A cost-effectiveness analysis of lowering residential radon levels in Sweden—Results from a modelling study

Evolutionary game analysis of indoor radon mitigation with local government involvement

Radon is the second leading risk factor for lung cancer after smoking. As a public policy, radon mitigation not only involves radon control technology or its cost-benefit analysis, but also includes the decision-making process of local governments. In this study, the evolutionary game theory was used to analyse the interaction between local governments and residents based on the subsidy of the central government. Considering the practical data in China, factors influencing the behaviour of local governments and residents were discussed using numerical simulations. The results indicated that radon mitigation is a fully government-promoted action; thus, its implementation largely depends on the subsidy of the central government and the share of radon control costs borne by the local government. The financial burden for both local governments and residents is a more important determinant than long-term health effects. The relatively poor local economic situation could limit the implementation of radon control. There would be a public policy paradox wherein cities or regions with higher radon risk would have lower willingness for radon control, mainly due to the significantly higher costs of radon control. This work provides reference data for decision-making to implement radon control and is expected to offer some suggestions for local governments.

Lung cancer incidence attributable to residential radon exposure in Finland

This study aimed to estimate (1) the number of avoidable lung cancer cases attributable to residential radon in Finland in 2017, separately by age, sex, dwelling type and smoking status, (2) the impact of residential radon alone and the joint effect of residential radon and smoking on the number of lung cancers and (3) the potential decrease in the number of radon-attributable lung cancers if radon concentrations exceeding specified action levels (100, 200 and 300 Bq m^-3) would have been mitigated to those levels. Population-based surveys of radon concentrations and smoking patterns were used. Observed radon levels were contrasted with 25 Bq m^-3 representing a realistic minimum level of exposure. Lung cancer risk estimates for radon and smoking were derived from literature. Lastly, the uncertainty due to the estimation of exposure and risk was quantified using a computationally derived uncertainty interval. At least 3% and at most 8% of all lung cancers were estimated as being attributable to residential radon. For small cell carcinoma, the proportion of cases attributable to radon was 8-13%. Among smokers, the majority of the radon-related cases were attributable to the joint effect of radon and smoking. Reduction of radon exposure to 100 Bq m^-3 action level would eliminate approximately 30% of radon-attributable cases. Estimates were low compared with the literature, given the (relatively high) radon levels in Finland. This was mainly due to the lower radon levels and higher smoking prevalence in flats than in houses and a more realistic point of comparison, factors which have been ignored in previous studies. The results can guide actions in radon protection and in prevention of lung cancers.

Characterization of Colorado residents and radon reduction behaviors through latent class analysis and path models

Radon is a naturally occurring radioactive gas that enters homes through cracks in the foundation where accumulated levels can cause lung cancer. Within the United States (U.S.), state level radon reduction strategies rely on education and outreach to motivate people to test and mitigate their home. Only about 5% of the housing units in Colorado, U.S. have been tested for radon. This study looks at the 2012 Behavioral Risk Factors Surveillance System (BRFSS) in Colorado to identify distinct groups of people using Latent Class Analysis, and compares radon awareness, testing, and mitigation to understand underlying differences of radon reduction behaviors using path models. Five classes were identified: 1) Wealthy Young Families, 2) Older Singles, 3) Empty Nesters, 4) Smokers, and 5) Struggling Young Families. Significant differences in responses to radon survey questions existed across groups in which Struggling Young Families were the least likely to be aware of radon, have tested their home for radon, and have their home mitigated. Average radon awareness, testing, and mitigation appeared to be influenced by financial stress. Results from this study can be used to tailor future radon interventions and policy initiatives to enhance equity of radon reduction behaviors including legal framework to ensure radon mitigation takes place in rental properties.

Cost-effectiveness analysis to assess the protection of workers from exposure to radon at work: A first application to Italian retail shops

For the implementation of the requirements in the Council Directive 2013/59/Euratom (2013 EUBSS), the cost-effectiveness analysis (CEA) is generally considered a useful tool to compare different radon policies aimed at reducing radon exposure both at home and at work. In the framework of the EU funded RADPAR project, a methodology to perform CEA analysis of radon control in dwellings was developed - and used also for WHO's radon recommendations of 2009 - and it is based on the evaluation of the health effectiveness in terms of life years and/or QALYs (Quality Adjusted Life Years) gained. In this work, starting from the RADPAR model used for dwellings, a so-called RADPAR4workplaces model was developed to carry out CEA focused on reduction of radon exposure at workplaces. In particular, different radon policies in existing workplaces were considered and their cost-effectiveness were estimated, as a case study, for the Italian retail shops located at ground floor. Main results show that a policy that requires remedial actions where radon concentration is above a certain reference level (RL) and that recommends them also below this RL has a good cost-effectiveness ratio and it is more effective than a policy with no provisions for radon levels below RL. In particular, the further implementation of remediation below RL improves the health effectiveness increasing QALYs gained of 20% while cost per QALY increases of only 14%. Finally, promoting the remediation of workplaces below RL, QALYs gained and cost per QALY increase of about 80% and 20%, respectively, if remediation rate rises from 10% to 50% below RL.

