Evaluation and equity audit of the domestic radon programme in England.

The U.K. has a radon programme to limit the radon risk to health. This involves advice on protective measures in new buildings, technical guidance on their installation, encouragement of radon measurements and remediation in existing dwellings in high radon areas. We have audited the radon programme at the level of individual homes to identify factors that influence the likelihood of remediation. 49% of the householders responded to our survey and 30% of the respondents stated that they had done some remediation to reduce the indoor radon levels. We found that householders with higher incomes and higher socio-economic status are more likely than others to remediate. Householders are less likely to remediate if they have one of the following: living in a property with a high radon concentration, current smokers in the dwelling, being unemployed or an unskilled worker, long length of time living in that property or elderly (65+ years) living by themselves. Householders appeared to be more likely to remediate if they considered the information on radon and its risk to be very clear and useful. This emphasises the importance of communication with householders.

A critical evaluation of the cost-effectiveness of radon protection methods in new homes in a radon affected area of England.

In the UK, building new homes in areas prone to radon gas is currently subject to regulations that require installation of radon-proof membranes. These membranes are not, however, the only way to protect residents of new homes against radon's potential to cause lung cancer. Alternative regulatory regimes can be constructed that would achieve the same end. The purpose of this paper is to examine the cost-effectiveness of four alternative regimes and so determine if building regulations for new homes could be altered to protect residents from the effects of radon more cost-effectively than at present. In addressing this question, the paper also contributes to the wider debate on how best to reduce the effect on public health of exposure to radon. The measure of cost-effectiveness used, cost per quality-adjusted life-year gained, is determined from radon test results obtained in properties in Brixworth, England, UK, a radon Affected Area. Confidence intervals for the cost-effectiveness estimates are also derived using bootstrap techniques. The central estimates of cost-effectiveness range from 2870 pounds per quality-adjusted life-year gained for the most cost-effective of the alternative regimes to 6182 pounds for the current regime. These results suggest that alternative regimes may be more cost-effective in tackling the radon problem. A definitive assessment of the most suitable to adopt will require extensive negotiation between government departments, the construction industry, and other interested parties to ensure acceptance of any new regime. The paper offers suggestions for future research that should help in the process of identifying the key features of a new regulatory approach.

A cost-effectiveness analysis of radon protection methods in domestic properties: a comparative case study in Brixworth, Northamptonshire, UK.

Building regulations in the UK have since 1992 required that radon-proof membranes be installed in new domestic properties to protect residents against the adverse effects of radon. This study compares the cost-effectiveness of the current regulatory regime with an alternative that would entail new properties being tested for radon after construction, and being remediated if necessary. The alternative regime is found to be more cost-effective for a sample of properties in Brixworth, Northamptonshire, UK. For this regime, the central estimate of cost per quality-adjusted life-year gained, the measure of cost-effectiveness used, is 2869 pounds compared to 6182 pounds for installing membranes, results suggesting a case for re-examining the current regulations on radon protection in new properties. Pilot studies will, however, be needed to consider how different means of protecting residents of new properties against radon might operate in practice and to provide improved evidence on their relative cost-effectiveness.

A new methodology for cost-effectiveness studies of domestic radon remediation programmes: quality-adjusted life-years gained within primary care trusts in central England.

Radon is a naturally occurring radioactive gas, high levels of which are associated with geological formations such as those found in Northamptonshire and North Oxfordshire in the UK. The UK's National Radiological Protection Board have designated both districts as radon Affected Areas. Radiation levels due to radon, therefore, exceed 200 Bq m(-3), the UK's domestic Action Level, in over one percent of domestic properties. Because of radon's radioactivity, exposure to the gas can potentially cause lung cancer, and has been linked to some 2000 deaths a year in the UK. Consequently, when radiation levels exceed the Action Level, remediation against radon's effects is recommended to householders. This study examines the cost-effectiveness of remediation measures in Northamptonshire and North Oxfordshire by estimating cost per quality-adjusted life-year gained in four Primary Care Trusts, organisations that play a key public health policy role in the UK's National Health Service. The study is the first to apply this approach to estimating the cost-effectiveness of radon remediation programmes. Central estimates of cost per quality-adjusted life-year in the four Primary Care Trusts range from 6143pounds to 10323pounds. These values, when assessed against generally accepted criteria, suggest the remediation programmes in the trusts were cost-effective. Policy suggestions based on the estimates, and designed to improve cost-effectiveness further, are proposed for the four Primary Care Trusts and the UK's National Health Service.

A critical comparison of the cost-effectiveness of domestic radon remediation programmes in three counties of England.

