Estimating the social cost of respiratory cancer cases attributable to occupational exposures in France

Our plain-English summary of Estimating the social cost of respiratory cancer cases attributable to occupational exposures in France, by H. Serrier, H. Sultan-Taieb, D. Luce, et al (The European Journal of Health Economics, 2014).

The study

• Authors: H. Serrier, H. Sultan-Taieb, D. Luce, S. Bejean
• Journal: The European Journal of Health Economics
• Published: 2014;15(6):661-73
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: The objective of this article was to estimate the social cost of respiratory cancer cases attributable to occupational risk factors in France in 2010.

Methods: According to the attributable fraction method and based on available epidemiological data from the literature, we estimated the number of respiratory cancer cases due to each identified risk factor. We used the cost-of-illness method with a prevalence-based approach. We took into account the direct and indirect costs. We estimated the cost of production losses due to morbidity (absenteeism and presenteeism) and mortality costs (years of production losses) in the market and nonmarket spheres.

Results: The social cost of lung, larynx, sinonasal and mesothelioma cancer caused by exposure to asbestos, chromium, diesel engine exhaust, paint, crystalline silica, wood and leather dust in France in 2010 were estimated at between 917 and 2,181 million euros. Between 795 and 2,011 million euros (87-92%) of total costs were due to lung cancer alone. Asbestos was by far the risk factor representing the greatest cost to French society in 2010 at between 531 and 1,538 million euros (58-71%), ahead of diesel engine exhaust, representing an estimated social cost of between 233 and 336 million euros, and crystalline silica (119-229 million euros). Indirect costs represented about 66% of total costs.

Conclusion: Our assessment shows the magnitude of the economic impact of occupational respiratory cancers. It allows comparisons between countries and provides valuable information for policy-makers responsible for defining public health priorities.

In plain English

In this economic modelling study, the authors estimated what respiratory cancers caused by workplace exposures cost French society in 2010. For lung, larynx and sinonasal cancer, they combined published relative risks with exposure estimates, mostly from French surveys (for painters, from employment data), to estimate cases attributable to seven risk factors, including asbestos. For pleural mesothelioma, they used asbestos-attributable shares from a French surveillance program: 38.4 % in women and 83.2 % in men. They then valued medical costs and production lost to illness and death. The total was estimated at 917 to 2,181 million euros, 87–92 % of it from lung cancer. Asbestos was the largest single factor, at between 531 and 1,538 million euros (58–71 % of the total). For asbestos, the authors estimated between 4,201 and 13,405 prevalent lung cancer cases and between 2,749 and 8,777 lung cancer deaths. They also estimated 636 prevalent pleural mesothelioma cases attributable to asbestos. The authors considered their estimates conservative, partly because some risk factors and intangible costs were omitted. They concluded that the work shows the magnitude of the economic impact of occupational respiratory cancers.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cost-of-illness study using a prevalence-based approach and attributable fractions (a modelling study, not a patient cohort). For lung, larynx and sinonasal cancer, the attributable fractions came from published relative risks and exposure-prevalence estimates. For pleural mesothelioma, they were taken directly from the French National Mesothelioma Surveillance Program.
• Who was studied: Lung, larynx and sinonasal cancer and pleural mesothelioma cases in France in 2010 attributable to occupational risk factors, estimated separately for men and women from national statistics
• Exposure: Seven occupational risk factors: asbestos, chromium, crystalline silica, diesel engine exhaust, paint (work as a painter), leather dust and wood dust. Asbestos was counted for lung cancer, larynx cancer and pleural mesothelioma. Asbestos exposure prevalence was 2.70 % for women and 26.70 % for men. Exposure prevalence came from the Matgéné or SUMER surveys, except for painters, for whom everyone in a painters' job category in the annual declaration of social data was assumed to be exposed. Asbestos fiber types were not distinguished.
• Main results:
  • Total social cost of the studied respiratory cancers in France in 2010 was estimated at between 917 and 2,181 million euros. Lung cancer accounted for 795 to 2,011 million euros (87–92 %).
  • Asbestos-related cancers (lung, larynx and mesothelioma combined) were estimated to cost between 531 and 1,538 million euros, 58–71 % of the total. This was ahead of diesel engine exhaust (233 to 336 million euros) and crystalline silica (119 to 229 million euros).
  • For asbestos-related cancers, indirect costs were estimated at 334 to 1,012 million euros and direct costs at 197 to 527 million euros.
  • Prevalent lung cancer cases attributable to asbestos were estimated at 4,201 to 13,405 in 2010, and lung cancer deaths attributable to asbestos at 2,749 to 8,777.
  • For pleural mesothelioma, the attributable fraction to asbestos was taken directly from the French National Mesothelioma Surveillance Program: 38.4 % for women and 83.2 % for men. This gave 636 prevalent cases and 667 deaths attributable to asbestos in 2010.
  • Indirect costs (lost production) made up about 66 % of total costs.
  • In the sensitivity analysis for asbestos-related lung cancer, changing the discount rate from 5 % to 3 % increased the social cost by 14.2 %.
• The authors' conclusion: The authors concluded that their assessment shows the magnitude of the economic impact of occupational respiratory cancers, allows comparisons between countries and provides information for policy-makers setting public health priorities.
• Limitations the authors state:
  • Not all known risk factors for respiratory cancer could be included because exposure-prevalence data were lacking, so the authors considered their estimate conservative.
  • Presenteeism (reduced productivity while at work) was valued with an average 8.5 % productivity loss for all cancers. The authors think this probably underestimates the cost for lung cancer and mesothelioma.
  • Intangible costs, such as suffering and the value of lives lost, were not estimated.
  • Prevalent sinonasal cancer cases were assumed to equal incident cases, and the risk of sinonasal cancer from wood dust is probably highly underestimated.
  • Diseases other than cancer caused by these risk factors were not counted.
  • The exposure surveys had no data for painters. The substitute method, based on a single job category, gave a low value of exposure prevalence.

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Mesothelioma, Crystalline, Lung Cancer.

Related studies

• An estimate of cancers attributable to occupational exposures in France — P. Boffetta, P. Autier, et al. (2010)
• Cancers in France in 2015 attributable to occupational exposures — C. Marant Micallef, K.D. Shield, et al. (2019)
• Estimated number of cancers attributable to occupational exposures in France in 2017: an update using a new method for improved estimates — C. Marant Micallef, H. Charvat, et al. (2023)
• Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis — C. Chouaid, J.B. Assié, et al. (2018)
• Medical costs of cancer attributable to work in the Basque Country (Spain) in 2008 — M. García Gómez, R. Castañeda López, et al. (2013)
• Respiratory cancer in relation to occupational exposures among retired asbestos workers — P. Enterline, P. de Coufle, et al. (1973)

Browse return to medical research.