The Cost Outcome Pathway Framework: Integrating socio-economic impacts to Adverse Outcome Pathways

Several chemical’s families are linked to a loss of intellectual quotient (IQ) points in children. This may lead to reduced working productivity and/or lower wages in adulthood and contribute to increasing the substantial socio-economic burden worldwide. The Adverse Outcome Pathway (AOP) concept, that leverages existing data to formalize knowledge, is a well-accepted concept in risk assessment although it does not handle the socio-economic impact that environment-induced diseases may generate. Here, we propose to extend the AOP framework by bridging an adverse outcome (AO) to a cost outcome (CO) creating so-called Cost Outcome Pathways (COPs) for including the socio-economic costs of exposure to chemicals. As a case study, a COP related to neurodevelopmental toxicity was designed, with a connection between the AO ‘decreased, IQ’ and the CO ‘increased, socio-economic burden’. For support to policymaking in the public health sector, this framework might also hold great potential for environmental exposure-related diseases such as cancer or obesity which are diseases with known detrimental socio-economic impacts. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement French Ministries for an Ecological Transition, for Agriculture and Food, for Solidarity and Health and of Higher Education, Research and Innovation (Ecophyto II+ plan) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript and supplementary materials