Radon remediation programmes in domestic dwellings were carried out in five areas, from three counties of England, and the total costs obtained. A single company, which abided by the Code of Practice of the Radon Council of Great Britain, carried out the remediation. The dose savings from the programmes were calculated and used to estimate the number of lung cancers averted. The data obtained allowed the cost-effectiveness of the remediation programmes in each area to be calculated. The remediation programmes in three areas (Northants 2, 3 and North Oxfordshire) were cost-effective whereas those in two areas (Northants 1 and North Somerset) were not. To be cost-effective, the Northants I and North Somerset areas would need to increase the number of householders that carried out remediation, if they were over the UK Action Level. Health policy makers should concentrate their resources on communities in areas where there is a significant proportion of dwellings above the UK Action Level and where the number of properties being remediated is low.

Cost effectiveness analysis of radon remediation programmes.

The economic implications of regulations governing radon gas level identification and remediation in buildings are poorly understood, and attempts to address these issues have been criticised for lack of comparability. It is imperative therefore that a general model for the economic evaluation of radon remediation programmes is adopted to ensure comparability between studies and settings and to increase the usefulness of the results to decision makers. This paper presents general guidelines for the use of cost-effectiveness analysis (CEA) as an economic appraisal tool in the evaluation of radon reduction and prevention programmes. The data requirements for a CEA of radon remediation programmes concern both costs and outcomes. These components are discussed with respect to: programme objectives, comparator choice, perspective, time horizon, discounting, uncertainty, and final ratios. Adhering to clear guidelines concerning these aspects of evaluations will facilitate meaningful evaluation of radon remediation programmes. Finally, by evaluating the radon remediation programmes using methods applied to other health interventions (such as lung cancer prevention interventions), comparisons using the same metric can be made across policy areas.

The cost-effectiveness of radon mitigation in schools in Northamptonshire.

A comprehensive radon survey of 2372 rooms in 348 Northamptonshire schools is reported, together with results of the successful mitigation of the raised radon levels found in 20 schools. From analysis of the occupancy of affected rooms and the costs of remediation a total cost of 19,400 Pounds per man-sievert saved annually was derived. This is around four times more cost-effective than the radon remediation in Health Service premises in Northamptonshire, and slightly more cost-effective than a domestic programme where all householders with radon levels above the Action Level carry out remediation. As only a small percentage of householders undertook remediation, a schools' remediation programme is the most cost-effective programme to reduce radon in an Affected Area.

A review of the cost effectiveness of radon mitigation in domestic properties in Northamptonshire.

The costs of remedial work, and the radon level reduction achieved, have been studied in a series of domestic properties in Northamptonshire, which is a radon affected area. The cost-effectiveness of the series is similar to published theoretical estimates for proposed national remediation programmes, and five times more effective than our similar analysis for the National Health Service workplace, if it is assumed that 100% of householders discovering levels above 300 Bq m-3 implement remediation. In practice, in the UK, far fewer of those who arrange an initial radon test proceed to remediation, but this domestic programme could be cost effective if more than 5% carry out remediation. Our series confirms that a considerable number of householders with radon levels in the 200 to 300 Bq m-3 range do not seek or implement remediation work.

Importance of radon as a threat to public health.

Since the discovery of x rays, the public has shown increasing concern about exposure to radiation. In the mid-1980s, with the dissemination of information about the ubiquitous nature of radon, this concern about radiation exposure has taken on a new perspective. As the general public realizes that exposure to radiation is an unavoidable part of life, questions arise as to how much exposure is acceptable when weighed against the costs of reducing the exposure. Because limited resources are available to protect the public's health and the environment, these resources need to be used wisely. The cost-effectiveness of the various options to lessen the potential adverse health effects from radon must be considered.

Regulatory control of indoor Rn.

Regulation of indoor Rn is explored in the context of cost-effectiveness of regulatory action. Evaluation of cost (i.e., mitigation expenses) and benefits (i.e., savings associated with medical expenses and lost productivity related to lung cancer) at various action levels indicate that regulatory programs would be economically inefficient and unreasonable if standards were established at or below the current EPA action guide (150 Bq m-3 or less). For the approximately 95% of U.S. homes with Rn levels near or below 150 Bq m-3, government programs should continue to focus on public information and consumer protection. For the small number of homes with high Rn levels, government programs should focus on identifying high risk homes and encouraging homeowners to reduce Rn levels. Because of the potential for substantial risk reduction, such efforts would be cost-effective in these homes.

Cost evaluation of control measures for indoor radon progeny.

Based on assumed conditions within a typical U.S. home, annualized costs for reducing indoor airborne radon progeny concentrations have been calculated for a variety of methods of control. These analyses were limited to methods for control in existing homes. Control through modified construction techniques was not evaluated. Methods assessed included increased air circulation, increased ventilation, particle removal using electrostatic precipitation and unipolar ion generation, and the application of sealants to room surfaces. Although surface sealants proved to be reasonably cost-effective per person- sievert dose reduction, such sealants are prone to cracking and the durability of their effectiveness is questionable. Use of ceiling fans for increased air circulation and particle deposition appears to be least cost-effective, but this method may be attractive in some cases for reasons of comfort. The use of unipolar ion generators appears to be the best approach from the standpoint of cost effectiveness. These devices are also easy to install and are esthetically readily acceptable.