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

Abstract

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.

Keywords: Cost-effectiveness analysis; QALY; Radon; Workplaces.