RHIZIKON

RHIZIKON 

RISK RESEARCH REPORTS 

CENTER FOR RIS( RESIARCH 

stdtaln s(j/ al 4 E(l/'anls 

soF I 

THE COST.EFFECTIVENESS OF 

LIFESAVING INTERVENTIONS 

SWEDEN 

Joakim Ramsberg 

Lennad Sjdberg 

Report No. 24 

!s rN I 

lssN 1101'9697 

rsRN HH5-CFR-g-24..5

EXPLA]NING TEE NFA4|]ON,., ,,. 

fHROMB(XN C4USED Bf OR''L CONTFICEP|IVIS 19 

P R'S]CI/N ASS IS1:E D A MB U IINC E 

coLt 

'r oF /!I9fER]{oRRL4ND. 

3A 

HE L ICO PIE R E MERG E NC Y TlE D IC /1 

E' E A")P H ILUS N FI, UE NZl IAP E 

UPID LOWEN]TG IN SI/EDEE PNA'1} 

R ON E M4AROW 7E4I\S P L4Nf ATIO N 

RADON IN DRINX]NG VATER..... . . 

RADUTTON PRATECTtON. . . . .. ...... ...... 

,tGE UMrf ON TOEICCO USE .. . .

Th€ Cost-Ef,€ctiv.n€s of Lifqlvhg 

tu Swed€r 

ltrleN€trriors 

Abskact 

Inpli€d lif€ nlue is deined 4 1he eslimled 6sl of slatisticalives sav€d. It meaFes tlr 

mst-etrecliveftss of irt€flentios ajmed at Educing heafth nsks. Inplied life valn6. roeethd 

wirh a bnd desqiltion dd refemeq e F*mted for 147 lifesavine inlenentions in S@ 

d€n. Th€ ost-etrectiveress of intwdnoro b6 bm foud i! pnblicly availalle analtses, or 

ir hs in sone particuld c6es bm cabtnabd by u. Seve€l of rhse intery.ntions produce 

nel savinss for society. ]!e nost dTrujve inieflentiou cost sddal hEdred mnLon SEK 

or n@. !d life saved. To improve the comlaililiry of the estinat*, certain cibna have 

bd wd to standardize the calculations, StiI, di$inilditi6 in the calcllation of inplied life 

vaiues Majn ed 1ne qualiry oflhe odcilal data is i! sone c6* mertajn. Despire this tud 

the ficr rhlt the inteNmtiom re rct a repestadr sdplq it is nevenheLess possible lo 

conclude that implied life values vary cFariy boih witiin dd betseer ditrmt wcitor of the 

Swedish society, nuch in the sue nmer d in clldt US daly*s. 

lntroduction 

wlat is tn€ \alue of a hMa life? One way of mwding this questio! is simply 10 slat€ thal 

all lives hare m €qual dd inlnite valD. In a philosophical sme llat my be the corecl 

al1$d md for o irdividul 11 is liobably irue. UnfortMtely, this aswa do* mt siv€ 

nuch euidece wlm deding {iln lne pmclical prcblds of rcsouce allocalion, since 

moucs N almys linjled. Anolier vay of apprcachins lhe queslioD is 10 use impli€d life 

valn€s. In this Eport, *e Fesent cosretr€ctivoess dals, mesuEd 6 implied life 1€lEs, fo. a 

ldg€ nubd of lifesaring inldenliotr in Sw€dd. 

To udqsrand {hat is n€mt ty d inpied life v.lue the notion of srarrrtcal ltv€r is utiliad 

Statistical lives r€f€ls 10 a sitution i! w!ic! d-post Didertiied p6os re subj{t to the 

nsk of ding. A siatistical life is sd to be sared when the lisk ulon a whole population is 

reduced and a uidmtiied peson is saved: ln a polulation of 100,000 alprcxioalely 3 

people will die mu.lly in road midats a€ordirs ro cLlmr Stedish estimates, bDt il is nol 

Lnoh beforelnd who will have a@idflls dd di€. If the risk of dyi4 ia a road acc'd@l 

mdd be Educed to hall for this populatioq fou slatisticat lives sotrld be saved.

RHIZIKON Risk R€rmh Relort No. 24 

Ar inplied life EIE cd be calculaEd fron the cost ol a dsk Eduction. Lookng once a$in 

at the exmple of fatllities fton rcad accidenrs, d idplied lilf !a.le @ be calculaled. 

AssMe tnat the nsk of fatalities could be Educed to ha.lf*ith a proeJm ained al chesins 

the behalior of nolonsls corcemil]e speet ud drunkd driving 4d that the pbgrm would 

cost SEK 40 miUion muliy. Since fou statistical lives sonid be expecred io be saved evert 

yed. rhe indied lif€ valE in this hlTothedcal !6g'd is SEK 40 nllliod4 lives, which 

eqlals SEK l0 nillion pd life saved. 

An e4licit life vrln€ is the value of saved $alisrical lives ued in cost-b€ne61 caldiati@. 

s*eEl different methods have b€m sd to estinate erdicjr life valn€s [39]. rbe hme 

apitai apptu&h, for e@ple. uses loss in Fodudion due to prqriue death 4 the explicil 

tilc valuq blt this apFoacn rcsdls in emelhins ofa noral dilelrm sirce p@ple e valued 

accordine to then sahies dd age alone. In addition. rhe hMo capitd apprcacn does nol 

6slgn d iltrisic rd!€ ro life ilselt The nosi favor€d n€thod i! Ecent yeffi h6 ben the 

coniingenl valuation nerhod, in shich a nrloihetical mker for risk Eduction is c@red in a 

swey [32]. hus, lhe respond@l d@s mt pnt a pnce lgs on his or hd life, bDt a life vahe 

cd be d€duced non lhe fspondats willingness 10 pay for nsk Eduction. Ite nost seriols 

poblen with the sntingetu w.lurion re1nod is its h}?olheiical .atue dd to 4har exte n 

n posslbl€ to nahe infercnces to Ear- le situtjos [21]. 

The N,1iona1 Road Adninistration in Sv€do has used explicil life values in cosrbeneiil 

aalyses of inv€stmenls in rcad efeq for son€ yem no* hey dsive lhe life value liom 

continsenr valution shrdi€s od add a hmd calitd loss. CM€nlly, a Iife is valued al a iitde 

norc l,\a SEK 12 nillion [39]. If this life valu€ is applied 10 th€ nylolhetical prcgrm lo 

chdee r!€ behavior of nolonsls presaled abowe, lhe proe@ should b€ inPl€netrt€d 

because r!€ cost ler Iile saved is less thm SE( l2 nillion. 

To the best ofou knowL€dse, orly 1{o sMjes bale been previously published corceming 

r[e implied ]ife values of lif€ sving inteddlio4 in several seclors of Sredish sociely. 

Hellqvh et al. con!red inplicit ed exllicillif€ values s edly 6 197?. Laplicit ed 

explicit lif€ values w€re calalaled for l0 seclos of society. Both the implicil dd explicil 

values sere fomd to vary between a tsv thoudd SEK up tlr SEK l ? nilion ll2l Sjilberg 

ed Ogand€r [48] later pr*enr€d eisl ces dd foud lhal ihe implied Iife value vdied lion 

SE( 540 fo! a cdpaign agaiEt snoki4 to SEK 250 nillior for a system lbr ieducing 

gsoline ss pouuiion.ln the US,\ several studies rcsrdins implied life *ies have rcloned 

wiarioD in ihe se order of merutude s sj6bers od osdder, o. oorc t3l I33l I1l. lle 

nosl mbirious efori to dale 10 collect inplied life valEs is epoded by Tenes elal. 1561, 

wheE the cosr etrectiv€ness of norc 6m nve-ludred lifesaving inteflmiios is pr€snled 

h a Bntish study, Soby, BaU ud lves [,19] als Elorted a vqy ldge vriation dd the nosl 

dbensive iftdention had e inDlied life value of ! 200 million. 

Thus. in spire of its inporral policy inPlicalioDs the issue hd nol been thoroughly 

invesligated excepi in the USA. A mnpalisotr wiih Swedish dab is i €resting because lhe

Rtr sb.'g 3 5r0be g. rhe cot efer \ ene$ oI rilesvins in.s suon\ 

Swedish sociery h6 less resomes to slqd on lifeevins inle(eltio6, dd t y€t nDch 

oriented los"rds safery dd scuity. Anolhq fa.lor wlich ditrers b€i,een the Amrim md 

S$edish socielis is the lev€l of d{Eses asdded by couls; Swedish lwels re rwo or tbm 

mg tdd le$ tle the US ones. The nel oulcone of thse factoB for life values mdd nol 

be dedeedr il had to be investisaled enpincally. 

Method 

w€ nav€ Fdched for publicly availahle €comnic malyses of lif€savils inlwmtios in 

Sweda i! $idtiic liErarre, gov€lmdl Eporls md Elorts from non-sovement 

o€mizatiom. Tle diteria for inclnding m malFis wft lhal ir should corcem life e\i!s 

inr€rdtios in Sseden ed report cosr per life saved, mst pd lifeyer saved or sutricient 

inf@non to calculate ole oi these ne4ms. 

The Fs l ofrlis sech ws sonephat disappoinling in thal vat lew alticles Eloned cost 

per life saved. Mfly sovement tpons md prcposals did not even conlain my qlmtified 

idomaron on the costs or effects of a prcloed intweniion. This h remrkable since 

S{€dish law requir€s govelmar agencies to pree cosls dd etrects of prolosd 

Esdalio$ dd inleNentions. Homvq, by conbinitg itJomation fron diffeient $res it 

w6 in nmy 6es possible lo calolate the cost pd life eled 

In ordq 10 be atle io comp{e dre cost€fectivoess of difidmi inlweniio6 

ideally be in the sm€ fom wilh Espect to a nmbd of tacio6: 

th€y shodd 

inlwenlioN 

h3ve both di€c1 md hdnecl osls. Ou goal wb to include only direci cosls. 

- cosrs ed b€neJits should b€ calculated on a societsl level. 

- Sone ideNentions have costs ed bdefils disEibut€d ov* tine. R€grding costs, it is 

@mor pnclice 1o disout the cosrs to a presdt value in dee cdes. concemils li\€s 

saved in rhe futue. d1ft hs been a debaE shedrd or not they shodd be dis@Dled 6 well. 

The najn rsm€n1 agaiBt discoutiq saved lires is that all ljles hav€ the sm€ \€lue, 

includinc tutw lives. Hosever. ifit is rccepted dat cosls shourd be discoNted, hur nol lives. 

rhe concluion vju be ftai it is aldls befler to sajl with d invesbnent ihat saves lives in the 

tuE. Bor! cosb and lives should lhqefore be dis@mi€d. We have chosen a disooul fte of 

- costs ud ef*ts shodd be ewluled agairt a bNeline aftmnve 

- Cost-etredivd*s should be expi$sed in 1994 SEK uirs dE seneEl consmei pnce 

An addilional f&to! mncemiry the compdabiliiy is tnal iniwentions u be inplmoted to 

vdious degrees. Sone ifterentions m only proposed ud sne of the pmposed 

interentlo$ will be impld€nled in lle nnw od olhes *iil no1,

RHIZIKON tusk R.*arc! RepodNo. 24 

Result 

ft€ nmbq of intervdtions we describe 's i47. The hed @st pd life saved is SEK 2?5.8 

nillion &d the medie is SEK 5.6 nillid. Howevo, in the daia rh* is orc exE€me ourlid 

of SEK 35,000 mnlion ed ifihat obswatid h dspped, ine ned cos! pd Iife sved is SEK 

38,0 nillior. Th€ vdiarior ir .ost per life saved is lalge, which cd be sd iD Fisue L 

30 

2A 

15 

10+E2 10+€3 10+E4 10+E5 10+E6 10+F/ 10+Ea 10{€9 l0+E10 

cosvlile s*d, 

1994 SEK 

Fiew t. Distibtdion ofcost per life wed. 

Irdplied life valu6 have b€m collect€d or calculated fd nine dltrd€nt categones of 

lifdavine: m€dicine, ddiation prohrio! load sfety, lifesryle ristr, et€clrical safety, 

accidents. pollntalrs in the @vnoMe ad c!im€. These €tegories @ admift€dly son*har 

ad /,o.. Medicirc inclu.tes by far the lugesr Ddber of obswaijo4, wlmd dine dd 

&cidmls ort in only on€ obsenarion e&h. The nhtEr of obsdalions dd nm fld 

nedid cost p€r life saved for the dif€rent calegones de Prcsdted in TabL€ l

Rm.oerc & sJobers: f}e.osr efiectlmes, ol l.fes,uc inElerdol" 

'l^bre r. Ntnbq 

af obsenatio,s, tudn and neAion Ju the nine .atesories. All coss in 

Polu&ds in the enviroment 

tl 

31 

l 

2 

; 

I 

(nillion sEK) 

17.1 

8.6 

0.06 

34.3 

565 

140 

67_5 

(nillion sEK) 

2.6 

19.4 

2.6 

19.4 

The inplied lif€ values for the inreNmrioff m prcsented in Table 2. Each iffefle ion dd 

ho{ l}e @st pd life or life yed saved wd cabdaled is prcsat€d i! the appendix. Each 

inleNenlion h6 a Ef€Ence to a plge in ilE alpendix. 

