The Cost Outcome Pathway framework: Integrating socio-economic impacts to Adverse Outcome Pathways for supporting policy makers

The Adverse Outcome Pathway (AOP) concept leverages existing data to formalize and disseminate knowledge and is a well-accepted concept in chemical risk assessment. However, it does not handle the socio-economic impact that environmentally-induced diseases may generate, which might be highly relevant for risk management and prioritization. Here, we propose to connect the AOP framework by bridging an Adverse Outcome (AO) to Cost Outcomes (CO) creating so-called Cost Outcome Pathways (COPs) for including the socio-economic costs of exposure to chemicals into the AOP framework. Exposures to certain classes of chemicals have been linked to loss of intellectual quotient (IQ) points in children. This may lead to healthcare costs and reduced working productivity and contribute to increasing the substantial socio-economic burden worldwide. As an in silico case study, a new COP related to neurodevelopmental toxicity was designed, with a connection between the AO 'decreased, IQ' and an umbrella CO 'increased, socio-economic burden'. This framework can support policymaking in the public health sector and might also hold great potential for other environmental exposure-related diseases such as cancer, obesity or neurodegeneration, which are diseases known to have detrimental socio-economic impacts.