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 per quality-adjusted life-year gained for the most cost-effective of the alternative regimes to £6182 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.     

The cost-effectiveness of residential radon remediation programmes: assumptions about benefits stream profiles over time

A recent cost-effectiveness analysis of a residential radon remediation programme considered and highlighted many areas of uncertainty in the parameters chosen for the analysis. One assumption not challenged in the study was the benefits stream profile adopted. There are several different ways of loading the benefits in terms of life years into the cost-effectiveness model and several of these are explored and the results are reported in this study. The benefits profile depends upon the lead-time to cancer manifestation post environmental carcinogen (radon) exposure. The literature reviewed suggests that there are many options for loading benefits to radon-induced lung cancer prevention programmes. In this study, the alternative benefits stream profiles are explored and their implications for the cost-effectiveness ratio are examined. Adopting different benefits stream profiles to the model results in a range of cost-effectiveness ratios from 14912.90 pounds per life year gained to 52416.27 pounds per life year gained. The preferred model is reported where the life years gained are assumed to be equally distributed over the last 15 years of the 40-year time horizon of the analysis (Y25-40) and the corresponding cost-effectiveness ratio is 37,943 pounds per life year gained.     

Lung-cancer reduction from smoking cessation and radon remediation: a preliminary cost-analysis in Northamptonshire, UK

Domestic radon levels in parts of the United Kingdom are sufficiently high as to increase the risk of lung-cancer among residents. Public health campaigns in the county of Northamptonshire, a designated radon Affected Area with 6.3% of homes having average radon levels in excess of the UK Action Level of 200 Bq m(-3), have encouraged householders to test for radon and then, if indicated to be necessary, to carry out remediation in their homes. These campaigns have been only partially successful, since to date only 40% of Northamptonshire houses have been tested, and only 15% of those householders finding raised levels have proceeded to remediate. Those who remediate have been shown to have smaller families, to be older, and to include fewer smokers than the average population, suggesting that current strategies to reduce domestic radon exposure are not reaching those most at risk. During 2004-2005, the NHS Stop-Smoking Services in Northamptonshire assisted 2847 smokers to quit to the 4-week stage, the 15% (435) of these 4-week quitters remaining quitters at 1year forming the subjects of a retrospective study considering whether smoking cessation campaigns contribute significantly to radon risk reduction. Quantitative assessment of the risk of lung-cancer among the study population, from knowledge of the individuals' age, gender, and smoking habits, together with the radon levels in their homes, demonstrates that smoking cessation programmes have significant added value in reducing the incidence of lung-cancer in radon Affected Areas, and contribute a substantially greater health benefit at a lower cost than the alternative strategy of reducing radon levels in the smokers' homes, while they remain smokers. Both radon remediation and smoking cessation programmes are very cost effective in Northamptonshire, with smoking cessation being significantly more cost effective, and these are potentially valuable programmes to drive health improvements through promotion of the uptake or environmental management for radon in the home.     

The cost effectiveness of radon reduction programmes in domestic housing in England and Wales: The impact of improved radon mapping and housing trends

In the UK, excessive levels of radon gas have been detected in domestic housing. Areas where 1% of existing homes were found to be over the Action Level of 200 Bq · m^− 3 were declared to be Radon Affected Areas. Building Regulations have been introduced which require that, for areas where between 3% and 10% of existing houses are above the Action Level, new homes should be built with basic radon protection using a membrane, and that, where 10% or more of existing homes exceed this level, new homes should be built with full radon protection.Initially these affected areas followed administrative boundaries, known as Counties. However, with increasing numbers of measurements of radon levels in domestic homes recorded in the national database, these areas have been successively refined into smaller units – 5 km grid squares in 1999, down to 1 km grid squares in 2007.One result is the identification of small areas with raised radon levels within regions where previously no problem had been identified. In addition, some parts of areas that were previously considered radon affected are now considered low, or no, risk. Our analysis suggests that the net result of improved mapping is to increase the number of affected houses. Further, the process is more complex for local builders, and inspectors, who need to work out whether radon protection in new homes is appropriate.Our group has assessed the cost-effectiveness of radon remediation programmes, and has applied this analysis to consider the cost-effectiveness of providing radon protection in both new and existing homes. This includes modelling the potential failure rate of membranes, and whether testing radon levels in new homes is appropriate. The analysis concludes that it is more cost effective to provide targeted radon protection in high radon areas, although this introduces more complexity.The paper also considers the trend in housing to a greater proportion of apartments, the regional variations in types of housing and the decreasing average number of occupants in each dwelling, and concludes that data and methods are now available to respond to the health risks of radon at a local level, in keeping with a general initiative to prioritise responses to health and social welfare issues at a more local level.     

