Brown Mary Jean
Med Decis Making. 2002 Nov-Dec;22(6):482-92. doi: 10.1177/0272989X02238298.
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.
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.
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 > or = 7.5%, strict enforcement did not lower costs.
This analysis suggests that strict enforcement of housing policies to prevent childhood blood lead elevation results in decreased societal costs due to the avoidance offuture medical and special education and to increased productivity of resident children.
铅中毒在幼儿中仍然是一种重要但完全可以预防的疾病。本文比较了严格执行与有限执行预防铅中毒住房政策在预防儿童血铅水平升高新增病例方面的成本和效益。
作者使用基于人群的数据进行决策分析，比较了两个具有不同执法能力的城市地区儿童铅暴露的复发情况，以及来自一个联邦项目以及医学和公共卫生文献的成本数据。
严格执法预防了新增病例，因医疗和教育成本降低以及受保护儿童的生产力提高而节省了45360美元。该模型对于随访、房屋维修、搬迁以及铅水平相对于基线的升高的估计变化具有稳健性。如果有限执行单位的复发概率比估计值低44%，或者如果在有限执行单位与严格执行单位中识别出的儿童较少，那么严格执法不会实现成本节约。如果未来生产力损失的贴现率≥7.5%，严格执法不会降低成本。
该分析表明，严格执行住房政策以预防儿童血铅水平升高可降低社会成本，这是由于避免了未来的医疗和特殊教育费用，并提高了常住儿童的生产力。
