Lung cancer deaths from indoor radon and the cost effectiveness and potential of policies to reduce themBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.a3110 (Published 07 January 2009) Cite this as: BMJ 2009;338:a3110
- Alastair Gray, professor of health economics1,
- Simon Read, analyst and programmer2,
- Paul McGale, statistician2,
- Sarah Darby, professor of medical statistics2
- 1Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford OX3 7LF
- 2Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford
- Correspondence to: A Gray
- Accepted 17 December 2008
Objective To determine the number of deaths from lung cancer related to radon in the home and to explore the cost effectiveness of alternative policies to control indoor radon and their potential to reduce lung cancer mortality.
Design Cost effectiveness analysis.
Setting United Kingdom.
Data sources Epidemiological data on risks from indoor radon and from smoking, vital statistics on deaths from lung cancer, survey information on effectiveness and costs of radon prevention and remediation.
Main outcome measures Estimated number of deaths from lung cancer related to indoor radon, lifetime risks of death from lung cancer before and after various potential interventions to control radon, the cost per quality adjusted life year (QALY) gained from different policies for control of radon, and the potential of those policies to reduce lung cancer mortality.
Results The mean radon concentration in UK homes is 21 becquerels per cubic metre (Bq/m3). Each year around 1100 deaths from lung cancer (3.3% of all deaths from lung cancer) are related to radon in the home. Over 85% of these arise from radon concentrations below 100 Bq/m3 and most are caused jointly by radon and active smoking. Current policy requiring basic measures to prevent radon in new homes in selected areas is highly cost effective, and such measures would remain cost effective if extended to the entire UK, with a cost per QALY gained of £11 400 ( €12 200; $16 913). Current policy identifying and remediating existing homes with high radon levels is, however, neither cost effective (cost per QALY gained £36 800) nor effective in reducing lung cancer mortality.
Conclusions Policies requiring basic preventive measures against radon in all new homes throughout the UK would be cost effective and could complement existing policies to reduce smoking. Policies involving remedial work on existing homes with high radon levels cannot prevent most radon related deaths, as these are caused by moderate exposure in many homes. These conclusions are likely to apply to most developed countries, many with higher mean radon concentrations than the UK.
We thank colleagues in the Health Economics Research Centre and the Clinical Trial Service Unit, members of the Committee on Medical Aspects of Radiation in the Environment, members of the Radon Subgroup of the Health Protection Agency’s Independent Advisory Group on Ionising Radiation and its reviewers, and staff of the Health Protection Agency’s Radiation Protection Division for helpful comments.
Contributors: SD and AG had the original idea for this study. SD and PMcG designed the methodology for calculating the number of deaths from radon related lung cancer, which was carried out by PMcG. AG and SD designed the economic modelling, which was carried out by AG and SR. SD, AG and SR designed the analysis to estimate the numbers of deaths from lung cancer that would be averted by various radon policies, which was carried out by SR. AG and SD wrote the report with input from SR and PMcG. All authors reviewed and approved the final report. AG and SD are the guarantors.
Funding: This work was supported by Cancer Research UK [grant Nos C500/A10573, A10293], the Medical Research Council [grant No E270/4], the European Commission sixth framework programme (project: alpha risk grant No 516483 (FI6R)), and the National Institute for Health Research. The funders had no role in the design of the study, carrying out the analysis, or the decision to submit for publication.
Competing interests: None declared.
Ethical approval: Not required.
Provenance and peer review: Not commissioned; externally peer reviewed.
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