Radon mitigation in domestic properties and its health implications--a comparison between during-construction and post-construction radon reduction

Although United Kingdom (UK) Building Regulations applicable to houses constructed since 1992 in Radon Affected Areas address the health issues arising from the presence of radon in domestic properties and specify the installation of radon-mitigation measures during construction, no legislative requirement currently exists for monitoring the effectiveness of such remediation once construction is completed and the houses are occupied. To assess the relative effectiveness of During-Construction radon reduction and Post-Construction remediation, radon concentration data from houses constructed before and after 1992 in Northamptonshire, UK, a designated Radon Affected Area, was analysed. Post-Construction remediation of 73 pre-1992 houses using conventional fan-assisted sump technology proved to be extremely effective, with radon concentrations reduced to the Action Level, or below, in all cases. Of 64 houses constructed since 1992 in a well-defined geographical area, and known to have had radon-barrier membranes installed during construction, 11% exhibited radon concentrations in excess of the Action Level. This compares with the estimated average for all houses in the same area of 17%, suggesting that, in some 60% of the houses surveyed, installation of a membrane has not resulted in reduction of mean annual radon concentrations to below the Action Level. Detailed comparison of the two data sets reveals marked differences in the degree of mitigation achieved by remediation. There is therefore an ongoing need for research to resolve definitively the issue of radon mitigation and to define truly effective anti-radon measures, readily installed in domestic properties at the time of construction. It is therefore recommended that mandatory testing be introduced for all new houses in Radon Affected Areas.     

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.     

Health implications of radon distribution in living rooms and bedrooms in U.K. dwellings--a case study in Northamptonshire

Environmental radon exposure of residents of domestic premises in the United Kingdom (UK) and elsewhere in Europe is estimated on the basis of the measured radon concentrations in, and the relative occupancies of, the principal living room and bedroom. While studies on radon concentration variability in the individual units in apartment blocks in various countries have been described, little data has been reported on variability in two-storey single-family dwellings, and the majority of extant studies consolidate living room and bedroom data early in the analysis. To investigate this further, detailed analysis was made of radon concentration data from a set of thirty-four homes situated in areas of Northamptonshire known to exhibit high radon levels. All homes were of typical UK construction of brick/block/stone walls under a pitched tile/slate roof. Approximately 50% of the sample were detached houses, the remainder being semi-detached (duplex) or terraced (row-house). Around 25% of the sample possessed cellars, while 12% were single-storey dwellings (bungalows), reflecting the typical incidence of this type of dwelling in England. In the two-storey homes, all monitored bedrooms were on the upper floor. Distribution of the ratios of bedroom/living room radon concentrations (BR/LR ratio) in individual properties was left-skewed (mean 0.67, median 0.73, range 0.05-1.05) with a tail extending to just above 1.0. The mean is consistent with the outcome of earlier extensive studies in England, while the variability depends principally on the characteristics of the property, and not on seasonal factors. In a small set of homes, the BR/LR ratio was anomalously low, (mean 0.3). BR/LR ratios in single-storey homes clustered around a value of 1.0, indicating that house design, rather than lifestyle, is the dominant factor in determining bedroom radon concentrations. Homes with higher mean annual radon concentrations showed lower BR/LR ratios, supporting our proposal that, in some homes, radon emanation from building materials may comprise a significant component of the overall radon level.     

Radon in the creswell crags Permian limestone caves

An investigation of radon levels in the caves of Creswell Crags, Derbyshire, an important Site of Special Scientific Interest (SSSI) shows that the Lower Magnesian Limestone (Permian) caves have moderate to raised radon gas levels (27-7800 Bq m(-3)) which generally increase with increasing distance into the caves from the entrance regions. This feature is partly explained in terms of cave ventilation and topography. While these levels are generally below the Action Level in the workplace (400 Bq m(-3) in the UK), they are above the Action Level for domestic properties (200 Bq m(-3)). Creswell Crags has approximately 40,000 visitors per year and therefore a quantification of effective dose is important for both visitors and guides to the Robin Hood show cave. Due to short exposure times the dose received by visitors is low (0.0016 mSv/visit) and regulations concerning exposure are not contravened. Similarly, the dose received by guides is fairly low (0.4 mSv/annum) due in part to current working practice. However, the risk to researchers entering the more inaccessible areas of the cave system is higher (0.06 mSv/visit). This survey also investigated the effect of seasonal variations on recorded radon concentration. From this work summer to winter ratios of between 1.1 and 9.51 were determined for different locations within the largest cave system.     

