Use of quality-adjusted life year weights with dose-response models for public health decisions: A case study of the risks and benefits of fish consumption

Risks associated with toxicants in food are often controlled by exposure re duction. When exposure recommendations are developed for foods with both ha rmful and beneficial qualities. however, they must balance the associated r isks and benefits to maximize public health. Although quantitative methods are commonly used to evaluate health risks, such methods have not been gene rally applied to evaluating the health benefits associated with environment al exposures. A quantitative method for risk-benefit analysis is presented that allows for consideration of diverse health endpoints that differ in th eir impact (i.e., duration and severity) using dose-response modeling weigh ted by quality-adjusted life years saved. To demonstrate the usefulness of this method, the risks and benefits of fish consumption are evaluated using a single health risk and health benefit endpoint. Benefits are defined as the decrease in myocardial infarction mortality resulting from fish consump tion, and risks are defined as the increase in neurodevelopmental delay (i. e., talking) resulting from prenatal methylmercury exposure. Fish consumpti on rates are based on information from Washington State. Using the proposed framework, the net health impact of eating fish is estimated in either a w hole population or a population consisting of women of childbearing age and their children. It is demonstrated that across a range of fish methylmercu ry concentrations (0-1 ppm) and intake levels (0-25 g/day), individuals wou ld have to weight the neurodevelopmental effects 6 times more (in the whole population) or 250 times less (among women of child-bearing age and their children) than the myocardial infarction benefits in order to be ambivalent about whether or not to consume fish. These methods can be generalized to evaluate the merits of other public health and risk management programs tha t involve trade-offs between risks and benefits.