Managing lung cancer risks associated with residential radon exposure in Canada

The weight of current evidence supports a small yet significant increase in lung cancer risk associated with exposure to radon in the home. Our study provides an economic evaluation of five national strategies to mitigate residential radon exposure. Analysis is based upon a probabilistic decision model which estimates the time-dependent reductions in age, gender and smoking-specific lung cancer risks following mitigation, and models the impact within simulated Canadian population over 80 years. The estimated costs of the radon programs are compared with these impacts to calculate the cost-effectiveness of residential radon mitigation.; All strategies considered were found to be very expensive, with total costs ranging from about {dollar}100 million to several billions of dollars. The more expensive mitigation strategies also tended to be the most cost-effective. In the majority of cases, the strategy with the lowest cost per lung cancer prevented was universal screening of all currently existing dwellings, with mitigation of dwellings above some action level. The cost-effectiveness of radon mitigation was improved by lowering the Canadian radon guideline from its current level of 800 Bqm-3; by maximizing the compliance of homeowners with the recommended action; by maximizing the degree to which radon levels are reduced within mitigated dwellings; and by targeting radon mitigation towards geographic areas with higher average radon concentrations. The implications of our findings are discussed within the context of risk management decision making in Canada.