'l^b\e 2. fhe cost efecnreness, nezsted 6 cost p* W saed or con per life year @ed af 

147 life raeing intenentians in Sve.leh tll coss tre in hilion | 991 SEK. For aI the interyentiohs, 

ftJercnce is nade to d b.ief dektidion al the intnention md how th. mstefe 

c | tue ne s v6 caldl at e d 

INTER\ENTION 

Medicine 

Million 

t994SEKr994 SEK 

AAA-s!€eni4, ail nd > 60 (assued nea t5 

A,AA-scremi4, nsk Crcups only t5 0.1 0.06 

t9 50 

Screening ofdomEd blood: Hw 2l 0.8 

Scremng ofdomEd blood HTLv_l 2i 15,000 

ViruelFimtio. of pldma 2l 50 

2i 100 

Prcs'e dcd sftening 0.6 

Twcpictue namogaphy 21 

11 

The uperadirs of venrilalion syst€ns in ,ll 

2t1 

l4 

Inil@a vami$tion: H2N2, age sroups: 27 

0.06 

9.2 

10.1 0.2

RHIZIKON: Risk Resetrch Repolt No. 24 

0.2 

6 0.2 

2.1 0.1 

4.1 0.05 

o.2 0.02 

aJ- 0.05 0.01 

0.1 

0.1 

H]N2: )1 

46,2 

)6.2 

19.6 05 

0.2 

4.1 0.2 

0.1 

0.05 

0.1 002 

0_2 

0.2 

0_24 

Pnysicim A$isted Ambrnmce dd Hdi@ptd 

Endgdcy Medical Sdices in the Couty of 

30 0.8 

Hehopt€r Emercqcy Medical Senicel 32 

Spa4eb popuiakd oreas eith phrnctun 3.9 

Spaêb populoted or.at. nithaut ptty\i.ian i.5 

20.5 

Hyperl€nsion Lealtnent 

l6 

EIT;iension t€atne wiln diNti6 or beia_ 

block€s, nd < 45 y€mi didtolic Uood 

pe$m: 

Im?t 

6q !ds: dia'ol c blood !c$mi 

n6 > 70 yess: diatolic blood lEssrc 

22.5 

t9.i 06 

16.1 05 

9.1 0l 

06 0.0i 

0 

0 0 

0.1 0.01

Rm.bers& cjobelB nre.ot'{e. 

v.ncc"of lifet\rsid'edmLorc 

HlTertension tr€atn€nt with diudics or betablock€$, 

won€n

REIZIKON: Risk Resffh Reporl No. 24 

women > 70 J6s. diArolic blood pessue: 

5.2 02 

26 0.1 

0.1 0.004 

0.6 

0.1 0.02 

006 

39 

namal adrice + plmacolagitul neahefl 11.4 

42_9 1.5 

Bonendow tE6plmtanon 4l 2.8 

M€6ws to €mov€ indoor mdor 

I a - q- I qo 2, e, I' n I ho b.s 

Prcposed heNwes 1992-2402, *istihs 0.4 

Ptoposed neasute\ to92 2042 Nw hows 01 

Sealing up leal6 + rddon tfttiah in Vjvtu 007 

&dlitg up leaki + radon su.rio, in ljratu 

honet nith 20G !0A Bq/n' 

Sedliig q leak + inaro'ed _rehtilation in 

priate hatuet vith> 4A0 Bq/n' 

M6@s to det€c1 dd move radon in 

Cddelines for leconstetion in nucled 

po*r llets (dplicit valE) 

Tle Nordjc Coucil: Clidelines for arl ryles 

of Fdiation prolection me6es (exllicil 

Infomation cmpaisn to in*e Public 

aw@ness egardilc rhe nsk of nalign nela- 

R€d@d risk for cmcer fion Fdiodieraly by 

d incresed ue ofcoal-nbre c6settes: 

The Radiation Piotection Inslitue's lolicy 

(dplicit \al@) 

02 

1.2.8 

49 0.2 

0.1 

26.7 

50 

Vnous rcad-s,fet! nusGs: 52 

New sp€ed linit syslm, presnt contol ed 16,1 

l0

Rmsbeig & Sjdbde: lhe coskEedivo6s 

oflif€eving lnid€ntios 

New speed limils, +5 limcs presnl control 16.9 

+5 tin$ lre$nl speed conlrol +10% toler 19.4 

Overpds at 4 rcad inlers*tion, &al da 

I ersetim. ru,l dea; 4-rcad inte46tios. 2.2 

shined 3-rcad inr@ctioc 

cooctu beis on divided tuclMay5 

loBe.rDs, rural *6, traffi. circles 5 

Local sped limit in 4- rcad inrdsectioDs wit! 

6.5 

bn-tm pockets, rual re6 

lbtdecLioD ube sl%, @f6c cirles 8.1 

70 lb^ ADT 4000-8000 1t7.4 

809 

90 bn^ aDT 4 000-8000 

76.2 

I l0 kn h ADT 4 000-8000 8.5 

12.1 

Speed bdps, ubd mN 

Speed bups on lesidental strets ADDIo 

13.3 

000 

22.5 

R{ons1llctlon to notolwys 110 km/h: ali 

20 

truk rcads 1 l0 kn/h, ADT 8 000-9999 

R*onsrruction lo notolwys 110 hr'l. all 

2l 

trutl roads I l0 l@1r ADT > l0 000 

Reco.structioD to nololwys ll0 h4! all 22.4 

othd mh roads 1 l0 kn4! AD D8 000 

Reco$lructior ro notosays 90 kn4\ all 

33.1 

othd min roads 90 kjitt ADT 8000-9999 

Reconsrrucrior 1o notosays 90 kb,4\ all 401 

otnei min roads 90 ktrr& ADDIo 000 

R€onsrrucrior ro nobsays 90 kd\ aI 

27.4 

truntroads 90 Lt/h, AD>3 000 

Iencs on divided niglsays. corrsl Es€ra- t.2 

Inl*cdo6, ubm d6,lt-ali. ciJcles 200.6 

Tnmc tehls ai 4-rcad iniesectim with 241.1 

ldge traf6c flor$' ubd des, 50 km& 

Anbags mdatory in all new c6 

JT.4 

Rmnstuction of all nilway crossins with 

9_7 

$ud ed light siglals to ha]f- lsel cio$ing 

Raonstruction of level crossilg gates 10 

overyds or uddpss inlesections 

219 

n

RHIZIKON: Risk Reseeh R@orr No, 24 

Lifestyle risks 

Aee limir on lobam e 56 0.t 

Cdpaign agai$t smohng 58 

A Tobacco Quii dd win Contest 60 0.0J 

Fire protection 

Ban€ry-opdaled fire detecto$ in one fmily 62 

Ban€ry-opdai€d nE deteclos ir nultifamily 62 

Maic-olemt€d tE d€t€cloB in onefamily 62 0 

Maj6{pented tu€ d€t€clos in nultifaaily 62 

Spriikler systetr in pnvab homes 131 

IiF pReooon n health d€ iMinaiotr 65 6ll 

Electrical safety 

Residual CEar Dwices nddatory in all 198 

Rdovai of 1n€ el€ctromgn€tic field fioo 

poser liles i! Belgshma 

Accidents 

68 932 

142.6 

Pollutants in the environment 

Sleves" on gMline pmps 1o @ove ben- 7l 254_7 

Crime 

Sffit' packages for women 76 

73 9.3 

73 4l.t 

13 t9.4 

73 t3.l 

Explaining the variation 

An important qu6tion h whel1jd ine brge vdialion h socielyt investllots ir life sving 

inr€Ndlios reActs the public opinion or mt. Mendelotr dd Kaplm ued a swey apprcach 

ro emine this issue l3ll. ften r$uhs showed that th€ public supporls sone vdiation in 

@s1-efrectivmess, bu1 th€ lfse veiation i! adul investmmrs sdd loi be eouled lbr. 

lhis could in pdt be du€ ro 1n€ melhodolosy ed itr 1he MendeloF dd Kaplm stndy. 

Orce ihe public opinior on the trEtler of investnois in lifesaling hs beo slabiisn€d, il is 

mcial to investigat€ the nechmjsm by *hich public opinion influences d*i$ons. Sjdhds 

lomd jn a study of lolilicims rhat the n* Ed@tion tbey desired sd nore slronely accouled 

for by lheir beliefs aboui rhe public's nsk ldcepiion thd by tDir oM risk perF 

tion [47]. This inding stronsly $pporrs ile idea tnal ii is inlonml b stldy public opinion 

on investne s in lif€saving i eFdtions. 

12

Rm. be-E & Siobers: Ttu co" -elT.ctivmeq ol ' fewrns D.m dtion\ 

A plausible hFothesis aboul inv€staent in lifesaving ideflenlions is that the size of the i!- 

vestm€ in absolute nmbds m innu€n€ rhe d*islon to invest. the larger tie investroe 

is, the nor coskffective it ha lo he. We have pdfomed a pFlimindf drtlysis of rhis hrpoihesis 

on ou data, bui codd fnd m suppon for i1. I]:lal is nowever nol a s!ffcient.e6on 

to condetely rej€cl it, a more ihoroqh study is reeded. 

In tl€llqvist et al.. impli€d life valu€s for difeHr secrors of sociery m presented &d rhey 

ma!€ e int€€stins cmldi$a 10 ou, noe Een! sddy ll2l. Sond of these inllied life 

values e pEsenled in Talle 3. 

Tab)e 3. Cost per tfe s@ed in nilion SE : Jat tone af the lifes@inE jntementions prcsented 

Cosl4ife saved, MSEK (Yed) 

Medical exdirarios 

for workds exposd to 

Driver's piolectio! on trclos 

Fire fieltting incothe urg 

lnprcved air rraf6c conrrol 

Saf€ty n6ws al abmdotred ninins siles 

Auronatic door locks on niL*€y cs 

Safety-al $a !rcpaemda 

Ssedish Lilehoat Swic€ GJdttdd,rtar,) 

Ud€rdriving lmle.tion on heaq huks 

2.5 (.1916) 

0.35 l\974) 

4.5 0980) 

2.1 0975) 

0.056 (t915) 

0.018 0975) 

0.07 09?s) 

I 

(r97s) 

Orc of tle most strjking feann* wlen conpdils rhe inplied life val@s in Hellqvisl et al. 

wilh the life val@s in w presed is that the vdiation is nEh ldger ir ou dala. Tlris co d 

refle.r either that the lriaiion is indeed larser loday tha il wd 20 yeas ago. oi fial rhe 

H€llqvisl et al, sdtle is not Elr€sertative od Elher small. UnJorllre,€ly. the mterial is too 

small to pemit a slatislical dalysis ofthe tFo d!t! sets. 

If i1 is the c6e tbat the vdiatjon i! inplied life r€lus ird incted ovd dne, d explmalion 

could p€rhaps be soqlt in orgmiztioml f@1o6.Insdy, regulabry agencies lave clmged, 

with respect !o both argeiztior ad scope. Secondly, dre nwber, ed inpaci, of intftst 

gloups have incl@d in the last decades, which night have a innum@ on lhe inPlied life 

valEs in al@ whft inte!€sl grcups de &tive. This expleation is pE sPer ation on ou 

behall but it would €nainly be i eresting !o psue ile issue in tuire r€swh. The nsk 

litelalN. esleciallt in sociolosr, sulpods $e idea thal orgmialion l factos re inporlal 

in explaining $ci€ty\ EspoNe to dsk 1461. 

The cost per life saved in th€ nosr er?eBive inrwddos is considmbly ligbd in ou siudy 

rlm what h is in nB1 of Eeilqvisr el al.. Ore po$ibLe explflalion is dral rhee h a decleding 

narginal efrecr of safeq nedues ed 10 eain additjonal safely hs in some des, such d 

domt€d blood,l€cone very expmsive. Sajeiy is nost likely a nomal sood md a iftone 

ircredes. so does demmd for saf€ty. To nr-ind ircEase safery in sone al6 cd only be 

do!€ ar a hign- ndginal co$. tn rhc l9?0's. lhere wrq accodins to this iypot]lesis, simply 

oore cosr-etre.rive ne4u€s io inpLenenl thm in the i 980\ od I990 s. 

ll

RHZIKON: Risk Reweh Roort No. 24 

Limitations 

It hb b€er ou dbftion to Mke 1!e figws conccming the cost etrecliveness of rhe 

int*entiors 6 conpdade to oDe doihq 6 possibl€. The @sts dd efecrs of lhe ditrdent 

iniwertiors e@ onginallt calculated by ditrfttrr aulloB, in oey ces 6ing ditrdent 

methods. With this conlilado!. re h.v€ e.noed the compdabilily ol UE interentioc, but 

the read€r shodd be a*@ that large dissinildities in the cahdalion of inplied lifr values 

slill r€nain. For iNlan€. tle lives sved md the cosis m nol dieobted for all the 

'ntde ions. For th€ majonry of rhe inlwmlios ody dn@t co$s e included in 1h€ 

calculaiioG, 6ut in sev€lal cses it ba not heen possible 10 inchde a[ dn€ct cosls. 

Furrllmorc, for sone int€frentiors it is the ,arytal @sr per life sav€d thar is r'Esnted, md 

for othd il is ihe derase @sl per Iife saved. 

Ihe original dala on which the odsi.nl a!"iyses wft baed of couse plt a limit or the 

duct of ou Esuils 4 wll. In the &scnpdons of the inlflentions, we have tri€d n) 

enph$iz the linirations dd th€ possible suces of eno. in the dar6. 

As matiorcd edier, lhe level of inplmentation vdies froh tully imllenalet inrerentio$ 

to lartially implenented intwentions, to inreNenliors thlr have ody b€en proposed or 

proposd ad Ej€cted. Wlm the infomrion could be oblaiDed. the lael of implmdradon 

is nenlioned in the d6cnpdon ofde inplendration in tbe appendix. 

The sonflhat uc€rtain qu2litt of the data dd dte vdios levels of inplenenrdiotr both 

€srrain rhe po$ibility 1o dnw concluiors about inlestne! in lifesvitrg interyqtions in 

Swedeo, FDrth€noE, it is lDlilcly that tEse iltoaentions consritule s EpEMrative smpl€ 

of all life saving int€N€nlions. yet aoihd re6on to be cautious whetr dBwins corclusios 

Discussion 

The pEsent results slDw rial Swdish drd US life values d€ conpdable. P€lhaps the $aler 

ecorcnic resou@s ol SwedeD d€ @npeNated for by a ldce concm for safely. 11 could also 

be the 6e tbal diffdent comties t€trd, to some e*ren! b inilate policies of a lese, domimtins, 

po*d suh 6 lle USA with its high nolia saiiqcy od mdy inporrdt connibulions to 

Codd $cial Frionalily be inpioved if lesufts $ch s the pEsml orcs wE b be t len i o 

Mout? h is obvioa thal lolal equlity is inpossible dd pedaps also udesjdble, Hoseld, 

authondes dd polilicis rced, in oE vifl, be not asde oflhe inpliotos ofinen decisiors 

wfth regard to mst efeotivdesg Few ofthe figms presenred beE ap!€d to have been 

ebdaled by thos ma&ins tle decisions. Hene. tbey may find that they wish to revi€w sone 

of rhose policies, one the salyses hale bem made.

Rmsberc & Sj6bds Tn€ mst-etr€criveMs oflifesaving intenendons 

Appendix 

Benetsson E. Bergqvist D, Jddteg S, Lhd8rcn B & Pe6$n U. (1989) UltrdonosEphic 

sc!€ains for abdorunal aodic m€urysn: dalysis of susical decisions for cosr efrectiveness, 

Vorld Jou al of Suryery r3, I2ls it h pBenled i!: HelhE P (.1992) Hdhoel,anonitt 

ineeerikgstaltjer i Sftrige 1975- 1989. lppendit.lltE \lo:}iE Paper Seds, Lud. ll3l 

Abdoninrl aona eeurys (dAA) is a ldy senou condirion md uftaied n is virtually alxays 

fnal. Ii is miDly older n€n, aged 60 dd ov*, thal ger A a A 

There de iechniques available lo detecl AdA in patients, od it is lossible 1o inplemdt a 

scEding !roe@ fo! .ddA. lely intflention is importa wilh AdA, dd it is crucial that 

lle sdning lrogrm ained at dly derection is followed by tusery !tr Emove the aeu 

rysm. Two prce@s de disssed in BenClsson el a1.: he tust corsists of scEmins of all 

nen ased 60 dd older 4ery smtb yed. dd 6o with a menrysm N al$ followed up in 

intfleins yed. h ln€ seold prc$d, ody nen with a tnom risk factor de scleened. 

The bde-line alt€tutire to both prog@s is rcnal nedical ce wilhoul sceenjns 

The d4ision ro inplendl scr€eniq prcsrms lies *llhin the comly coucils or health cs 

disricts. i,iib rhe d€cision to opera$ is talen by the patieni md the phlsicio.' A prcblem 

facins lhe p,tieni is that the scresing cd give a false Positive indicalion od 1be op*ation is 

not wil,lout nsk. The nonaliry 61e for lnis kind of susery is estim$ed lo be beNeen l_12 

In the Bensrssn et al. study. it is estimated thar tre egecled nmber of life yeds incrcaes 

wirh d ayerage of t .8 y€ds if all men over 60 m scEned. If o'ny no, aged 60 or older' 

wirh a knou nsk felor re scEned, ine erpecled incEde is 3.7 y@s. 

fte cosl of scremins alorc is SEK 200-SE( 650 dd the aulhos be their calcL atio6 on 

the lo*r @sl, bul no redons foi 1nis de siv4. ln lhe cosl pd lile_yd sained ale the cosrs 

fo! susery, bolh aole md elective, de included. 

