Costs and Benefits of Enforcing Housing Policies to Prevent Childhood Lead Poisoning

Abstract

Background. Lead poisoning remains an important, yet entirely preventable disease among young children. This article compares the costs and benefits of strict versus limited enforcement of lead poisoning prevention housing policies in preventing additional cases of childhood blood lead elevation. Methods. The author conducted decision analysis using population-based data that compared recurrence of childhood lead exposure in 2 urban areas with different enforcement capacity, and cost data from a federal project and from medical and public health literature. Results. Strict enforcement prevented additional cases, resulting in $45,360 savings from decreased medical and education costs and increased productivity for protected children. The model was robust to changing estimates of followup, housing repairs, relocation, and increases in lead levels over baseline. No cost savings were realized by strict enforcement if the probability of recurrence in limited units was 44% lower than estimated, or if fewer children were identified in limited versus strict enforcement units. If the discount rate for future productivity losses was ≥7.5%, strict enforcement did not lower costs. Conclusion. This analysis suggests that strict enforcement of housing policies to prevent childhood blood lead elevation results in decreased societal costs due to the avoidance of future medical and special education and to increased productivity of resident children.