The value of Seasonal Correction Factors in assessing the health risk from domestic radon: a case study in Northamptonshire, UK

Following an intensive survey of domestic radon levels in the United Kingdom (UK), the former National Radiological Protection Board (NRPB), now the Radiation Protection Division of the Health Protection Agency (HPA-RPD), established a measurement protocol and promulgated Seasonal Correction Factors applicable to the country as a whole. Radon levels in the domestic built environment are assumed to vary systematically and repeatably during the year, being generally higher in winter. The Seasonal Correction Factors therefore comprise a series of numerical multipliers, which convert a 1-month or 3-month radon concentration measurement, commencing in any month of the year, to an effective annual mean radon concentration. In a recent project undertaken to assess the utility of short-term exposures in quantifying domestic radon levels, a comparative assessment of a number of integrating detector types was undertaken, with radon levels in 34 houses on common geology monitored over a 12-month period using dose-integrating track-etch detectors exposed in pairs (one upstairs, one downstairs) at 1-month and 3-month resolution. Seasonal variability of radon concentrations departed significantly from that expected on the basis of the HPA-RPD Seasonal Correction Factor set, with year-end discontinuities at both 1-month and 3-month measurement resolutions. Following this study, monitoring with electrets was continued in four properties, with weekly radon concentration data now available for a total duration in excess of three and a half years. Analysis of this data has permitted the derivation of reliable local Seasonal Correction Factors. Overall, these are significantly lower than those recommended by HPA-RPD, but are comparable with other results from the UK and from abroad, particularly those that recognise geological diversity and are consequently prepared on a regional rather than a national basis. This finding calls into question the validity of using nationally aggregated Seasonal Correction Factors, especially for shorter exposures, and the universal applicability of these corrections is discussed in detail.     

Time-integrating radon gas measurements in domestic premises: comparison of short-, medium- and long-term exposures

To identify the most applicable technology for the short-term assessment of domestic radon levels, comparative assessments of a number of integrating detector types, including track-etch, electret and activated charcoal were undertaken. Thirty-four unremediated dwellings in a high-radon area were monitored using track-etch detectors exposed for one-month and three-month periods. In parallel, one-week measurements were made in the same homes at one-month intervals, using co-located track-etch, charcoal and electret detectors exposed simultaneously, while three of the homes were also monitored by continuous-sampling detectors at hourly intervals over extended periods. Calibration of dose-integrating devices against each other and against continuous-monitoring systems confirmed good responsivity and linearity. Although track-etch, charcoal and electret devices are suitable in principle for one-week measurements, zero-exposure offset and natural radon variability cause many one-week results to be equivocal, necessitating repetition of the measurement. One-week exposures can be reliable indicators in low-radon areas or for new properties, but in high-radon areas, the use of three-month exposures is indicated. This analysis also established confidence limits for short-term measurements.     

Swedish nutrient reduction policies: an evaluation of cost-effectiveness

Since more than 30 years, the Swedish government as well as other governments in the drainage basin strives toward a reduction in nutrient loads to Baltic Sea coastal waters in order to combat eutrophication of the sea. In spite of this, the cost-effectiveness of actual environmental policy for meeting Baltic Sea nutrient targets has not been evaluated by national or international bodies in the region. The aim of this paper is to evaluate Swedish national nitrogen and phosphorus policies with regard to cost-effectiveness. This is done through a comparison of nutrient measures implemented through environmental policy decisions 1995–2005 with cost-effective policies for present national as well as Baltic Sea Action Plan (BSAP) targets. The cost-effective measures are calculated using an empirical programming model including all countries adjacent to the Baltic Sea. Calculations show that measures that jointly reduce nitrogen and phosphorus are hardly applied in actual policy and that reductions in the agricultural sector are much smaller than is cost-effective. Data show, surprisingly, that considerable reductions have been carried out in the Bothnian Sea catchment in spite of there being no nutrient reduction target for this catchment. Results suggest also that the Swedish costs for meeting the new and geographically more restricted targets under the BSAP can be reduced if a policy with less restrictions on the location of phosphorus abatement is applied, compared to what is now suggested.     