Borh costs ed life-yeds re discomr€d *ilh a di$oul 6te ol 5 percdr dd we 6sme thar 

fie osrs de !resenred itr 1988 sEK. 11!e msl per discomted life yed gained is SlKfl5llo 

if all na aged 60 oi oldd re scEen€d md SEK 13 j00 if only nen with a kno$n nsk factor 

' nris orcrusidn is &rM b) Htud 

ttrl. 

t5

RHIZIKON: Risk RMb Repon No. 24 

Th€ cost pd lif. s€d is not pr€mild in tLe &iicle, but it @ be cabdaLd slsuiDg that rh€ 

e!p@i!.d nuts ol tmining life y6 is for ex@le l0 't6, for tlis gturp of ?€ople. 

Tlis Illes th.t 1.8 life-y€s srtd oftsldds to l-8n0 = 0.18 liv6- Thu, th€ .osr pd lif€ 

wed is sEK 45J00/0.l8 =.5EK25?JZB if .ni Id .g€d 60 or olde re scH€d ed SEK 

38,800/0.37 - SEK 104.r6s if dny rer {ith a hom risk fa.tor @ sllt6ed.

R-fisbere & Srdme fte o.-eFecLiver". of Li'ev\ ilg in .n enuo$ 

Asthma 

PeBson U, S!fld P & Ode8Ed K (1994) Sanhtllelto"onisl,t ,nstnader @see"de a et 

Ciska beear Jbr bath/rM j S\erige I983- 1993.lll-!, /nba{cpport 1994:3 I37l 

Alergic dis*es iDclude aslhm, allersic denalitis $d hay fe€. All d!€e de comon in 

Swedfl. Nealy one niltion peopie il S{€den @ esrinaied to have sone $n of alldgic dis 

*q md 389.000 ofihse de esrinaled to sufrq fion 6dnua 

Ailhma dd olh* alldsic dise&s cd ca@ considfrble tro$le, ed L.lbma cm even be 

faial. It is estiMted dEt doud 100 p@ple die evdy yea in Sseda qth 4lhma 4lbe di 

recl mtre. Lr additiorl 4rnma contributes io flolhd 900 &talilies witholt being the direc! 

case of dealh. A deMing Eend in rsthna-Elat d far,lities h6 b€e! ob$ryed orq the ldt 

deades, but th€ p!€valence of d$ma hs incffid. Tne decEN in falaliries is nost likely 

dle to the aqilabiliq, of betrd dine iJstndt. The rea$N behind the incEded p€valoce 

@ not knowl but it cd prcbably be dplain€d in part by p@r hdoor enviNmdlal condi 

tions, wheE th€ qullity ofd€ v.nlilation sMs to be paniolely inlonant. lt sho'ld be 

noted thai ihis is most likely not lhe nosl inporlol faclor causins asdma. Olhd, prcbably 

noE jmporrafi, fados include sftoking and gaelic heEdity. 

The quality of indoor an cm be inFoved wilh the inProml ofreftilation sy$ens. In Pess! 

et al.. a nebde of air cnculation is sed lo estinare 1he percenlaee of the buildi4 stock tlai 

is in n€ed ofinDroved ventilalion. Ditrffil estiftales ofrhis nmb€! cm be made. depadins 

od viat lwel of tr circdation is 6sued 10 b€ sdlicienr. h tne Present calculalions, a nem 

oflhe hichesl dd lo$est esiimates q'ill b€ ued. 

The eFect on 1ne preval€rce ofddea is hdd ro estimte. In the r€port, a Efersce is nade to 

a Ssedish study ihai indicated a i0 20 peicent d€cree of allersic disedes following ib 

plorenents in indmr air qulity. However, this Es m b6€d on subFcrrle repons ot 

healh stat6, dd a n€dic.l chectu! co d not detect my inprcvemelts ir healrh ln the pres_ 

efi calcllatio6. a 5 Dercot decre4e in incidence of 6$ma is 6sued it should be noted 

tlat 1here is no supporl for rhis asmFion in the Epon. Iurthmor, a 5 pml decrease in 

aslbma is dsmed b Ed@ tne nmbd of dtlnaielaled fatalities by 5 percenr, which 

wonld nee 5 less fatalities. eullY. 

In rhe followjng, all costs ae pEsmt€d in 1993 sEK. 

I|e o$ of upCEdins the vdtilaiion in the whole stock of buildinCs in Sseden whdever 

n€€ssry, vries betwen SEK 7,200 niUion-SEK 24,000 nillion, dependins lpon Nhat is 

asmed 1o be a suficienr level of at cncubfion. fte dee of dis is SEK 15,600 nillion 

Wiih m asued life spo ol20 yeds md a disoEt ate of s pmdi.lhe calculated mMl 

co$ becomes SEK 1,25I nillion usins the ne& cost. 

t7

RHIZ IKON: Risk R*dcb Repd No. 24 

Asthrna gives !s to ldge h€alth ce costs ed 6sls from tn. bs ofprcduction. Rednctiotr 

in these @sls slDuld be snbteted Aom the @st of investnol in improved @dlaiio!. ln rhe 

repor! ir is efiMled tha! the diFcl cosl of healih ce in hospilds, for borh childrm ad 

addrq uouts ro sEK 1.232.7 mjllioa rhe @sr ofheshh @ in the hone 10 sE( 324 nnlionand 

Lheco.rolprcdLcnotr.osrsro SLK2.16!.4nill.oD.' A 5F@r.lecw in $.s 

msts is €{!al to SEK 186.I niuion, 

tf the smu.l inwsnne cost is Ed@d by rhe.6b eved for he.lfi ce dd prodEtiotr 

loses, the r€sdring mual cost is SEK 1,065 millid, A$ming tha,this investn{t sav€s 

five tv€s mually, dre cost pd life eved is SEK 2l 3 nillid. 

It ha to be sires€d thEr rle furB in the tron e very apptuximar€ dd wiiabl€. This is 

especially the c6e wirh €stimres ofth€ e6ets ofimprcyed vatilstion or 6tbm. ln the report 

ir is pointed out that noE snrdis d€ Bd€d befoE dy !.c()Imddaliom cm b€ bade. 

Al$, it is sid ilrat the crlcuhnos, whicn @ mt the see a the cdcdatio$ pr€* .d hft, 

siodd b€ rcerJded 4 qmpl*. 

The 6smed rcdtrctiotr itr falaliri€s i! th€ caloularioN pEerted above is bNd or the frtaliti6 

tlirecuy caued by asinm Il F6 pointed out dlia th* asrhm conlibutes to Imy nore 

fatalilis. I{owe€. ee have rct varu.d lo gEs lle possible reduction mong these addil8

d)berg& 

cldbss Thecor eFecti\ene.. of lifesa\ins ib'nd'or. 

Thrcmbosis caused by oral contraceptives 

Dalnb:lck B (1995) Test nir AfPc-rcsisrd lbF Fpilleftc€pt, Zakanid,ing.b 92: 4a,,4558 

456r [4] 

Thonbosis, or blood clot, is a clor of oagdaied blood that biocks the now of blood in a 

vein. Most often, tlronbosis is fomd in the legs, bln ir ce also occu ir olher plac$ in the 

body such d tlE bnin d lhe lugs where ii cm case life-tbreat€ning condilions. Oral onrJaceFives 

e know ro increase the lisk for lbsnbosis. Smokjns dd ov€Fwetllre other 

facror lhat indee lhe nsk. Rtratly a gdelic tuctor, the $ called A?C- resislecy. hN al$ 

The lisk oftlrcnbosis is nomally 0.sl/10,000, p€r ytr, but fo! peopi€ who re AIC Hislmr 

tne nsk is five lines highd. If d AIPC resisrdl mtm takes oral conrEceFiv6. there is 

a drmtic ir*6e in dr nsk. The risk of thionbosis seems b be lesest in dre fisl 6-12 

no ns 1!€ wIrE tades onl conramptiv4. 

A?C-resisrmy u be rcquned from one pd6i. in wiich ce ir is cdled hetdo4Satic rcistancy, 

or ton born. so calbd nozdrysotc Bisldcy. It the irsl cse, beterczygolic rcsistancy, 

the nsk is ircr€sed 35 tines if dre @nd rales orai conlieeptiv€s, mmpded wilh a 

sond who does nol&lie oral contraceptlv€s ad is nol APC rcsistm! od in lhe srcod 

cde, honozysotic Esistsnoy, the nsk is 200-300 ines as high. It hs been estimsted ihal l0- 

15 pdcot ofrle Swedish population have het€rozygotic APC Esistancy md 1/200400 have 

To conchde, the risk of lhrnbosis for difr(Mt Croups is s follows: 

0,5,t10000 

Wonen {ho rate oral mntraeptir$: 

r-2n0000 

Heterczygotic a?c €sislat peson: 

2,5-5n0000 

Homozygotic AIPC resisidt peson: 

2.5-5/10000 

Hetdozygotic AIPC Esistel @nd, who taLe oral conlraceltives: r7.5/10 000 

Honozyeolic APC EsGlant wone, who late oral contEceptives: I 00 200/ I 0 000 

Now' the risk of dyine fron thrcnbosis hd been estiMted 10 be 1-2 perent [29] Nole ibal 

this figue is nol bsed on lhe Ftio of*onen who m Eporled to !41€ died fioh dronbosis 

acluired d a side efe.i of olal cont&epriles, becaue in llis cN tle ndld or repoded 

tl&nboss is ioo smalL. In lhe lEsenl conl*, lle risk is Nmed 10 be 2 peicmi. 

3OO.O|)0 4|]0,000 SwedGh wonen tale oral conFaceptives. Assme that I 0 peGn! or 30.000 

won€n, @ heierozygolic APc.esislel, md v300. o! 1,000 mmen, d€ honozycolic AIPc 

!€sist!!l. civd the nsk estjnales p€sented aborc, 52.5 of the hebozygolic APC Esistant 

wonen, 15 of the honozygoti. APc r€sistdt mmo dd 40.5 of the wonen who take oFl 

coniJmptives, silhout beine AlC resis141 wiil &quire thronbosis in a eiven yw. he total 

l9

RHZIKON: Risk R€edch R€ert No. 24 

Mbq is da 108. If the nsk of dying is 2 p@ri,2.16 of the @men who acqune rhron- 

'Wirh a blood ,lalysis, i1 is possible ro detemin€ if a !6otr is AIC 6i$.rn. It hN b€o sug- 

Cested b' n@hd of the nedi!.I comuity, uorc othds, lnar sll wonen who take oral 

contraceptiv$ should be tested.' Tle only ne$w coNidftd h@ is that wona who d€ 

foud to be.A.PC r€sislanl shodd lor be prsiM oral ontaceprives. Any nnth€r mesuB 

thal @uld be tat@ ro EdEe the nsk for th* wonm e rcr inciuded in the presdl study. 

As indi€ted bv the cabnatioG aboE. 31.000 woma wornd b€ identited s APC Hislari 

tfall ofthm slopp€d taking osl mltu€Fives, 7.8 m'nd mquiE tbmnbosis in my evdt. 

T!u, 59.7 ws tuuld be psdt€d again, givd a nortliily nsk of 2 petu! l.l dearhs 

suld !e pEretrl€d F. Y@. 

Ilie @st of ore dalysis is alpexinately SEK 200. inctnding rhe @sl of m addilional test for 

ihe wmer wno re l€sted positive 1 rhe lrsl resi On tne individu.l level, the nsk Ednction 

@ be esdmr€d s de nsk of dying frm lhrmbosis aftd laving lak€n or.l cortaeptives 

minE the nsk of dying wi{Fut havilg rrtd oral oniraceptiv4. ft. lmbahiliti* of ditreF 

d! outcomes de desaiH in 6g@ 2, 

a rn. Hc i3 cllffidy ollabodting w 

nig G D,nblck I4i. who discov.Ed rhe APc resisb.y dd dcveloped 

20

Rmbdg & Si6beB: Tte @,1

RHIZIKON Risk Reearc! Repor No.24 

For d individoal A.PC rsisk$ rctu!. tle tolal pnbability of dying is tnu 0.0000045 in a 

giren yed, if she rakes orel conEaceptives. Silce the lmbability of dyine if she dcs ml tlke 

oEl @ntrmptivs is 0-00000052, the nsk rEdudioD achi€v€d with rhis test is 0,000004- The 

@st oforc l*t is SEK 200 drd tht giv€s e implied life vrlue of 

200/0,000004 = sFK 50 nilli.n. 

Ihe nmb6 !rce €d shodd be tre.t d with delibeErior! especially the esti@dior ofrhe 

isk oftbronbosis. whicb is bad on @ single study [35], lfth€ risk is &tl.lly highd, rhe 

implied life vale goes doM ed ifit is lo*ea lire inplied lif€ !€]!e goes up. Tle tesl i! iiself 

is reliable, ht it should be rcted i]rat some ofde hie!-isk lati€ s e detected without the 

16! ed hmce, lhe pDbability that a wmd eill test positive bidt be lower. 

A mnplication, whd it comes lo lolicy decisioG aerrdilg lhe e of 06l contac€ptis, k 

rbar a[ the positire ef6rs ofEing thd have to be rcgarde d ftll [35], Ior exmplq the 

risk of gefliry dmmbosis js glstly incr*d fd pEcldt MDetr. Ideauy, the etr€ct or lhe 

nub€r of pEglncie should al$ be tdla into eoui M&h of lhe de!€ie ha focwd otr 

ilF ieI4ed ris& with ihe lbird gdeEdor dtla.eFives @o!@d wilh the seold s€rcration. 

btrt tbat is rot the isu€ in this p€statiol 

22

Rnrb. e& Srbbe'C: r.ocr+Fe,Lvefsiof.ilesa\iDeinreneltionr 

Blood transfusion 

Eoemd CF, Lindholn A & Akdblam O (199, A,*skaiade thkz, ned blodta6fîon, 

Ldlartidnined 92: l9i 1999-2004 [14] 

In the dly days of blood tr$stusioa n w6 rct uusu.i that blood-group inconpalibili9 

qwd far.liti€s dong parienls. This is re roday, thels lo ef€clive seuiiy sysrem in the 

hmdlilg of blood, but sme orhd risks witn bbod tra$tusior !€min. Nomdays, 6l,ad 

t6,16,,, metu trmitsion of blood @mlorcrts. md this h$ Iiu$q reduced th€ nsk of 

transtusion re&rioc. Tn@ G also a nsk lhai ! vinl or belenal infeclion will be trdsnitted 

fion the donor to dr receiv€r. It hs long ben krom that hepalitis @ be trasnined bt a 

rranstusion. In Emr yeds, the nsk of HIV infeclion hs atimcted muc! aftenlion, al$ in 

public debat€. tlepatitis is a srioN disw. The latidr Nally Ecovers, bln lhm is a nsk of 

ctuonic liver.ondition. No esti@tion of rhe nortaliq nsk non hepadns is Civd in the 

snrdy. gMs the vitu thal caws AIDS and hft th€ norlalily is aMed to be 100 ldcent. 

