Economic evaluation of environmental interventions for low-level childhood lead poisoning

D. E. Glotzer, M. Weitzman, A. Aschengrau, K. A. Freedberg

Research output: Contribution to journalArticle

Abstract

Objective. To estimate the costs and benefits of various environmental interventions for childhood lead poisoning using decision analysis and data from a randomized clinical trial. Methods. The model incorporated environmental costs as well as projected costs of medical follow-up, special education and future lifetime earnings based on pre- and post-intervention blood lead levels. Data came from a trial of 150 urban, preschool children, in Boston, MA, with venous blood levels of 0.3-1.2 μmol/l (7-24 μg/dl), randomly assigned to one of three groups and followed for 11 months. The three groups were: (1) paint, loose paint stabilization; (2) dust, loose paint stabilization and interior dust abatement, and (3) soil, loose paint stabilization, interior dust abatement and soil abatement. All interventions were performed only once. A cohort of comparable children from other sources was used to assess the costs and benefits of no abatement. Results. If total (direct and indirect) net costs are considered, the costs of the one-time paint, dust and soil interventions are $105, -$204 and $4761 per child, respectively. The paint and dust interventions are cost-saving under many conditions, whereas the soil intervention becomes cost-saving only if the cost of soil abatement could be reduced to less than 33% of the baseline estimate. Cost savings occur at 115%, 83% and 246% of the baseline estimate of projected lifetime earnings per microgram change in blood lead level for the paint, dust and soil strategies, respectively. None of the interventions are cost-saving if indirect costs are not included. The no intervention cohort had the greatest decrease in blood lead levels, and was the least costly strategy. Conclusions. Paint and dust interventions may be a reasonable use of limited financial resources in neighborhoods with a high incidence of lead poisoning. Soil removal appears to be extremely costly, despite modest improvements in blood lead levels following soil abatement. The effectiveness of conducting no environmental abatement for children with blood lead levels up to 1.16 μmol/l (24 μg/dl) requires confirmation through additional study.

Original languageEnglish (US)
Pages (from-to)255-267
Number of pages13
JournalAmbulatory Child Health
Volume3
Issue number3
StatePublished - Nov 28 1997

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Keywords

  • Abatement
  • Cost-benefit analysis
  • Decision analysis
  • Lead poisoning

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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