Regional cost effectiveness analyses for increasing radon protection strategies in housing in Canada

The incremental cost effectiveness ratios for implementing a recent recommendation to install a more radon resistant foundation barrier were modelled for new and existing housing in 2016, for each province and territory in Canada. Cost-utility analyses were conducted, in which the health benefit of an intervention was quantified in quality-adjusted life years, to help guide policymakers considering increasing investment in radon reduction in housing to reduce the associated lung cancer burden shouldered by the health care system. Lung cancer morbidity was modelled using a lifetable analysis that incorporated lung cancer incidence and survival time for localized, regional, and distant stages of diagnoses for both non-small cell and small cell lung cancer. The model accounted for surgical or advanced lung cancer treatment costs avoided, and average health care costs incurred for radon-attributable lung cancer cases prevented by the intervention. The incremental implementation of radon interventions in the housing stock was modelled over a lifetime horizon, and a discount rate of 1.5% was adopted. This radon intervention in new housing was cost effective in all but one region, ranging from $18,075/QALY (15,704; 20,178) for the Yukon to $58,454/QALY (52,045; 65,795) for British Columbia. A sequential analysis was conducted to compare intervention in existing housing for mitigation thresholds of 200 and 100 Bq/m³. This intervention in existing housing was cost effective at a mitigation threshold of 200 Bq/m³ in regions with higher radon levels, ranging from $33,247/QALY (27,699; 39,377) for the Yukon to $61,960/QALY (46,932; 113,737) for Newfoundland, and more cost effective at a threshold of 200 than 100 Bq/m³. More lung cancer deaths can be prevented by intervention in new housing than in existing housing; it was estimated that the proposed intervention in new housing would prevent a mean of 446 (416; 477) lung cancer cases annually. The cost effectiveness of increased radon resistance in foundation barriers in housing varied widely, and would support adopting this intervention in new housing across Canada and in existing housing in higher radon regions. This study provides further evidence that the most cost effective way of responding to the geographically variable radon burden is by implementing specific regional radon reduction policies.

An assessment of uncertainty using two different modelling techniques to estimate the cost effectiveness of mitigating radon in existing housing in Canada

The burden of lung cancer associated with residential radon in existing housing can be reduced by interventions to screen and mitigate existing housing having radon levels above a mitigation threshold. The objective of this study is to estimate the cost effectiveness of radon interventions for screening and mitigation of existing housing for the 2016 population in Canada and to assess the structural uncertainty associated with the choice of model used in the cost-utility analysis. The incremental cost utility ratios are estimated using both a Markov cohort model and a discrete event simulation model. A societal perspective, a lifetime horizon and a discount rate of 1.5% are adopted. At a radon mitigation threshold of 200 (100) Bq/m³, the discounted ICERs for current rates of screening and mitigation of existing housing are 72,569 (68,758) $/QALY using a Markov cohort model and 84,828 (76,917) $/QALY using discrete event simulation. It appears that minimal structural uncertainty is associated with the choice of model used for this cost-utility analysis, and the cost effectiveness would improve at increased rates of radon testing and mitigation. The mitigation of radon in existing housing is estimated to be a practical policy option for reducing the associated lung cancer burden in Canada.

A cost effectiveness analysis of interventions to reduce residential radon exposure in Canada

The objective of this analysis is to estimate the incremental cost effectiveness ratios for the 2012 populations in Canada, each province/territory, and 17 census metropolitan areas, for practical radon mitigation scenarios to reduce residential radon exposures. Sixteen intervention scenarios compare radon mitigation implemented at differing rates in new and existing housing relative to preventive measures installed at construction, using three different radon mitigation thresholds. A period life-table analysis was conducted using data derived from two recent Canadian radon surveys, along with Canadian mortality and quality of life data. Analyses adopted a lifetime horizon and a discount rate of 1.5%. It is practical to reduce residential radon and associated lung cancer mortality in Canada, and the most cost effective scenario at each radon mitigation threshold is the combination of the activation of the preventive measures in new housing and mitigation of existing housing.