Two orhd, closely relared, litues rnat m be imnitted e I]TLv-i dd I]TLv-ll. ETLv-l 

is knoM ro cause a leuologica.l diseae alin to ndlipl€ $lmsis, but 1ne dis€se is very 

@, After a lorg latency tihe HTLv-l is also believed lo caw a spaial fom of leutmia in 

14 pel1nt of the ctiq! ]tu non lity nt for lhis partiold lom of leukdia is not Eiva 

in the srudy. but here we dsme n is 100 !eM! lo avoid { udeEslinale. HTLVII has lor 

yel beo omed€d wifi dy dise4e. 

Sevehl ne4ues cm b€ rakm to potect latidis n n re@iving @ltaminated blood. Th€ 

6s1 is to rDke a selection ofblood donos dd nol dcell blood non donors wirn a krom or 

sNpected inlecrion. The nel:l n€due h to *reen all doml€d blood for vinses. Finally. it is 

also possible to d€contmimle 1he blood products wftn a method ofviEl decontanimrio!. In 

Swed€q all domted blood is rouli.ely scEded for Hw. leparftis (t}!e A, B tud C), mLVl 

and rflLVlL Wlile viral de@nlaminalion is not cmtly usel in Sweden it is ptuticed in 

sone @utries, wh€r€ the techniques in no$ nequent u$ ee heatins, lic}t heatneni md 

The tesl procedu€s N Eliable ad de nsk of gefiing m infectiotr nom blood conponents 

thai have bed lesled neeative is, ler 100,000 hesnEed blood uirs, 0.01-0.03 for HlV, 0.02 

0.3 for hepaljtis 4!e B md 0.1-l for heparids ryp€ C (HCV). Ifviml deconlamimlion is also 

sed, rhe nsk is fiItlE reduced. 

In Table 4, the cosi pq patim! pior€d€d asainsl trdsi$ion tesnined viral disese. is pre- 

23

RHIZI KON: Risk R€*arcb Repon No 24 

r^bb 4. Cost ps patient pfotecte.l asai$t nonsiaion trMitted 

1995 SEK 

viral Aseak, in nillio, 

Te of all domEd biood 

0.8 

AIti mtv-l 1,400-5,600 

M6lG o€ dd alove iesting 

Viral dsrtaEtu tjdof plma 50 

6 monLb qumr'line of pL6da 100 

The cosl pd liE saved is sEK 0.8 nillim lor HIV- lor IITLV-I the mst pa iife eved is SEK 

1,400 mnloD/0.04 - sEK 35.000 nillion if a mrtality dre of 4 pftat ed a cost of SEK 

1,400 miliion !€r pro€cted patient h Nued. Foi HCV il ii not posible to cabdat dE @sl 

Ior m€ua ovd ad abow lesline. such 6 viEl d4od,ni"ation dd qllmtile of plan4 

rhe cost Fr lif€ sav€d is bighd. As % ndiided @lier, lh. risk of g.nine llIV Aom biood 

fiat h4 bem t sted n%aiire is a! Ue non 0.03/100000 blood ei1s. Iflh€ norlality mr€ is 

ssmed to be 100 pd.Dt for the i.f@ted latidts, which is e ovftstimtio4 lhc cosl pd 

life eved is SEI. 50 nnr." for vi.al de@nLeinalid of dma ad SEK r00 milion for 

I! Hoerm e1a1., ir is stressedEt lhe 6e!e peoted in th€ articl€ should Dot be ser 6 

abslm€ iruths dd iiat soEe ofthe estinatiom re iMcue becaEe ofthe sall lEvaler@ 

of viru in blood prcduds. The cosr etrectirercss od Ei?tive benefils of rhe ncdms d€ 

24

Rm.bers& < dbng ft e cos.-etredi \ eless or I ileevios inh enrom 

Mammography 

Iotuen E & IleLsson S (1986) Ekomniska konsekro$r av nmogransk 

-ean\enlk]- Lakamdninseh 83 : 2050-2053, ll8l 

hinsokonlroll 

Ludsren B & Medin B (1981) Hdge koshadq nen beexinsad vinst ned ivebildsmnosrafi 

wid !l@ni4lg, U r*,/td, i"Ceh 18: 2455'2451 I28l 

Bodlh anicles pi€snred ir H€itnn | (1992) Hdlsoetnnahiskd ihraldi,sstul$er 

1975J989. AppehtlL\, IHE working PaPer Senes. Lud, 1992. [13] 

i S\eriEe 

B@t @cer is the mosr comor fod o{ cscd in mn€n I! Sweden atpronnably orc 

wond oui of el4en {ill ger hreast cscd dEing her liJe time Arcud 20 percenl or all 

bre6t 1@os de Dralien [2'l]. 

As eith nosi foms of ce*r. swival 6tes e hishd the @lier the ce@r is detected Al 

p,esn_ 1ne. 5\e r@ rdâ .Re, b@t dF s 65 percenr D s*ede ' lr4l (wi\d nk 

ba\e dcrded in Lhe l4r de-de.. mn) due 'o ediJ dek-rion wilh nffogDp\J 

' \rm_ 

moerphy is a ladiological t€chnique to de&cl br€Lst @cer that is u€d in ldse screenins 

prcgtus in mmy oufies. 

In a namography, €ilhq one or two pictu* 

noE a4m1e, bnt dso nore expensve 

cd t€ iak€n. Tm-pictue hdmocraphv s 

In the followins, all p.ices d€ in 1985 SEK. The exP€cled let @st pd lati€nl G SEK 140 for 

one-pictue llrMosnpht dd SEK 165 foi No_picir mamoetphy. T1E acnral scni4 

pro€d@ in itser costs SEK 30 noE for two_piciue nalmosapht 4 onPred to one 

pictre mamoeEphy, bul it eiv€s lisler specincity. Accordins 10 Jonsson ard Hdkflsson (J 

& lt). 70 cdes of bEst c@6 de detected in 10,000 *Eened *od€n sith one-picture 

nalmoaEphy. By usins two-piciw mmography iNt€ad, the nmber of dele€ted cdes 

incre6es to 70.5. In Ludgren dd Medin (L & M), this is slated 6 d incEde in sensitivitv 

nom 9410 95 pmt. fte cost of ore additional detected odcer is SEK 500 000 in J & H 

Norc of the studies ciled presdi a @s1 per life or cost per life_t€d estimale Ho*eldi ir it 

H b€ dsmed that non,liiy rates go doh fton 100 to 35 perc€nt th€ cosl per life saved is 

SEK 7?O.oOl]. wilh J & H's figms, Eoweve!.lhis nsk reduction is probabtt o!ftslimaled 

since it /esupposes thai the cecq vould not be detected utii il w6 loo lale if it is not foud 

h lbe seenins. If we instead 6sde lne risk red@lion ro be 30 percenl. the cosi per life 

sared is SEK 1.7 miilion. Wilh m 4smed lisk Educlion of20 Percen! the cosr n SEK 2.5 

' Pal Hovd{, fin ir cuftdly a m..h debded nsue in ssedh se ror *mple t55l 

25

RHIZIKON Risk Res*h Repor! No. 24 

fte bs*line alten8tit h@ is one-picru€ IMoSEply, tud nor th€ @nplete dcluion 

of Mography, which is imFrtaDt ro ke€p ir dhd It shornd a&o be noted that th€ @sr 

estimt$ dare to 1985, but the swirEl Etes e Aom 1990. T!. @st p6 life saved estimres 

shouid be trcat d wirh good dis€tio4 esp.cially silce rlE ttu wival 6t6 haye nor bm 

ilclud€d. h addition, the cost of tratuenr aftd tn€ mer na bsa d.neci€d is tur included 

dd the r.sdt could ch{se sonewbnt if ir M ircluded- 

Tlft i a orgoilg d€bate whether 1|€ b.Eits of namognphy onlweieh ihe @$s IrE 

cos! pd life saved is said by son lo b€ hieh. ll}at is noE imlotr4t, ndy Mnetr lde to 

be tesi.d 10 detd jusr a fd 6es of br€asr ceq, md oey will be tested false posirire in 

the prccess. Iltis @ues nDch lllrmesary worry dd 416 @sir. 

26

Rd bers & SjobeB Tle \ ot ef

RHIZIKON: Risk Re*trb Repon No. 24 

d@d by ihe savirg" socieD males i! dimiqi.hed bqlt! @ 

Ail osts e prcsred in Table 5. 

'hble < Cons ol a Ee*ral va..;norion ptosaq Jq di&tekt 

heabh carc ud los in prcductio"fon 6 epidffiic itlluw. 

cosls ard loses in prcductio!. 

W^ of i'||reM atut cos^ tu 

A costs inni iM 1980 SEK 

H2N2 

H3N2 

veinallon q€alrh 6€ Los in pc Loss i! prod@tior 

owing duotion owing 

toilln* to faialiris 

2,439 

241 2,890 5L2 

4,326 

591 2,946 655 

Roos has calcDloted tle cost per qlality-adjut€d life,@ fo! ditreEnt age goup6 dd th*e 

@ pBdted in Table 6. The Gsueed .trecl of the v@irc is 60 pet@t in the cslculstio* 

pEssrl€d in Table 6, to @ouDt for lhe &.t that th€ rcdncri@ in frtalitid ed halth cN 

costs e rcr 70 !q!e!t. In the osl ps qualit-adjsted life-y@, the

Rmberg & (j6b.1g: fte 6cl

RHZIKON: Rilk Relemb R.pon No.24 

Physician assisted ambulance and helicopter emergency medical 

services in the county of Vasbmor and 

Smdst€n H (1995) ,4nbdMhelibpnar i V.temoriandt 1994 t995: er utualdefinE, 

t6dstincer vtnmonltud [54] 

P6son U, Odegr.rd K & Brisl@ B (1994) Elahohkla Bpeldd pA hebkopErahbulans i 

r'riaddrt ar, IHE AJbetsnpporl 1994:4, Lud [40] 

Ir cerr.in ttles of eidenls @d illnes, il is ctuial rhat rh€ pan6l r€ceiles E€nnent s 

pronptly s posible. The dme it rakes to get rhe patidl udq Fopd ce mo$ ono delends 

on th€ dislane b the na€st hospital. ln sldely poNlaied ed llis distdce cm be quite 

ldge. For islatre. ac@rdi4 1o dat! Aon the USA, 26 pde of all oad trcident falalities 

codd be avoided ifthe accid€lts occ@d in noslirll eneqeocy &oms. 

Erdples of sitnalioff ir which erly tr€atnent is oiien n{6ssrr 

emqgen' cddiovdLuldcondir'or od in'iie. b Lle sDire 

ft sevele rcad accidenls, 

To red@e ihe rime il tak€s to Fovide plopq nedical cde, n is possible eidrd to give noe 

adtued @e at rh€ site of the accide or 1o Edee lhe sdspoiation tine, or both. In 

spffiely lopulated es, in particdd, helicoFm re uFd for mersmcy t:aspon. Th€ heli 

copter ce be stafed in difierent Mys, depadils on the g?€ of missioD for which ir is used. 

ft @ swe d a tying mhdd@, wirho$ a plysicia.. h which qse it is ued for quick 

tmsports. This is dre mosl colmon nodel, in fo! ffiplq the USA. If rhe helicopler h 

st tred with a physicia!, or in sone c*s a qualifi€d nNq adequt€ cN cd, for $me types 

ofrccidmc, begin alEady at the sii€ ofthe accidenl.o In Gmmy. wheF helicoptqs primdily 

re u*d in codedion with sevft road rccidenls, all helicopteE de sr.fred $ith physi 

cids. Als in NoNar. whft ldce distac€s re colmoD, all helicoFe$ de *.fred vith 

Ir is also possibb ro hale special dercmcy cm {ilh phtsicias hd tley swe rhe purpose 

of prcviditrs ldequle cde already al the site of rhe endgercy 

ln th€ @mty of Vdslemonled, whic! is a ldse, r€lariely spffiely popdated couly it the 

Non! of Swd€!. a nes model for pre-losPital enersercy cre h6 beo lesied. The usual 

mb de swice, FscN sflice dd prilEry hellh cae h4 been conpl€bsted by emdsency 

Es wilh physicims and h€licopreF 6si*ed bt pbysicim. The helimpier bNe is situ 

aied in Suds!€il ad h6 24-nou seNie *ith ashling lhysicibs. Enersency calls de 

taker bv the SOS swice. 

ii'dquie, md a quick tuspon b in e. $n i5 ndt valid ror 3.ut coft 

isbes ftom hosPib!: I' ' l 

l0

mbe€ 

& sjiibers: Tte con-elT4ivftesc of Lifeevi.s irEEdro6 

A part olthe trial peliod, Octob€r 1994 to Augnst r99s, hd b@! evahared. In alt, 7r4 s- 

sigM€nts wqe eeived tud mud 70 pmar of th.se wE hddled by d emerEacy cd. 

The nedical vahe of the rr@tn€nt for lhe patienis h6 bea €raluted e@rdilg ro dte so 

caled NACA eale by e desor€siologjst with long tem expeidce in emergdy @, It 

w6 found dDt in 2 p@ ofthe 6*, tnai is 13 !ati6ts. the c& savd dE paridfs lile. 

Tle total @sl of physicie ptese@ in 1h€ nelicoptd dd the ddgeDcy 6 is approxibat€ly 

SEK I milion per non{l Sin* the €valuiion peiod is 1l nonlbs, tle roal cost is SEK ll 

nillion ed with 13 sved lives. the cost pe! Iife eved is sFJ< 0.34 nillion. 

The drta cmemins lhe effect o! swival should probably be teated riltr delibeEtion; oDly 

one expert m involved, ed lhe mple is quite $a[ lAis is also pointed out i! r[e rcport, 

but il is also claimed that th€ nmber of eled liv€s is comD@ble to *tEt hs been foud in 

snrdi€s Aon other @unies. 

Al de lBar nomd! the tutue of the Fogm in v&lerlotten ls very becE. Ile lrial 

tqiod anls in Deenber 1995 dd aftd that thea is no n&ding for the pmCrd. 

ll

RHIZIKON: Risl Resdh Repoft No. 24 

Helicopter emergency medical service 

tqsson U, Odegaard K & BrisM B, EkDhoniska dsp.klet pA helikopteranbularc i 

i,ianldrtadr. IrIE &betsralport 1994:4, Lud 1994 [40] 

In carain ryles of accideds ad illnss, it is hcial dDt tle palielt rcceiv6 t!€ahrdt s 

!rcndly 6 posible. The time it r.les b get the patient Eder prcps cde most oft€n dep€nds 

on ihe dislm@ 10 the rcrest lospilal. h spasely populated a@ this distance co be quile 

l,ig€. Ior insrdce. @ordins io data fiod the USA, 26 p€Gnt of all rcad accidenr f3ialilies 

@u]d be avoided if the accidefts occutr€d in hospitsl delgency oons. Exdples of situtiors 

ir q4ich €rly treaErmr is oiien lecessary re seve€ turd &cidents. enelcml cardiovdculd 

@nditiG md injuies to rhe spine. 

To Edue the tine t btes ro provide props nedical cre, it is po$ible either to giv€ nore 

advs*d cre at the site of the accid.nl tr io ledr the lr€sDortatior time. or both. In 

s?dsly popdat€d d€s. in particuld, nelmple4 m used for mds€rcy trdsport. The heli 

copttr 6 be statred in ditr*nl Mysi d€pending on the E?e of ntsion for wbich il is used. 