Analysis of the individual health benefits accruing from a domestic radon remediation programme

Although radon can be present within buildings at sufficient levels to pose a health risk, levels can be reduced relatively easily. Recent studies on a group of radon-remediated homes, based on assessment of collective population-average risk coefficients, have estimated the benefits and cost effectiveness accruing from remediation and have confirmed that domestic remediation in UK radon Affected Areas would result in significantly reduced cancer risks to the population in those areas. Although the population-average approach used hitherto has applied occupancy and lung-cancer risk factors, these are potentially misleading in assessing discrete populations. The study reported here uses the recently developed European Community Radon Software (ECRS) to quantify individual risks in a sample of householders who remediated their homes following indications that radon levels exceeded the action level. The study proceeds from population-averaged to 'individual risk' evaluation, successfully comparing individual and collective risk assessments, and demonstrates that those who remediate are not representative of the general population. Health benefits accruing from remediation are three times lower than expected, largely because remediators are older, live in smaller households, and smoke less than the population average, leading to the conclusion that the current strategy employed in the UK is failing to target those most at risk.     

Two error components model for measurement error: application to radon in homes

In this paper, a simple model for analysing variability in radon concentrations in homes is tested. The approach used here involves two error components, representing additive and multiplicative errors, together with variation between-houses. We use a Bayesian approach for our analysis and apply this model to two datasets of repeat radon measurements in homes; one based on 3-month long measurements for which the original measurements were close to the current UK Radon Action Level (200 Bq m⁻³), and the other based on 6-month measurement data (from regional and national surveys), for which the original measurements cover a wide range of radon concentrations, down to very low levels. The model with two error components provides a better fit to these datasets than does a model based on solely multiplicative errors.     

Soil radium, soil gas radon and indoor radon empirical relationships to assist in post-closure impact assessment related to near-surface radioactive waste disposal

Least squares (LS), Theil’s (TS) and weighted total least squares (WTLS) regression analysis methods are used to develop empirical relationships between radium in the ground, radon in soil and radon in dwellings to assist in the post-closure assessment of indoor radon related to near-surface radioactive waste disposal at the Low Level Waste Repository in England. The data sets used are (i) estimated ²²⁶Ra in the <2 mm fraction of topsoils (eRa226) derived from equivalent uranium (eU) from airborne gamma spectrometry data, (ii) eRa226 derived from measurements of uranium in soil geochemical samples, (iii) soil gas radon and (iv) indoor radon data. For models comparing indoor radon and (i) eRa226 derived from airborne eU data and (ii) soil gas radon data, some of the geological groupings have significant slopes. For these groupings there is reasonable agreement in slope and intercept between the three regression analysis methods (LS, TS and WTLS). Relationships between radon in dwellings and radium in the ground or radon in soil differ depending on the characteristics of the underlying geological units, with more permeable units having steeper slopes and higher indoor radon concentrations for a given radium or soil gas radon concentration in the ground. The regression models comparing indoor radon with soil gas radon have intercepts close to 5 Bq m⁻³ whilst the intercepts for those comparing indoor radon with eRa226 from airborne eU vary from about 20 Bq m⁻³ for a moderately permeable geological unit to about 40 Bq m⁻³ for highly permeable limestone, implying unrealistically high contributions to indoor radon from sources other than the ground. An intercept value of 5 Bq m⁻³ is assumed as an appropriate mean value for the UK for sources of indoor radon other than radon from the ground, based on examination of UK data. Comparison with published data used to derive an average indoor radon: soil ²²⁶Ra ratio shows that whereas the published data are generally clustered with no obvious correlation, the data from this study have substantially different relationships depending largely on the permeability of the underlying geology. Models for the relatively impermeable geological units plot parallel to the average indoor radon: soil ²²⁶Ra model but with lower indoor radon: soil ²²⁶Ra ratios, whilst the models for the permeable geological units plot parallel to the average indoor radon: soil ²²⁶Ra model but with higher than average indoor radon: soil ²²⁶Ra ratios.     

The effects of geology and the impact of seasonal correction factors on indoor radon levels: a case study approach

Geology has been highlighted by a number of authors as a key factor in high indoor radon levels. In the light of this, this study examines the application of seasonal correction factors to indoor radon concentrations in the UK. This practice is based on an extensive database gathered by the National Radiological Protection Board over the years (small-scale surveys began in 1976 and continued with a larger scale survey in 1988) and reflects well known seasonal variations observed in indoor radon levels. However, due to the complexity of underlying geology (the UK arguably has the world's most complex solid and surficial geology over the shortest distances) and considerable variations in permeability of underlying materials it is clear that there are a significant number of occurrences where the application of a seasonal correction factor may give rise to over-estimated or under-estimated radon levels. Therefore, the practice of applying a seasonal correction should be one that is undertaken with caution, or not at all. This work is based on case studies taken from the Northamptonshire region and comparisons made to other permeable geologies in the UK.     

