indirect	$116,000	$232,000
Neurologic	Muscular pain	$11,000	Stewart ^84; Indir:dir is 3–4:1 (Stewart 03^84, Carlson 11,^85 Letvak 12^86)	$24,000	$35,000
	Ocular disorder	$7,000	Direct = indirect	$7,000	$14,000
	Depression – mild	$4,000	Indir is ×2 (midpt of Welch^50, Greenberg^92 & Stuhldreher^53)	$8,000	$12,000
	Depression – severe	$25,000	Indir is ×3 (Stewart 03^84, Greenberg^92 & avg of others)	$75,000	$100,000
	Nervous system disorder	$22,000	Noyes 06^54; Whetten-Goldstein 97^88; Rubenstein^89	$43,500	$65,500
	Panic disorder	$2,200	Indir is ×3 (Pittig 14^87, Stuhldreher 14^53)	$6,600	$8800
	Dementia	$63,000	Direct = indirect	$63,000	$126,000
Reproductive	Fertility damages male	$35,000	Indir has added time loss (Wu^90)	$37,000	$72,000
	Fertility damages fem	$101,000	Indir has added time loss (Wu^90)	$103,000	$204,000
	Preterm birth	$161,000	Time loss is mom’s losses	$163,000	$324,000
Kidney disease	ESRD	$144,000	Direct = indirect	$144,000	$288,000
	Chronic kidney disease	$23,500	Direct = indirect	$23,500	$47,000
Carcinogenicity	Lung cancer	$115,400	Direct = indirect	$115,400	$230,800
Mortality	Value of a statistical life	NA	NA	NA	$9 mil
Anemia as comorbidity		$56,000	Direct = indirect	$56,000	$112,000

Table 4 Exposure estimates, based upon NIOSH estimates of lead-exposed workers

System	Subcomponent	Exposure estimate (%)	Exposure estimate (calculated)	Number of workers
Cardiovascular	Hypertension		550	550
	Myocardial infarct		6	6
Neurologic	Muscular pain	2		200
	Ocular disorder	0.5		50
	Depression – mild	2.5		250
	Depression – severe	2.5		250
	Nervous syst disorder	1		100
	Panic disorder	1		100
	Dementia	5		500
Reproductive	Fertility damages male	3		300
	Fertility damages fem	3		300
	Preterm birth	1		100
Kidney disease	ESRD		130	130
	Chronic kidney disease		130	130
Carcinogenicity	Lung cancer	1		100
Mortality	Statistical life		10	10
Anemia as comorbidity		1		100

Table 5 Total estimated annual attributable health-related damages associated with lead exposure of U.S. workers (thousands 2014$)

System	Subcomponent	Exposure estimate	Total estimated medical costs	Total estimated indirect costs	Total
Cardiovascular	Hypertension	550	$935	$935	$1,870
	Myocardial infarct	6	$696	$696	$1,392
Neurologic	Muscular pain	200	$2,200	$4,800	$7,000
	Ocular disorder	50	$350	$350	$700
	Depression – mild	250	$1,000	$2,000	$3,000
	Depression – severe	250	$6,250	$18,750	$25,000
	Nervous system disorder	100	$2,200	$4,350	$6,550
	Panic disorder	100	$220	$660	$880
	Dementia	500	$31,500	$31,500	$63,000
Reproductive	Fertility damages male	300	$10,500	$11,100	$21,600
	Fertility damages fem	300	$30,300	$30,900	$61,200
	Preterm birth	100	$16,100	$16,300	$32,400
Kidney disease	ESRD	130	$18,720	$18,720	$37,440
	Chronic kidney disease	130	$3,055	$3,055	$6,110
Carcinogenicity	Lung cancer	100	$11,540	$11,540	$23,080
Mortality	Value of a statistical life	10	NA	NA	$90,000
Anemia as comorbidity		100	$5,600	$5,600	$11,200
Totals			$141,160	$161,256	$392,422

Table 6 Sensitivity analyses (millions 2014$)

	Total direct medical costs	Total indirect costs	Mortality valuation	Total-total annual estimate
Baseline defaults	$141	$161	$90	$392
Default assumption indirect costs = 0.5 direct^a	$141	$117 (−27%)	$90	$348 (−11%)
Default assumption indirect costs = 2 × direct^a	$141	$270 (+67%)	$90	$519 (+32%)
Default assumption death = $1 million	$141	$161	$10	$310 (−20%)
Default assumption less:more severe is 2:1 for renal disease & depression	$134 (−5%)	$151 (−6%)	$90	$375 (−4%)

^a Default assumptions used for eight health endpoints.

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