Ir cm sen€ 6 a flyinc dbulecq wiihoul a physicim. in which c6e it is used for quic! 

rrtusporis. Tbis is the nost co@on nodel. in for Mple, the USA. If th€ heiicopte! is 

srafr€d vilh a physicie. or in sone @s a qulli6ed-nNe, adequle cde 6, for some trTes 

ofa€idenrs, b€sin al€ady althe siie oftne aeidenl. ln Genmy, whqe helicoptes pnnd 

ily e wd in come.rior *ith severe road ecidols, all helicoFers N slatr€d wiir physicids. 

Ale in Nosay, wher€ ldge dislancs d€ coImon. all helicopleB de slafed wilh 

In th€ reporl,1bree altemative s6 ollelicoples m di*usd: 

1) li€licople$ wiihout a physicim oa dre siaff 

2) Helico e6 wiih a physnia on the sbfi. in spdsely lopulated e6 

l) Heli@pte$ wilh a physicim on t\e stali in ubm al6 

h Table 7, the msl p€r life sav€d for allemtive uses of helicoples in eme4ency medical 

swice is preseni€d. lhe cost+Eecliveress mtios Prese.red e b6ed on ndeirDr imprcvenots 

in swival with helicolter mergdcy senice 5 compdd to ordinary mbdmce 

snie. Note that ody rcad &ciddh e coBider€d. All costs e pee edin 1990SEK 

nq conditions or accidenb ar l4e dihcs 

ftom bospibk tt ll. 

12

Rmb€ig & Sj.ibere: Tl€ cosr€fecnveness oflifesavile inrdeniioN 

1) Helicoplcr r{ilho$ ? lhysllia! !!$c !a Every ddgency call with e mbutdce is 

estinated to cost SEK 1.000 in ubd a@ ed SEK 2,000 in spusely popdaled rea, Ar 

eneigflcy call eith the helicoller dbdece js dsmed 10 cosl SEK 27,000. Tie line it 

lalcs to instisate adeq@te medical treaEirhr is 6shed to be reduced. on ine average, fiom 

60 to 30 nilut€s in spasely populared @6. No efecl is 6sued in uban ded. Tle nd 

sinal cost is th$ SEK 25,000 for spdely populated ae6. 

The ffiginal €Eat on swival. yhm using a heli@pler imtead of e mbulanG. is 4shed 

10 be d increase in the swival rate wit! 8 p@enl fo! road ecidenls in roa1 ma. Asshing 

that the dsk of dying in a road accident G 8/100 000 p€r y€d ud thal on€-lhird of all emer 

gency calls silh the heliopler ue foi road rccidelts. the cost !€r life sav€d is sEK 3.3 tuil 

lio!. 

2) H€licorkr sith a nhvscis .n th lf the helicopter is 

staffed with a lhysicim, the mst h estioated lo ircrese with SEK 8,000 per emdgency call, 

dd ttre tine it lates to iGtisate adequte medical treahre is nfiher Educed, doM to 20 

ninutes. Slrvlval nles wodd incEde m addiliomL 4 pdcert drd the mst ptr life saved is in 

this c6e SEK2.l nillion. 

Nole thal the be line altmarire is, in rhis *se, a helicopter witLour a physicie on the stafa 

If inst€ad, fie bae-line alr€mtiv€ $€s m ordimry ubulmcq the cost per life saved wornd 

beS-EK2.9!illi.!. 

3) HEtielllcr&lh a pbrslliar-oallE-lleff-i!.rllbclilesi. Iris nesN would increse rhe 

@srs jus! d nucl d it do* itr spffily populaled N6, bul the Iusilal iDcrede in swival 

d€s mdd not be 6 high The tine ir bles 10 tzsport the palie ro adequate cm is d- 

smed io be r€duced by 5 ninules, frcm 1510 l0 ninules. on tne avenge. Swival iates m 

4smed ro increNe by 2 pelcm! Bhich results in a cosl pa life saved of SEK 17.2 million. 

ln additioa a model of swjva,l a a nDcian of tine fo! lrspon h6 hee! elimated for diff€lent 

parts of Ss€der Th€ co$s md health etr€cls ofhelicopre! emersenc' serie in tle 

couty of V:islerbottd d€ ued as m applisble €mple of the model. 11 is uLculated that rle 

probabiliry of swival goes D! 7 percdr at a cosr of sEK 12,800, which gives a cosr per life 

sav€d of SFX 4 7 million. 

radble 1 . Cost pq life s@ed fol alt.mative uses af helicopter ehersehct, dedi@l seojce. Alt 

.asts in hillioh 1990 SEK 

lMlh physdan 

Spdsely popdared ee6 | 1.3 

Spdsely lopL aled aed 12.9 

Uibmde6 | l7.2 

Vs.elbonen I z 

Wrihout phtsician 

The authos sbess rhar 1h€ fieues presenlel should be looked upon wiih eood dieErioD. ad 

they seE only 'niended to seNe s h)"orheticar exmpl€s, bNed on nlher rcush eslimtions. 

Al$, due lo the lack of SredGh dal4 NoNegid dala ns been used for *yeEl of the esli 

il

RHIZI KON: Ris! Resrucb Repot No. 24 

Haemophilus influenza type b 

Tmmns B (1994) Cosl-benefir Analysis of Gffial vminalion rgainst Haemophilus iniuetJe 

typ€ b in Swede& S.adiwim Jomal af lnfect. Dieet 26:611614 I59l 

iladophilu i!flllle 9Te b (IIIB) is a siou infecrion 6at dong oth* ilrings cm caue 

nqi4itis or acute epiglonnis wnicL ar tml lor childJer! cm lead to neuological ddEses, 

dditory inpaimed, and in sevd€ @es dea6, Sildies have shoM that duirg de yeds 

198!83 thee w* on dr avdage 157 @es of haeoophilu innwM GII) neDinsitis in 

chn.Lo 0-14 y6 old ad I62 ces of &ure epiglottitis in childs, .tll of $lich in the pr€s- 

€nr cortext e ssMed b be @ued by HL It is ftnler 6smed tha,l a.[ 66 of El de 

caued by EIB- The etr€cts ofHIB on childreD, in d a!@ge yed m: 

- Six chil&er die mualy Aon HIB dise$es in Svedo. 

- Tso chil.lrEn develop sv€re ntuological seq@lae, Equning chronic @ ar d istitution. 

Tsenty childrm d€veiop l€ss sw* 

luologicaL sqEl&. 

Twnty childrd develop audirory inpaimml followinc liIB mdingids. 

In t99l ad 1992, two vaccires against HIB wele liceNd by the Medical Prcducls Asency 

itr Sw€dd. It {d @oImdd€d tnai all bGnts should b€ ofeEd a HIB Eccine fre of 

charEe. At fialj ene couty coucils w* Elucr{t to ofe! the l{B r@irc, since it is nore 

erTetuive rhm olhe veiles otrered 1o infan6. Hower, since 1993 aU @bry coucils 

o1ld the v&cine ne of cnffge. 

Th€ HIB vaccine is offftd sindra€ously with other Ecciles for infets, $ch $ diplrthena 

polio fld tetdu at 3. 5 od 12 monlhs of age. h lIEy @utries fou doss of HIB d€ recome 

ed instead oflb€e. Two co rolled studi€s nave shoM thal HIB conjuerale v@cines 

e noE rhe 90 percmt effslive, bul sone 6es of HIB rill occu eva afier sereEL vui 

nanon. This is dE 10 fi€ fact that sone iifants nave not yet ba vocimted, or hde only 

ln the follosing, all c6b de eiva in I993 SEK. 

Tle cosr of one dose oIHIB vrccin€ is sEK 125, Given rhal appioxinalely 120,000 childrer 

de bom i! Sredo every ye&, th€ total mual cost of Coral veinalion wilh lbEe doses is 

SEK 45 nillion. With fou doses, the mual cosr ilcress to SEK 60 nillion. 

Howve!, soci€ly als h6 gaiN non v&cinadnC inf@b againsl HIB, in llc fom of costs 

that de avo'ded beause ofrle saller incidence ofdisdes €wd by ItiB: 

34

Rmbss & Sj6b€rg: The cost etr€clivaes oflifesaling itleNduons 

ll Two chrldre! develop seveE neuological Fquel&, tquirins chrcnic ce a1d institulion 

for which ln€ musl cosl of this cde is SEK 18 nillion. This is uder lhe dsuption thal lhe 

cnil.lrm live fo! 10 ve6- 

2) Twmty children develoP les sevde lewlogical sqlelae Tne 'nnul cdsts for 6ese chil 

dr6 re dtiMred b be SEK 8 mnlon. Tlis 68rtre is bded on a studv fiom lhe UsA ad il 

shodd b€ rcted that these c6ts de tul n*essdnv lhe sde s in sweden 

3) T$@ry child&n develop audirory idpalmdi foilowing ItiB menjnsitis fte €slimaled 

mud cosi for these cbildrd is SEK 15 nillion. 

4) Vhd the childier &€ sicL pmrts will in Imv c*s bav' r' 6e *senl ft6m wdk md the 

tolal mud cosr for this loss of prodetion is estinared at SE( 3 5 nilLion 

5) Eoeiraliation due to &ute disse n6 d mud cost of SEK 10 mnlion 

Tle bral @Dd @$s lnus avoided mout to a ndimu of SEK 54-5 million. Ifthe €fr@- 

riven€ss of the uccimrior is 6smed 1o be lOO !den! the wnole rcduction is !€alizd ad 

society {ill make a nel mul evirg of SEK 9.s milion, given ln41 dtr€e doses is slf Ecienl 

fte @sl per life sred will thd be

RH\ZIKON: Risk Re*mh Report No. 24 

Hypertension 

sBlJ (1994) Matrgt lrht t blodrFl, sBU Eptrl r2l [44] 

Johmsson M (1994) TlE cost-etrectivaess of rhe switch lowdds more €r"e.sive mtinyperlznli!. 

dngq Heabh Poncy 1994: 28i l-13. 0 61 

Cddiovedd disess d€ today th€ most comon caue of ddd, in r$em $cieries. The 

nsk ol cddiovdc'nd diseN* inc@6 with incEaing blood pressE. Th€ upper limir of 

rcnd blood press@ is uu.lly et at 140 m Eg sysrolic dd 90 Im lls diNrolic. Above 

this, blood pEssN G sid 1o be lD"e/teartd. wld hlTertesior occ$ simdl&eously with 

sigs of damse ro the cddiosola! system. it is comideEd to be a palhological condition, 

bhelen bbad yesste diw. 11h6 been estimated that apprcximar€ly 20 !€lcenl of the 

Sw€dish populstion i! rhe age 40 70 tai or aboui 600 000 psple, in repsred neaue' 

menrs have a di4tolic blood pressue above 90 m Eg. Io. people older thfl ?0 yem, olher 

rln€slolds apph 160 Im Hg systolic tud 105 Im Hg didtolic. Approximately 350 000 

people re above this lini!. 

In 1!€ Crcup of40-70 yes old $ilh !$erteDsioD, half ofrhe populatior lave a diaslolic pBsu€ 

b€iwed 90-99 Im I&. Ofthse 300,000 people, pob$ly about 200,000 hav€ rh€ nildesr 

fo@ oflylert€mion, thal is a diaslolic lressm betwen 90-94 rm Hs. In all, 500,000 - 

600,000 peopl€ rceive tr€atrndi for hFerte6iotr in Swedd loday. Appmximately one-dird 

e aged 70 yeds or olda. 

A hish hl@d pressue ce be IoreEd with phanrcolosical treanrenl. shich in nosl ca€s 

nnsl be iakn rhe Imilds of the patient s life. The mlihy"ertedv€ drugs i! non comon 

use de b6ed on diwrics or beta-blockeB. The €feclivoess of these dncs t well esrab 

lhhed in clinical triars. Tnft re also nor€ Eenl\ developed dngs in uq such s calciM 

di.gonis! alfa-block6 md AcE-ifibitor, but tn€ effet of th€s dngs. on norr.iity ed 

mo.bidity, hd nor yel been shoM in clinical trials. Non-phmcoLogical trearnml is ln eene6l 

diected rowrds ofiei risk factos for cddioscuid disses thm blood pEssue. Most 

ofrn, r1E aim of 1ne non-phmcological treatu€nt is to chm8e the lifeerle of 1be parient, 

wilh respecl to smoking. dielary habits, alcohol consmption dd exdM. 

TMtIrnt qth dli-hypertensive druss redEes the incidetre of (apopletic) stoke by 35-40 

perent, hd for older ase sroups. sler strokes re colmol! lhis h a substantial gdn. Re 

gaiding corcnary hearr dGeses, treatueDt with dtihFeftensive drugs h6 ! relatively minor 

eff*t dd the redncrion of lhe risk of a heart attack is in d)e 6ge 8 16 percent. Also, n 

sholld be noled thd rhe nsk of tutw illness for h,"ertdsie pade s is 10 a lase e\1ent de 

pendert on the sinultanons pres!€ of olhq dsk factos. It hd for smple been estinaled 

that sith nild lyp€rt€sior. siine up snokilg h6 a Creab ef€ct on 1he prcenosh, tbd 

do€s lowdins the blood Dressw. 

i6

Rd.berB & Sjdbns The .or-etreclveness of lfet:qtrg inlenetrtioN 

M W 

90-9,1 681 r.805 26 

9s-99 55r 1,328 C) 

100-104 438 931 C) 

>105 2a3 422 C) 

f)=.otpnlifr05 62t 1,114 G) 4 C) ( ) 

(-) =onp{ lre yees,ined:0 

11

RHZIKON Risk Reseaich Repot No. 24 

No clinical taals lEv€ shoM o inprcved risk r€duction fo! ACE idribitoB md calciu d- 

tagodsts ovd druetis or bela-btockds- B6ed on this, the Ecom€ndation in the study is 

that AcE-irhibftos dd calcim mt gonists shodd be ued Findily whd dim1i6 dd 

bera-blockds d€ connaindi@r€d. In Table 10, rhe cost per lifry.r eaincd for rreahenl wi*l 

AcE-inhibiror or calcim dlagolisl conpded to ftatnent with dimtics or b€la-blockers is 

'l.ble 10. Cost per life-yeo gainea hr &dtuekt ,th TcLinhibitot or ctlcith dhtaqonist, 

conpu.a b teatmeht with djoetics or bettbloctni The rlieount tute is s per.ent Jor both 

costs dntl life yea8. m. period oftreatnent is aae !ed, isk rcduction lor CHD is 16 percenl 

and for apopte.tic anokt 38 percenL All casts in tho^dnd SEK, 192 pricq 

- 45 yem 45-69 70- 

M W M V M W 

90-94 919 6,238 r4l 647 105 171 

9s-99 776 5.622 115 592 92 159 

100-104 651 5,029 19 551 83 r41 

>ros 486 4,288 54 496 67 132 

t) = m* ps rifeyer gained: o 

It woDld @slNud SEK ore billion 10 tqt all people tftn nild hyped€trion. Tle msl pd 

life-yed sained for patimls with a distolic blood !ess@ of 90-94 Im llc would vary betwe6 

SEK 8,000 for wonen ased ?0 or oldd ueated wirh diwlics or beta-hlockers dd SEK 

3.l nillion for somer udq Ll€ ase of45, tleated wilh ACE inlibitor or calcim-mlagodst. 

h Table 2, cost per life eved is al$ p6enled. The cost !d life saved is cilculaled by ndtiplying 

d€ cost per life yed with the erTected Mber of Maining y€4 tbe ditrqent age 

srcups bave. lor palimts ud€i th€ ag€ of45, th€ life-expeclaDcy for 45 yeml.ls is ued. 

