Table 8.

Incident breast cancer cases yearly attributable to nitrogen dioxide (${\mathrm{NO}}_2$) exposure in France and related economic costs (in millions of 2019 Euros), depending on the considered counterfactual situation.

Counterfactual situationa	Attributable to $\mathrm{N}{\mathrm{O}}_2$ exposureb			Related economic costs $[€(\text{millions}\left)\right]$
	Count (95% CI)	Incidencec (95% CI)	% Baselined (95% CI)	Cost component	Amount (low, high)e
Compliance with the WHO guideline value	3 (1, 5)	0.09 (0.02, 0.16)	0.01% (0.00, 0.01)	All costs	1.43 (0.99, 1.87)
				Intangible costs	1.26 (0.84, 1.68)
				Direct tangible costs	0.14 (0.13, 0.15)
				Indirect tangible costs	0.03 (0.02, 0.03)
Low pollution level	1,677 (374, 2,914)	51.1 (11.4, 88.7)	3.15% (0.70, 5.48)	All costs	825 (570, 1,080)
				Intangible costs	729 (486, 972)
				Direct tangible costs	80.7 (73.8, 87.6)
				Indirect tangible costs	14.9 (9.91, 19.8)
Low pollution level within the same urbanization degree areas	1,331 (296, 2,319)	40.5 (9.01, 70.6)	2.50% (0.56, 4.36)	All costs	654 (452, 857)
				Intangible costs	579 (386, 771)
				Direct tangible costs	64.0 (58.5, 69.5)
				Indirect tangible costs	11.8 (7.86, 15.7)
Pollutant concentration levels ${1\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$ lower than baseline	121 (27, 213)	3.68 (0.81, 6.49)	0.23% (0.05, 0.40)	All costs	59.4 (41.0, 77.7)
				Intangible costs	52.5 (35.0, 70.0)
				Direct tangible costs	5.81 (5.31, 6.31)
				Indirect tangible costs	1.07 (0.71, 1.43)

^Note: Based on the meta-analytical relative risk corrected for publication bias of 1.023 (1.005, 1.041) by $10\text{-}{\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$ increase in ${\mathrm{NO}}_2$ exposure. Note: CI, confidence interval; WHO, World Health Organization.

^aCurrent WHO guideline value: ${40\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$ for ${\mathrm{NO}}_2$; “low pollution level”: defined as the fifth percentile of concentrations at the French territory scale (i.e., $6{.3\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$ for ${\mathrm{NO}}_2$ in 2013); “low pollution level within the same urbanization degree areas”: defined as the fifth percentile of concentrations within areas of the same degree of urbanization (i.e., 12.3, 8.9, and $4{.7\mathrm{\mu }\mathrm{g}/\mathrm{m}}^3$ for ${\mathrm{NO}}_2$ in 2013 in “Cities,” “Towns and suburbs,” and “Rural areas,” respectively), according to the DEGURBA index provided for each municipality by the European statistical office of the European Commission (latest update: 2011; see Figure S1).

^bIn 2013, based on the modeled air pollutant concentration data.

^cFor 1 million person-years.

^dProportion (%) of the baseline annual new breast cancer cases, based on the regional incidence data provided by the National Institute for Cancer (INCa) over the 2007–2016 period.

^eRegarding intangible and indirect tangible costs, low–high intervals are based on the uncertainty range of $\pm 33\%$ applied to the value of a life-year (VOLY) and to the value of a workday in Aphekom project, respectively (Chanel 2011); regarding direct tangible costs, they are based on the 95% CI of the treatment cost estimates for breast cancer (Cortaredona and Ventelou 2017).