Cost-effectiveness analysis of radon remediation in schools

Indoor radon is an important source of radiation dosage in the general population and has been recognised as a world-wide environmental and public health challenge. Governments in many Western and Eastern European and North American countries are undertaking active radon-risk reduction policies, including the remediation of existing residential and work place building stocks (1). These endeavours include a priority of remediating school buildings. Epidemiological and technical radon research has produced information which has enabled attention to be turned to specific effectiveness and optimisation questions regarding radon identification and remediation programmes in buildings, including schools. Decision making about policy implementation has been an integral part of these programmes and questions have been raised about the economic implications of the regulations and optimisation strategies for workplace action level policy (2,3). (the action level applied to schools is 400 Bq m-3). No previous study has estimated the cost-effectiveness of a radon remediation programme for schools using the methodological framework now considered appropriate in the economic evaluation of health interventions. It is imperative that this should be done, in order that the resources required to obtain health gain from radon remediation in schools can be systematically compared with equivalent data for other health interventions and radon remediation programmes. In this study a cost-effectiveness analysis of radon remediation in schools was undertaken, using the best available national data and information from Northamptonshire on the costs and effectiveness of radon identification and remediation in schools, and the costs and health impact of lung cancer cases. A model based on data from Northamptonshire is presented (where 6.3% of residential stock is over 200 Bq m-3). The resultant cost-effectiveness ratio was pound 7,550 per life year gained in pound 1997. Results from the sensitivity analysis show that the ratio is particularly sensitive to assumptions of two parameters including: the average capital cost of remediation and the discount rates chosen for the life yells. The overall model presented in this study can be applied to any other area, and alternative regional parameter estimates can be substituted if these are available. As the sensitivity analysis shows, however, remediation is likely to prove cost-effective even if these parameter estimates are substantially different. These results should help to inform further discussion of policy setting for radon remediation in various settings. It provides an empirical example of the type of economic analysis encouraged by both the UK NRPB (1986) and the ICRP (1983). General information on the average costs of remediation and potential savings to the health care system will be helpful as increasing numbers of local authorities start planning remediation programmes for the schools under their care. This study also highlights the need for the evaluation of other schools remediation-based radon-induced lung cancer prevention programmes in other countries using similar methodological techniques. (author)