Ior patiois 45-69, the life e4ectarcy for 5, yee-olds is sel. dd for 70 yeds dd olda, rhe 

life-qpectancy for ?o-yed-olds h Md [53] 

It shodd be noted l,\al the @s!€faectiveness of Feiins a spedific patienl within uy of these 

caEcones vri€s. It night for idtance be cosi-etreclive io ftai a youg mm for hnerlension 

ifthe€ e sevdal olher nsk hcro6 p!€*ni 

t8

Rdsbdg & Sjobeg: The cost-etrectivqss oflif€evins ifteNmtio6 

Lipid lowering in swedish primary health care 

Johm€sson n4 Borsquist L, J66son B & Lindloln L (1995)The Cost Efectjlere$ of 

Lipid Lorerirc in SwdGh Prindy Ilqlth Cm. Sunnin€d nr "LMI of lntertut Medicine 

t17l 

h Swedo. @diovascdr diseNs e tne mosl comon €e ol death. Today it is sell 

knom that de ris* of ddiovGcrnd dises in@es {ith incEalng seIm cholesterol 

So call€d h}?erchol€sltulmia is &tned 6 a stu cholestml level : 6.50 mol/L. Abour 

20-25 pecnt of the aduh loldanon in S{e.ten de estinaied 1o have a strm choleste.ol 

level > 6.50 Imoyl. which nakes rhis a pnblic h*llh problm of c@sid€rable sia. 

h Sweda roday, lhe inirial rc()mended treatn.rt for hDmhohsterolMia latidts is 

non-pha@ceuticsl tr€atud! includine, for *dplq dieiary nodifi€li@s. tf dris does noi 

lower the sff cholest€rcI l€vel beiow 6.50 ImovL, phmeeutical tatn€ is recon 

In rhe Jolm€soq Borgquist, Jaisson &d Lindlola shrdy (beMter ctll€d JBJL). the aim 

ed to c@!e fou ditrmi st alegis for lowine chol6terol levels @ong niddle aged 

nen. To he eiigible for ilcluion in the shldy, latients had io te aged 30-59 yem, nave nodda& 

blercholesr€lol*mia dd at ledt two other cardiovdcula nsk lactds, foi empl€ 

.no.1e. obe"i$ ortlGd*ron fte.mege. derhefo|ow dC: 

l) Us!,Iadvice only, $tr* the latienr is given advice by a d@tor to chmge his dieiary habits, 

start exmising dd quil smokine. A ldlhlet on the sutjecl is ale hmded oul lo dnmce 

2) Us@l advice, s above conbined with phmaetrtical tatnenl co6isting of the lipid 

lowdine dne prdatat,. 

3) Inlensive advice only, mdsli.s of the uul advice givs by lne doctoi md also Etoup 

meetings led by hcafth cde €xperts. 

4) lnlnsive advice conbined witb phmeutical treatnent. 

In liie &tu,l study, strategy one M ercluded baause il did rcr ]rave ay efi@t dd slrategy 

fou s dcluded b€€se it had $e sme effecl a sirat€gy tvo. llence, stBtect two dd 

39

IJ{IZIKON: Risk Re*e(n Repod No 24 

Tbe najorjiy of p€ople silh b"ercholesttulaenia d€ mea niddle ased md old€r, bln nfry 

*oner als have ht!@nolestercLaenia. Eowe!. i! the JBJL study o.ly niddle aged men 

h lhe followine, cosrs re calculated over a peliod of a y€ ad a hali ed reported in r 991 

SEK. 

For srJa&sy iwo. Domal advice ad phmacdtical ircal,nar, 1he calcdaled cosr is SEK 

9.700 !d patiert. Tle calculated cosl pd ladmr widl srmt gy thrce, inlesivc advice only, is 

SEK 6.400. Tlse estimatim inciude th€ @srs for mN lations and grcup n€etings, laboratory 

iesls, patienis line ed tavel er?Ns, md dngs. Ihe msl Per life-y€d gained dePends 

on the asmed etr€diveness of rhe ftalnent ln rhe study, rne msl per liJe-y€d gained is 

oalculated for two levels of red&tion ol corolary hean diese (CED). If the reduciior of 

CED is fie epideniolosically expecled, (d !rcdicred non tne FIminghm risk €qurior for 

CtD, adinsled for rcsr€ssion dillrion bia) ihe msr per life-y€r gained is SEK 0.37 nillion 

for stateCy tso dd SEK ] l4 million lor shregy 1,1itr. Tle tull €pidmiolosicaliy expected 

Educlion in norrality niell !o! be rcalie4 oainly b€mse il codd be out-baleced by a 

simne inc6e in nortaliiy fion odrd eses, To eoul foi rhis, the cosl per lif€-yeu 

gtned w6 calculated also for 1!e c$e of a Educrion in CHD at 50 peeoi of the epid€nioloaically 

expecled. In thi. cse, the cost pq lifeyee gined is SEK 0.85 nillion lor slraleet 

No dd sEK 2.8 nillion fd siraiesy tlEe. Ihe cost per life yed gained is pr€sent€d in Table 

I l. Nore 6at bodr cosls md rhe life-yeds gained @ di$ouled al 5 p€rcenl. 

'lable rr. Cost per lde-lea/ gai@d with dttq.t neatuent stategies ta 

tetul lerel i, nek, ni.ldle dged Md older; snatug 2 n 6ual a&je 

\not?E,! i intctu'veod,\?onlt .an dpinSFK IooI p|ces. 

100'" of erpe( ted cHDFductiotr 500/" of expecEd CHD reducr ion 

r66,000 851,000 

r,140,000 2,801,000 

ID Table 2, osr per life saved is ale plested. The cost !s life saved is c.bdated by nuldplting 

the @st per lifeter wi1h $e sp&ted nubF of rmalning yed for 49_yee-old 

men, which is28.58 yed [5]1. 

The lesult ofthe slxdy shos inar stralesf, thr€e is donimied by sliat€gy tmi ad thNi n is 

not Ecomeoded by 1ne audids. However. it is still possible thal slraleey lbEe, or sinild 

sfi*esies de &nrally beine Ned in health cd€. 

In the JPJL study. ii is stessed tial the nclfts dd calcDlaliotr have to be tr€ted very cau_ 

tiouslt. in lanield regarding the efects on oofiariry md norbidrty of lhe diile€nt slrai€_ 

sies. Howevei, the lmge dvm by usiry te levels for the ssMed efed of t:eallnot should 

suffice 4 d apploxinadon for the cost per life yed gained

Rd.berc& Sjoberc: The coi eflerlJee$olIfe$M.C 

neêDtion. 

SBu 11995). Md*"t lersdktinq fu prostatamcel (SBu-repoll No. 126), Slockholn: Staf 

es berdlins 1dr ultrdenng av nedicinsk teholosi.l45l 

Postate cdcer is lo&y the oost 61mon fom of @cd uol8 neD in S$tdeni appoxi 

mately onertuarler of aU 6c6 ces in Swedish nen tre proslale cmceE. Wilh 2,220 d€ths 

pq yed (1992), it is al$ fie nosl comon cmcd relat€d €use of d€alh mong nen in Swe 

d6. Prostate mcq geneElly oem mtnd lalc in life fld the leee najofty (75 p*sl) of 

diag.osed cNs ae nen ov€r ?0 teds orage. 

h nost cdes of cmcer in the lroslate, the nnor Ciros slowly ed may not caus the patiot 

dy Foubie at all, or o.]y slarplom sinild 10 thos of a bmign enldseme oflhe ploslale. 

Howver, in sooe instdces the tmd Cros nore aegiesively tudor hd melastaes, in 

which cse the cmGr My uhimtely be leilal. Sin@ nfry of dre Patiols e elderly, lhe 

cmcd mislt sdll not be the cause of d€th becae rhe palimi dies fion sone othq cas 

belore the cdce. i6 killed th€n. 

Tn@ de diE*nt sEateaies available for aeating the cd.er, imludins radical susery of the 

pmstate, chmicrl thelapt. radio thenpy, ad ddocnle thmpy. 

A sering plo$an @!ld be inplenented 10 qfidce lije chres of sly deteclion of 

prcslale @cer. Ther€ de sevral difEnt n€tnods.vailable for scE@ing: direct palpalion 

of the proslat€. tmsEctal ult@omlomosmphy, teslins for posllte-sp*ific dtisen or a 

conbinalion ofdese. A sdeming pros@ would be acconpdjed by lr€ahr€fi for some of 

ihe patidrs that re €$ed positiv€. The najor probld wilh a $lMing Prosar is th3t at 

lEsent rim€ it is difficult to distinsuish betweeD a cdcd i.hai will be l€lhal, or caus€ the pa 

tidt much rrcuble, ed a c@cer 1har wil not @ue oy, or ninor, houble for the patient. This 

mes thar 1he result of lhe sfening will, in trmy c6es. be iDconclNive 

Oily nen eei prcstate cmcer. lurthemoE, the cdcer is alnosi ody foud in nen over dle 

ase of 50, wLich is why a scredine prcsrd muld be dnecied rosdds nen older th@ 50 

Thse is also d upper sge linil whe!€ tresrlnmt of tle cdcer is nor aPPropnaie ln Sveden, 

F*rmdl is not eomended for latieDts with a Enaining life experancy of less thd l0 

yeds, slich mems thal nen above 70-15 ]ed vould b€ exclnded nom the scening pro_ 

$d T1E ieson for this is rhal tr€atuqi would nost likely not atrect then liie ev€chcv. 

ed n nat cau* the latifrl norc lrouble tha lhe cdcd do4 

In the SBU repo( ro co$ per life saved or cosl pd qualiry adjust€d life yeds have been 

conpured. It is in fad mphasired that n is rol possihle to nate a @rect carcdalion wiih the 

crenr inse* knorvledge of tle €ilstlv€ness of diffeenr n€rbods of |eatndi TherefoF. 

rhe ca $ per life saved that we calculale shodd onlt be lesdded 6 a very rough eslimte The

RHIZIKONT tusk Resach R@on No. 24 

SBU study bneny descnbes d analysh ofthe cosls Nsociar€d witn a $reoing plosrm for 

all Swedish nen i! the ase grcup 50-69, wh* ir is found that the d,,ia.r societ l costs for 

pioslate mcd muld inc6e with SEK 5l milion, inclnding $e costs tor d€ sdeenins 

piogIm. IlE dsmed $!€enirs method hde t diEcl lalpation (DRE), epeaied wery lbird 

y*, md de prcs@ muld lesdr in e addilio.al 569 nd und€ieoing sugery for locatizd 

cms, compded wil! the brc-line altemative of m scEding poerd. The cosls dd the 

nmhd of opmtios de pEsenled i! Table 12. 

T^ble 12. me q?eded MaCe health ctre coss fut ptostde cancer and the nunbq oJ 

vostatecton! peryet .ltnhg 6 tEaB, fu a ga"p ofnen aged 50-69. 

MSEK 

524 

1.O93 

!:L 

+51 

+569 

T!€ lo-yed dis6e spdific swivt rale ofthis tugery is sajd to be noE thd 90 percm! 

md if w€ ssue thar ir is 95 percdr, w m @nclDde lhar 54l paddrs (on of the 569) su 

vive then prost le cd@, Howdd. ir is nor knoM befo€nad ifa gird patient would have 

swived tne cmcer €ver wirhout the sugdy, which neds that not all of these patie s e 

"saved" by 1ne scr€enins plogld. h is ths lecessy to nake sone Nmplion about the 

natual swival nte ofproslal€ cmcer od dEt is difrcuL becse th€le d€ very few clinicai 

studies on which lo b6e the eslir&tion. Hores, the Esuft is not very seNnive to this 6- 

sMDftn. ar least not in the cuot co!te}1. If d i eFal of a 4G90 !fteDt natual swival 

!a€ is 6ed, 54-325 pali€nis e sav€d with the scrdns ed n@ft€ni This 6ults in a @st 

pd life *ved in dr tug. SEI. 160000 - 940000, wirh a nedim of SE( 550-000. 

fte SBU dcs not @oIme a llrs{cltains prcstm for prcslale @cer in Sweden. This 

h b$d on scidlific rcMB: Il h6 not yel bd shon thal such a prqru muid have 

posilive etrects on ihe swi€l late or th€ quality of life. nre cost-etr€ctiv€nes of the p!oslm 

hs not bed diss€d, neilh€! 6 a slpolt fo!, no! s a dsment asainst a e!€enins 

42

Rmsbers & Sjiibers: The cosl-etrecdv@ess oflifeevjng inteNentions 

Bone-marrow transplantation 

Sjijbqg L & Osmdq T (1994) al redda liv - Kostmder och etrekler, Rappon dll ESO, Ds 

1994:14 [48] 

In a report fton 1t€ "Expen Crcup lbr StDdies in Public E omni6'(ESO), Sjoberg ed 

Osedd have conpil€d dara on iNeslnrsls in lifesavins for €isht ditrmt cdes: Ure euse 

of ssoline ga at gGolhe sr.dons, a mtaign agaist flokins, the trdsplatadon of bone_ 

meow, th@osettiry pldtics in the workplace.lhe plevertire fiE protection al healtn-ce 

ifftitutions. mdsNs to edue indoor ndo4 slade{lossing bdid, md salety litls on w€lls 

'fte cde of bone-nmow taslldation is lresdt d here. fte 6e of th€mo*tting pl4lis 

in ile wo ,Tlace is excluded becaw it is trol intended lo sav€ lives od !h€ othd 6es d€ 

presnr€d elsewheE in tljs relort. 

Asdd 1.000 c6es of leulenia re discov@d elery yed in Swden Lelkdia @ be he_ 

Fdftary, bul it cm also be caued by, fo! qdplq adianon, beme drd solvots. The nost 

important faclor G poblbly lif€style: molinC; dietaiy babits md su bathing, bul tbe relatioships 

have nol yer been tfny esLablished, Unteated leul(di3 is prdcally always lhbr. 

The corventional FeaEnent of leuldia is chmetheraly, but in lecenl yed bon€_nmow 

tmDlmlatiotr has beode m alr€naiiv€ for a ldge grcu! of Patierts lD a bone ndow 

rrsplolatioa tne pati€nfs oM, oi donated, bonebmw is eivd intravenouslv to the !a_ 

tifl1. Conlded to convmlioral lreatnmt, bonem@w lrespldraion is usuuy noe effective. 

but the ftarmenl is lery dif6cdt for the padent This is tne min r€son wht bon€ 

!r1:mw Fdsplanlation G tut ued il lhe Paliats chdces oi sNival re snalq thd l0 20 

Frcot. Alolh€r F6on h thal Esomes for bone nmow lrmPl{lltios de limiled ln 

Sweddl only one hospilal provid.s tnis lird ofthedpy. 