A study of radon levels in NHS premises in affected areas around the UK

Radon gas contributes a significant fraction of the natural background radiation dose, and in some areas raised levels are found in buildings. both homes and the workplace. Different UK Action Levels apply to homes and the workplace. because of the diurnal variation of radon. This study reviews the results for a number of hospitals throughout England and Wales. and suggests that the likelihood of finding raised radon levels is similar in the workplace and homes in the same area. Radon measurements and consequent remediation of any raised levels are appropriate in all workplaces in radon Affected Areas with over 5% of houses above the UK domestic Action Level of 200 Bq m(-3).     

Assessment of natural radiation exposure and radon exhalation from building materials in Greece

In controlling the natural radiation exposure for the residents of dwellings, it is necessary to determine the levels of natural radioactivity (external exposure) and radon exhalation rate (internal exposure) from building materials. Using a high-resolution gamma ray spectrometry system, the activity concentration of natural radionuclides was measured. The radon exhalation rate was measured by hermetically closing the sample in a container and following the radon activity growth as a function of time. Three different methods were applied in order to find the most appropriate, i.e. that with the less uncertainty for the less exposure time. Typical building materials were analyzed in order to examine the external and internal exposures. In addition, the total annual effective dose was evaluated for the residents of a typical Greek dwelling.     

The costs and benefits of radon remediation programmes in existing homes: case study of action level selection

Radon gas can be present within buildings at sufficiently high levels that it becomes a health risk. Such levels can be reduced, and so radon remediation programmes in the home in UK Affected Areas should result in reduced risks to the population. This paper considers the benefits and costs of the domestic radon remediation programme in Northamptonshire, UK, and considers the implications of the choice of Action Level, in view of the adoption of different levels in many countries. A programme with a higher Action Level will cost less, and target those most at risk, but will be less cost effective. In addition, a higher Action Level leaves a higher residual dose and risk to the remaining population. Such doses are higher than and inconsistent with the radiation dose limits for the general public in the EU Basic Standards Directive.     

Radon remediation of a two-storey UK dwelling by active sub-slab depressurisation: effects and health implications of radon concentration distributions

Radon concentration levels in a two-storey detached single-family dwelling in Northamptonshire, UK, were monitored continuously throughout a 5-week period during which active sub-slab depressurisation remediation measures were installed. Remediation of the property was accomplished successfully, with both the mean radon levels and the diurnal variability greatly reduced both upstairs and downstairs. Following remediation, upstairs and downstairs radon concentrations were 33% and 18% of their pre-remediation values respectively: the mean downstairs radon concentration was lower than that upstairs, with pre- and post-remediation values of the upstairs/downstairs concentration ratio, R(U/D), of 0.81 and 1.51 respectively. Cross-correlation between upstairs and downstairs radon concentration time-series indicates a time-lag of the order of 1 h or less, suggesting that diffusion of soil-derived radon from downstairs to upstairs either occurs within that time frame or forms a relatively insignificant contribution to the upstairs radon level. Cross-correlation between radon concentration time-series and the corresponding time-series for local atmospheric parameters demonstrated correlation between radon concentrations and internal/external pressure difference prior to remediation; this correlation disappears following remediation. Overall, these observations provide further evidence that radon concentration levels within a dwelling are not necessarily wholly determined by the effects of soil-gas advection, and further support the suggestion that, depending on the precise content of the building materials, upstairs radon levels, in particular, may be dominated by radon exhalation from the walls of the dwelling, especially in areas of low soil-gas radon.     

Study of a predictive methodology for quantification and mapping of the radon-222 exhalation rate

We propose a new methodology for predicting areas with a strong potential for radon (222Rn) exhalation at the soil surface. This methodology is based on the Rn exhalation rate quantification, starting from a precise characterisation of the main local geological and pedological parameters that control the radon source and its transport to the soil/atmosphere interface. It combines a cross mapping analysis of these parameters into a geographic information system with a model of the Rn vertical transport by diffusion in the soil. The rock and soil chemical and physical properties define the entry parameters of this code (named TRACHGEO) which calculates the radon flux density at the surface. This methodology is validated from in situ measurements of radon levels at the soil/atmosphere interface and in dwellings. We apply this approach to an area located in western France and characterised by a basement displaying a heterogeneous radon source potential, as previously demonstrated by lelsch et al. (J. Environ. Radioactivity 53(1) (2001) 75). The new results obtained show that spatial heterogeneity of pedological characteristics in addition to basement geochemistry--must be taken into account to improve the mapping resolution. The TRACHGEO forecasts explain the Rn exhalation variability on a larger scale and in general correlate well with in situ observations. Moreover, the radon-prone sectors identified by this approach generally correspond to the location of the dwellings showing the highest radon concentrations.