Utility gains from reducing lung cancer morbidity and mortality from residential radon interventions in Canada

Abstract

Background/Aim: Lung cancer is the leading cause of cancer mortality in Canada, and radon is the second most important cause of lung cancer. The goal is to estimate the utility gains from radon interventions in new housing, and in existing housing built without preventive measures, to reduce the burden from radon attributable lung cancer morbidity and mortality in Canada. Methods: A lifetable analysis is conducted using the 2016 population data, including mortality and smoking prevalence, the recent Canadian Cancer Registry data on lung cancer stage at diagnosis, and the results of the 2009-2011 national radon survey. Markov modelling of lung cancer incidence and survival time is conducted for small cell and non-small cell lung cancer, over a lifetime horizon and using a discount rate of 1.5%. Years lived with lung cancer morbidity are evaluated using quality of life decrements reported for local, regional and distant stages of lung cancer. Results: Installing passive preventive radon measures in new housing over a 100 years is estimated to result in an average annual increase of 5,612 discounted quality-adjusted life years, preventing an average of 2,336 lung cancer cases and 1,286 lung cancer deaths annually. Based on a radon action level of 200 (100) Bq/m3, testing and mitigation of existing housing at current rates over a 100 years is estimated to result in an average annual increase of 150 (410) discounted quality-adjusted life years, preventing an average of 35 (102) lung cancer cases and 19 (57) lung cancer deaths annually. Conclusions: Including the reduced lung cancer morbidity in addition to mortality results in larger utility gains from interventions in new and in existing housing in Canada. Future inclusion of costs of radon interventions and health care use in this lung cancer model would refine cost-effectiveness estimates of residential radon interventions in Canada.