Five-y* swival ofleutemia is on lle avelage l5 pere atcr bone_mmow hdspldlaiion 

tieanndq but for sone goups, childH for inndce, il is highd 

The cost of t@nns ore patidt is on the aveFge SEK 750,000, in i988 !.ices. Wfth a nsk 

r€duction of l5 pden! lhe cost per life saved is sFJa 2 mitlion 

h Sjdbdg md Ossdd it is poitrted ou1 thal tne c.lolatiots e approximte od ba€d on a 

snaU erolp of ody I 8 Parienls

RTflZIKON: Risk Resmh R€polt No. 24 

Radon 

Startr Stahkyddsinslitut (1993) Radon 1993 En raPPon aiv€r ldse! SSI nppon 93r0 [52] 

Radon is a mdioactile g6 rlat ocs naturallt in the 8roud. but it H de be fobd in some 

const@lion mlenlls. whd hum hhale radon ga. or its d€conposition piodncls. mosl or 

the ear is im€diately exlaled, blt sone ptrdcl€s adhere to the lug tissue fte alfa_mvs 

fion il€ daonpositlon of these ddioactive parricles My daage the lugq ed lo4-tem 

€\Tosw to ndor gar especially in combinatio wi1! flokirs, cd ultinalely lead lo lus 

@cer. In fact mdon consritutes th€ lag$t isk of iodzing radistion in Swedeo roday md il 

is esrimled thal mud 900 people *ery y€r get lug caEr caued bv 6don ll nomallv 

r,kes 15-40 y@ 10 develop lDg md due to qposue 10 radon, slv the ng@s de sone_ 

what uceiain. fte pailiclld kind of lus cmcd caed bv radon h incMble dd the morr.litr 

nte is cloe io I00 pd&nt. 

h Swdel. rh@ e lbEshold lev€ls Esulaline the ndinm allowed concedraiion of in_ 

door radon cd in both ensdng and rs buildings. The thrcsnold lev€ls e issued bv th€ Na_ 

rional Bodd ofllouing, Brilding &d Plmirs (Aotq&!r) md the Nalio!5l Boad of Healrh 

ed Welfde (S,c,aty.tu€,). The ltu€sholds de ndddory dd re valid in dl roons serc 

DsDle DellldeDLll Rside tor exrsn,s rte" dd votl p#'. d'e tbF'bold n '00 Bq m 

itr nev bui drss he 

_hr"told i. 70 Bqr' aPPuinatelv ljo 0oo \omes ffi esnnded ro 

have a con@nLation of ndon s5 in the indoor air i! excess of tne rhr€shoid level of 200 

Bq m . Anodefb

Rhtb.' C a SrdFe. 1e cocr -efieen etres of lile.a. irs inlen ebtior ' 

In lne rcpo4 lhe ror.l socier,l cosl of ndon proi€ction for lle y€G 1979-1993. is esrimated 

ro b€ SE( 860 million, in 1992 pnces. Tnis cosi ilciudes the costs fo! rseNh od daelop 

no! i.lomatior, neduing iad@ in hon*, n€au€s io lov€r the concentrariotr of Edon 

g^, od adminisrrative costs. No ildiiecl cosls. for losFs i! prcduction or h€ah! cN costs 

Tle totll one-tin€ cost of the ne4wes pioposed tD t€ rald in lne tutE is sEK 2.550 nil- 

Iior In addition, a mual cosi of sEK I60 nillion is er?€cted. 

Tle @sl per life ere4 both Eln lle h6ues already lakd md Aom 1hos prcpoFd, vdies 

b€twen sEK 0.1- LI nillion sd they @ lFsented in Table l3. 

Tabl€ 13.me cast pet life sNed for nedures taken t979 1992 md io proposed neNures 

1992-2A02. me cdldlatio8 oe b6.d on a vobabilitr of lne cmc- of 2.5+14 

" ws per 

Bq.lear/nt nd a 60 yeu! expowe ta rudo,. A discatkt nE af 5 Perce"t is 6ed and aI 

r919-1992 

Existing houss Na 

r992t002 

l0ye6 ADually 

private Ensdn8 hou*s New pivate 

Costp{lif€ ev€d 1.3 0.1 

Also. in 1ne @on lhe actu l msls of neses taken 10 iedu* th€ conentation of 6don in 

2Ol S{€dish hon€s de lsed lo calcdate i\e ost pd life sav€4 couting the cost ofn*u* 

ody. ln ilis calcularion lhe cost pd life sved is SEK 0.07'0.6 nillion dd lne resdl G pE 

Tabb 14.Ihe cost per life @4 

ures dtut dillerdt concenndioht 

.odtiagthe con) ot n?^Lr?t ont\ fat tuorDe. otaeôfratlon. 

All @sts in 1992 prius 

Ai edee .or *DmrioD ol Edo!. beloF dy redm ha been EIm 

200 - 400 Bq/b3 

0.2 

ahdi!. A. sqLrc !p Ls r theroudanotr rd ndoi 'uaioD 

Alrcmarivr B: Sealing np l*kr in rhe fmd{ioi md irpnved tntiranon 

Tne nsk of lug m€! fiod radon is hod 10 estimate dd the calculations shourd be h€ied 

wilh discrtion due 10 iris f&1. Horever, even *ith the most coNeNative eslimte lhe cosj 

D- life saved is noi drmaiicallv alrered. 

45

RIUZIKON: Risk Rs*cb Report No. 24 

Radon in drinking water 

U\.trd€leerke4 F.ifnaE d srd"tundenf.r radon i drict:vatten,Li\nedelsvdk€t, U!'p 

sala,1995 [27] 

Radioactive radon s6 o@N mtrBlly in ercud mler ad spaially high concenhariotu de 

foud in bedrock w€lls. $/hd this *€rd is ued in a hoGehold. th€ ndon is quickly rcleded 

into the indoor an dd thu coftribures 1o the an Edon dEt nishl be pBsr dn€ ro ado! in 

building Mt€rials and rador in the Eroud. 

The pHen€ of Edon in the jndooi air is cosid*ed lo caue appoximately 9006es of Ius 

cm6 mualy i! Sweden dd ]t is a fom of lug ce.d lhat today hd a vdy low pobability 

of swival. h is estimted that radon in drinking Mler caus 35-756es ofc&cd every 

ys in Sweder Apad frcn @iribuling to the radon in the an .lr]nking warer 6don also 

causs abortr 10-20 c6es olaHoninal mer pd yed, wilh d dp€ci€d sNival 6te of 50 

pffint. In the fonowine, radd in drinling water is asMed ro oue atFoxinalely 55 

d@rh5 mnrlly in sw€den. The faialitis e dhtiibuled ovq diffeFnt levels of exposue to 

Edon in drinking Mte! 6 preFnted tu Tatle 15. 

'fabte 15, Evecte.l nMbq ofMuol fatalities in S-eden as a rcsu, of etposue to dilfueft 

levels ofrddo" in ,binking \|at* 

< l00Bql 

100- l,000BqI 

> 1.000 Bq/l 

2040 

10 25 

5,10 

Crendy there is no legal lbreshold lev€l fo! ndotr in dlintilg ratd il Sweden. A Bon 

nmd.iior from rhe National Board of Eealth dd Verare lsocialsr,rehe") sr it' ltbr 

neass shoqld be ta|€n wnen fie level exceds 1,000 becqueEl per lite! (Bqn) is sd a d 

"infomal 

thresboldlevel. 

Rece developmelts i! risk dssmenl hN shom thal drinkirs watd Edon is a hi$er nsk 

factor tho 6 peviouly knoM. Tlis h6 cased the Nalional Food Adninist ation 

{ljvruedets?rt"i} to prcpose ns $reshold levels for Fdon in drin}ing *aler For nmicipal 

Mler supplids tbe dieshold would be 100 BqI dd foi pnvale supplies a lircshold of 500 

BqI is suegested. fte rcw lbresholds *ould need 10 be acconpdied by lesls, ed in some 

iNtanes also by aclive meMs to move 6don lion l,\e wai€r. 

I|e target group is rhe shoie popdatjon, but son€ iisk groups cm be id€ntiied within the 

population. ChildrerL for inslance. & g@er61ly nor€ €xpoed to radon in dri*hg R€ter dtu

Rmber8 & Sjobe?: laF coq etre.tverss oI lrrervins inrwel 'on' 

d€ addts. Also, peopl€ living i! al6 wnere bedrock wells e colmo! @ nore e&osd. 

gow€v€r, most ofrhe saved Iives wilL oeu in {@ gderal population. 

The msts rcfd 10 t€sts ed lo n6u€s 

de presented in Tabb r 6. 

to ienove 6don fton the dinkils water. All the costs 

Ihe @sl of ore single 6don test is approxiMiely SEK 200400 drd rnrce diff€r€nl lres of 

waftr supplies vould rced to be rested: 

Mmicipallltclllpdles 

l,800 supplies.lested once a yea vifi a total con ofSEK I nillior p€r yee. 

PliralerEllr 

All bedr@k wells (approximtely 200,000 w€lls) wouid ininally he tesred ed in the futu€, 

all rells wodd be tesl€d once evely l0 yem. ftis wodd 6dr in m inirit cosl of SEK 80 

nillion md e mual cost of SEK 8 nilior h the tutw. 

odained olila@rupplils 

An mual test of 1,900 ordailed Fivate supplies will msr SEK I Dilllon. 

Me8des to ,@9e ,adtu 

MeasEr in mpicipal$llli!! 

Acdding to i|e Radialion lrotectio! lnstiture (,tia?ru JrA^t/drt Jlidr), about 8 perent 

ofthe mmicilal water supllies (apprcnmbly 120 suppliet carry Mtq with a adon cort€nl 

above 100 Bqn ed &tion nee.ls to be t kd to Educe tbe conte in th6e supllies. Sone of 

the supplies ned hor€ ea1€Nive and cNdy n@ues Md this wodd te declded don 6e to 

c6e, but de esinaled cosl for all afi.cled muicipal supplies is SEK 6 nillion. 

MEc$IeiLliv4cr{clb 

Tne ruls re difieMt for piivate weUs comped !o hujcipa.l suppiies. 11tuuld be Bonmeded 

10 lemove hdon fion the $ater only in a!o!t l0 pdcdl of the wells wid a cont€nt 

of ladon in rhe Mtd b€rseq 500 dd 1000 Bqr. Ofrhe *ells sith a content beiow 500 Bq/l, 

applonmrely 5 ptrenl ae estinated 10 be in reed of nedues to enove hdon. A rcusn 

€slimtio! of the costs for nears in Fdvate wlls is SEK 200 nillion dd rhis sm also 

includes nesfts for all pDvrie wlls win a conlst ofndo. above 1000 Bq/1. 

M6ues in ordained dde sn@Iier 

Il20 peicent of lle 1,900 odlined polale supplies have nore rbd 100 Bq,/], th€ tolal mst, 

giv€n tnal ditreEnt l€vels ofruification de needed, wodd be mmd SEK l3 nillion. 

Tle rotal cost for lests dd neaues to lmov€ iadon whde n*essa4, muld be d initial 

.o{ or sEK 304 mil.'on, d. M @un "os oisr < 0 nil ion.

RHIZIKON: Risk Rd.eh R.pm No. 24 

'fable 16. Costs fo tettt ahd deMd 10 redow radob flon ddtkiiC dte. ih Sve.len /4ll 

I ri.l @r (MSEK) 

Ordlined privale suppli€s 

; 

200 

l8 

304 l0 

fte btal dticilEt d efat of this prcem on 1!e incidence cder is mt dsiM in the e 

porr from tlE Nalio.al Food Adninistniion. HoweB. refening to the dttribuiion plls.nr€d 

in Table 15, a Esomnt estination is tbat all (E @cd ces rurntirg nom dpos€ to 

laelsind6sof 1000 Bqn, half the ca6 r.$nring fion expoffis of 100-1000 Bqn ad 

none ofthe 66 rcsultilg fion ef?osw ro l.v.ls < 100 Bq/l would b€ avoided. h all thai 

sould ned a 30 pde r€ductlon dd thu, 16,5 livs wodd b€ eved mu.lLy. It mmaly 

t kes 1540 yed to dev€lop lug cdcd ton Fdon dd dF liv6 thai G saved m theEfore 

"tunE" lirs dd shodd b€ discouled. fte @sts should ale be dieout.d ro a n t prcmr 

lalue. EvalDat€d ove. l0 yem, thar is Aon yff 15 to 25, the net lGsent trmber ofr€duced 

farrlities is 64.3. Ile net pEs@t 6s! also calculated over l0 y6, is SEK 359 dUi@. fte 

di$out ilt Est nte is 5 !.rcot in bolh 66. Ile implied life va.lE of this prcere wodd 

rhd be s6( 56 nillid. 

In the elort, Fvdl possible euc* of emr re discussed dd the conclEion is that lhe scifriific 

bsis of the loCre is nor d $rorg 6 muld be d$ircd. Eosdd, ih€ $ie inc 

grcud fd distins thrshold. for mmt othd subsraces is of simil{, or p@er qt'ali1y. 

The reader should b€ ame of the fact that 1n. implied Ii€ valne in this c$e is to a l.4e ex_ 

tmt depddmt or the lime penod oE {hich th€ Fo8@ is $€luled. 

48

Rm,be€ & SJdbdg Tte mstseEdiv.Fs< oi lfc"avbg ueruotom 

Radiation protection 

StatdE srrAlskrdCsinsijrDt (1992) Vad fu styu @t siAhinC och andtu risk r ,astd. SSI' 

8!pon 92-10 [51] 

The Sr€dish Radialion ?lorection listitlte (Srakrr rt tu/qardri6r,irt) is a govffi@t 

agacy drd it lE e oveEll rcsp@sibility for l!€ design of Etliatior pro€cti@ ne6@s in 

sw€der At@ \rd* lne Rldiation Prol€dior Innitute is @tive e for exa&lie {F followitrg; 

indoor 6dd, the opdtion of nucl€r Powd ddi5, mdiothdaPv. dd el6tromagletic 

The Iiltituie rlili2ls m *llicn Ife ul& in ost-b€rcEr daly*s which m usd d a slppon 

in then daision Daling. Iris explicit lile ulue is bsed o! wnlineless to pav studies, d€ 

explicil life val@s ued in olhd agoci€s md othd @hlire &4 slso on the iodicil iif€ 

vdes in orhs seto$ of eciety. Thee coBideEtios have lead lhe RadiatioD Pelectj@ 

bslitute to adalt th€ policy rhat mels$s falling inro the 6SB SEK-5tl-ri11i!D pd liie 

sav€d shcttld be ihplendcd. 

Also, in the fport sone *plicit life vdues adotted bv othtr agdcis d€ Presnled: 

Vatte.fal, a Swdish lucled pow! pl&t oleruror': Cuideliaes for eo.stru.lid 

powdpleis: 

SEK'10 80 millio 

in nucltr 

The No.dic Coucil Cuidelines for aI tt?es av radiation prctection Imsl 

SEK i2 million 

Inplicil life 1d!es lion tm @d mder the spourhliv ofthe l$tiirle re al$ nentionedl 

info@rion cdpderr ro ircede public aMeDess rcgardins rle nsk of malie! m€laonal 

SEK 200,000/lif€ sav€d 

Rednc.d nsk for cm€ fion FdiolhmPy by d ilcr€sed s of coal_fib€r csetres: 

SEK 100,0004ife eved

RHIZIKoN: Rjsi ReseNb Repon No 24 

Lamp-posts 

Laveborg U { r 995) Tusenials rya di'dsstolpd siitis upp vale a!. Moto 1995.3:6 13 P3l 

Single vehicle. lon-pedestriu collisions con$itute a sisnifimr part of the f3rahies due lo 

mad accidents. Obslacles or the roadside lose a nsk to v€hicles that @ideni.lly leave the 

ma4 ad inc@ 1h€ nsk of fat litCs dd s€vft injui€s [6]. ln Sweden, n hd been esri_ 

mt€d thnt abour 60 fataliiies, od 5 10 iimes a mmy sevE iljuies, re cased by collisiols 

wjrh ohstacles ned th€ rcad, w€r] yed, Atonrd 20 ofihese fstalilies ed 200 of the 600 se_ 

\se | 1. ues m cad b" colli5ior -i!h ldp-oosa alorP 

Since the 1960's rh* e sevdal ditr€Ent tt"es of en'lmp-posts, tl€t bleal€Ey whs 

-fte 

inp€cied on the lNkei lmp-post H either have a bae that slips away when idpacted 

with. or 6 also be snstruci.d to allow defomarion upon inpact 

In all, l!€F d€ aptmximaleLy 500,000 lm!-posts alorg Swedish roa&, bur odv a verv iin 

ited nuber de the sofi ryp€. Every yee, 7,500 ns lmp-posts de @cled in Sweden ud the 

ldee mjolity olthese replae old iamp-posts. I! 90 percem of$e ces, the new lmFposts 

e 

"lwd 

, ttEr is, they do not breakaway 

Most of th€ lm!tsposts m the Fsponsibility of local aurhodties ed not lhe gov€ment 

Eowever the National Road Adnjnistdlion hs recomerded that brca&aMv lmp-post 

should in smeml be sed, bul appNnrly, thh did not iave the i ended effecr' 

A pnvde orgmisalion for motolists in Swedm (M,t /fta,,e,r rtb,'n rud) hs $scested 

thal ody bcakavay lmp-post should be qected md thst the nmb6 ofposls that re put ul 

should be in@sed to i 5.000 p€r y6. At a nle of 15,000 per yed, il wodd laLe 33 vem 10 

EpLace all 50O,()OO lmp-losts cMer y srandirg alons the oads in Swden This neaw 

Rould armost cqrainly have its largen etrcct with the 6rs1 lmp_posts ihar de €@ted. md 

afts {ial a dreaing meeiml efect would nost likely be obs€fled The !€dn tbr this is 

lhal s tne lmpposts thar re collided witi N replaced, f€wd md f€wr of ln€ high{ish 

lmp-posh wodd Imain. Mdy lmp posts d€ situl€d in seh a Mv ihar lhe prcbabilirv of a 

collisio! wfth then is vsY low 

Tne cosr ofa breataway ldtrpost h loday SEK 4,000-6.000, which @ be comld€d io the 

cosl a ordinay lmp-p6t wnich is doud SE( 3.000 hh nates the mual cost or lmp 

bosts rodal SEK 22.5 million. If idtead 15,000 soii lmp posts were b be *cted' the cost 

;odd ircrede ro sEK 75 nillio& silo a cosl of sEK 5,000 for a ldp-po$ Thns, the in 

cr€Ned est is SEK 52.5 nillior Discouting rhis iDvestnent ovd 29 vem with a discoul 

raie of 5 ldcenl sives ! ner-pres€lr lalrc of SE( 795 nillion. 

50

Rm.bers & Sjdbdg nre ' oianectitr$ 

ol I le.avins inhenrion. 

To calculale lle nubd of lives sv.d by ihis irteMtion rcquir€s some 6sup1ios, whch 

- In t ,rr$J€u, when &e first ld!'posts m €rccted no liv€s e sved. 

- ln the se.ohd tcdr, 3 \ies te se.A. 

- In]€a J t o addilonal 2 lives e sved eac! ys. 

- In jad 6rq one additionalife is sav€d @h yu. Hdcq rhe nMbd of fitalili€s is F- 

du€d by 50 p*tr itr6yeds,ddby70p€Ea1inl0ye6. 

-brnene 

iA teos, s.dditional life is saved evcry third yed. 

- lntIE ldst 9 letrs of ^29 yettineslaqoneaddition llif€isFvedw€ry6fr!y@. 

Ilqe dsm?tioB m inrfld.d 10 Efl.cr tbe.led€6ing nargiBl Etlm Aon the investaent 

in soft lmp-posrs. Ifih€ sv.d liv* d. dis@uted wifi a dis@Ef Ere of 5 psmr the "nen 

prsmt nubei' ofavoid€d faialities k alFonlEt€ly 180, 

A @s! of SEK 795 million with 180 eved lives gis e implied life r€lu€ of SEK 4.4 nil- 

Tle tire horizon is set ro 29 yed i! this calcolaiio4 but it is of coNe possible rhar th€ 

lep-posls conioE to eve lives €@ aad 29 y@s, Eows, due lo the disouling it 

muld trEke very litrle diffem@ if eothd l0 y6s d $ wr€ imlu.led. i! addition, the 

siuarion regrding fo. erdple technolog ed nad tlmpolt even 29 yds from now is 

imposible to pEdict; il is for that een alone loindess ttr have a lonsa time horizon in de 

Il snouE be noted rld tle calcdation ofa life vde M not ircluded in ey of th€ onginal 

snrdi6, il is @mplerely r prcducr of lhe aurhoB oflhis Eport. 

5l

RSZIKON: Risk Resqcn R€bod No. 24 

Road satety 

Pe sor U & Svtu$n M (1991) BerdlainEu, BilaEsT ml: SahhallkLtnohisk priolnerinE 

d iofLsiittrheBaryd.der, TFB & vTI Ese&h 7: l 1991[38] 

Road accidenb @ a pnhlc n ahh piobld and one of the largesl contiibutds to fatahies 

non ciddrs in Sw€dm roday [61]. Ov€r l,\e lasl yds, thft ha been d avaage of 700 

fablities dd ahout 60,000-80,000 itrjuies mully on the roads [58]. Th.rc hd b*n a sirar! 

decile in injuis dd fatalities itr rhe lan few yes, bur this is prcbably minly dn€ to the 

genedl dec@ in tavcl by cd, €sp€cially uong yonng diiv€B, ihat ha followed the eco- 

Unrii 1993, whd Uey wer€ phaed ouq rhe Sw€dish Naliolrl Road Sa{ety Ofrce 

(Tnfksdtefietee.tet) han te ovqrll €spGibili9 for rcad efety ir swedo. Every yed 

tne Natioml Road Safeb, Ofi@, rogelh* $ith tE National Coucil for Road Safety 

(Tldfi^.dkefhekadet), epueJ a rcad-*fetr plosm thlt w6 haded in to the govmeni 

Tle last y@ tht w done w6 in 1990. 

rere identiEed 61he foUow- 

Tle gendal eoa13 ofihe rcad slety work il the 1990 plosru 

ing[58]: 

1. The roral n@hd of cNalti6 (fat3litis ed iduiet i! traf6c should be prc$essively 

2. Tne dsk ofbeine killed md injwd 

in tra6c should be Drosressivelv r€duced for 6ll cne- 

3. The nsk ofleing hilied md inju€d in rrafrc should be redu@d ro a s@ler degle for ull 

nerabie rhfl for Fo&cred road-usen. Speial @Biddation should be siveD 10 the pbblens 

The soals see also qmtified, and il m said thal by the yed 2000 rhee should be a ndinD 

of 600 fatalities @d 40,000 inju€d people fion accidmls on tle swedish @ads. To 

o!.mtiooalize these soals, a eonp of dp€ns wa jointly colmisioFl by de National Road 

Safety Ofre ad rne Swdisl Tmspon R€emh Bodd in 1989 to p!€pe data for the 1990 

pogm. This Esult€d i! a reponi "Socio€cononic mtins of road sdety nedues" !01. 

whde a n€thod of scior@nonic rekins w6 usd to prcpose a &nking of th€ road_safeiy 

ndEes n*d€d ro ehieve the aoals al th€ lowesl socio-4orcmic cost. 

52

Rmsberg & Sjaibrg: fte @st-elfectibss of lifesavins inrelmtioB 

Ile erTert gmup idstiEed a ldse ruha of possibl. rcad-efety neMes ed thc lin of dre 

29 neaslH that ws fi!,Iy irclud€d i! rh€ Entilg is lEsled in Talle 17. On the lisr e 

foDd iltdemios lrimily disted row"rd tte physical @nditiors aEecting irafrc. dd 

telalively litde att€rtio! is paid ro benaviordl faclos whjch haae & eFet oD road sr&ty. One 

advolaee of tlis is that for mosr of the lr1ru@ dD effectiveds, in lens of injury redue 

li@ ad edrced fataliti€s a well a os1s, re nlhd well k oM. 

Irp cddelines for {E $cio+@nonic mnking of tbe tuitu 

lowins [30]: 

meM€s ft, in bn€f. ilE fol 

- .t\ re6re of cost-efe.ttuehe$ is ued (instead of a cost-bdeft dElysis)- 

- tn the er corr, borh direct costs, such 6 coftlrudio! @sl\ dd sotr indiel cosrs! sucl 6 

in@d lmvelilg time for motonsts, e ilcluded. C€ltlin indiEcr costs, lor qmple edi 

rom€ntal etrecrs, lave not ben included in dre calculalioN. 

- The di$out nte is 5 percml ad both the @sls md the sledliv€s equivaidrs de dis- 

- All @si5 md b€refits de in Jdualy 1990 SEK. 

- The savediiv$ equivaldts a€ Dade up of faBlides dd injuies ad the cosr p* sav€d-liv€s 

equivalots is pEsmted i! Table 17. Howqer, in rhe lif€ !€lm lEsenl€d, only fataliti€s m 

- In the n€r ssts, tlr costs of njuies m also ircluded. 

53

R}IZKON tusk Re*mb Repon No. 24 

Iable 11 . me cost/life sded and the cast/sae*life equiahtu fot 29 rod.! safet! ihtenen 

tiod ik Swe.Ln. AI costs ih Jahud), 1994 prices, nillion SEK, dis@uhted at 5 P.t@|. 

Cost/saved-life equivai€nl 

(MSEK) (MSEK) 

t)New sp*d rinit sFm, pEHt cmh' ad 

,) N.w speed riinir, +5 hm6 pasd obnor 

, +5 rins presr spad Nnftr +ro% bkF 

4) o*rpas ar 4 mad intsdioi, imr RA 

t Ped.sim,'r,iq.rebnn.reove'lN* 

6)riEBdioni iuL d.ar 4-mad inrdedoi 

7l coi.rcE bamss otr d ! id.d hiehr:)s 

3l bktrcbois, mlf.a Hni.(dles 

e) Lo€l red linft in a rud in@.dons 

w b bn-M packets, ]ul re6 

) v dLLre fence 0 rJb,6 {Dr - a 000 

ir) rndesd sow 

1r) sptrd bdPc rtu ?16 

l4)sped bmps on rcsid.ndal ste* aDT>lo 

'6) Rddshctid b mdo*rys ' '0 knrl a'r 

1?) RemNtudion b mdoNar I r0 knh, ar 

l3) Re'insdction b nddays 1 10 knft, a1l 

dh6 nain rcads I l0 rnh, ADD3 000 

re) Reonstucrid ro nobs-'ar e0 kri4 all 

oth{ min tuids 90 lJ rADT3 00G9 999 

,o) Rrdstudlm b ndos"rr ,0 k-L, al' 

o$trminroadl90knftADDl0o00 

,D Rem@.iion b mobNrYs e0 hra, arl 

funkrmds90kn5'AD}3000 

2) wirdrre fercs eo kn'b, ADDa M 

ra) Fhcs on divirsd higNays eohl rcse. 

5r rD6

Rmsbers & Sjoberg: fl . coq+ddi\ oesq ol I ileevins ir@.buo$ 

23) kdbndion or aI dilw,y dosines viin 

sed md lisrn sicsls ro h3lf lev€l crcsing 

2e) R.@shcdoo of rcwr ft$L'e caB b 

Ihde !s r@ftly ben a shift in rhe alprceh rowdds rcad sfery in Sw€dd A @flp&isn 

b.twe@ rhe rcad-efety piogre of 1990 sd lre rcad-efery prcglm of 1994 nales this 

shn appenl. Msh noE .nph4is tu put on lhysical meau€s in 1990, wh*s the 1994 

Fog@ onetrtates on b.havioEl liclos, In addiiio!, rcCtrdirg the nesuila of the etrects 

of Md{afety irifldtioF m a sbift, avay ton qwiifimtioD, b€ detecled. 

U.fortra|lly, th@ is !o dat colcebilg lo $Aioh l4el dD diffeMl n affi propced by 

the 1990 rcad+aicry prcgru hav€ bcen inplendted Ir plogld ibelf M ndd impb 

mert€d, trd ev€n polilically eepte4 blt some of the intwenti@ wft @i€d thronsh re_ 

'' Ihe anb.g is asmed b .on sEK 3,600 

55

RmZ IKON: Rlsk Resem h Report No. 24 

Age limit on tobacco use 

Folkiiisoinsiituret ( 1995) ,.i/de ^graE rid tabakxf.rsdtnins?, Tobaksplosrmeh 

nr l,l99s l8l 

faldantne 

Sociald€paitementt 099tlldd6sra6 id robahstbp,Ds |995:66 150) 

Snoking h the single ldeesl @ntributor to lremtre death in S*eder loday. Il is ioom nl 

cause. or @ntribule to, cardiov6cdn dis*es, @q, cholic pulmonary condilions md a 

ldg€ nmb€r of oiher dises, nise adv6e €ff{rs m weli docmenledi d alonishing 

60,000 studies .€gardils ihe lealrh effecb of snoling hale b€m lublished worldwide, sine 

the 1960 s. In Sweden, 8,000 - 10,000 peode e stlnaled to die every y@ de io snoking. 

Ovd lne lasr y6s, t!ft hs been a d€c@ing lrend in snoking in lrhy westm socieries, 

imluding Sweden. Despiie this f&! 30,000 youg people iake up lobacco nse elery y€d in 

Tne e&lier a person tales up snokine, the lagq ine dsks b€@me. lor dmplq ile risk of 

lue cdcd is fou tines lighd *neD a !tu! stdts shoking befoE &e age ol 15. conped 

to lhe nsk for a peson who stdrs afte! rhe 5se of 25. Fufihmore, d ney 4 90 pdcor ol 

oll mokes stad befo€ the age of 18. Fo! tho* p@ple *ho hale not sEned shoting before 

rne ag€ of 18, il is very urnikely tlat they will wq srai. 

The Nalional Instilub of Public Heallh h6 prcposed o ase iinit of 18 yeds in oder b be 

able 10 pahde lobacco. The Etiomle behind this is both fiat snohing h nore d,ngeiou for 

youns people thd for adults, md n is als qpecled to conribule to dEl fewer leople lale up 

An age limir is b€lieved to not only nale it nor€ difioh 1o set hold oflobacco, bul 1o also 

hale m efect on the social acceplabilily ofsnoking, $us supporting peerts in the foslering 

ol 6eir chitlren. Aho of ioporia@, d ase linit is a fon of commq infomalion. Mdy 

coulries al!*dy have d ag€ linit on snokins. a1 l6 or 18 yem of ase. 

Tkre de v€.y few stldies concming tle etrecl ofe ase limit, but in seneral d age linil 

sds 1o redue mokins in fie yougd age eronps. Ilis concluion is also supported by 

studies on orher tpes ofdrugs, suc! 6 alco[olic bser€es. In dre rcpoll. &e Nalional lnsli_ 

tute ofl\rblic Heald tutes a coNnativ€ eslinaie conceDite th€ effecl ofe age limil. lt h 

asmes tnat fl ag€ lnn {il1 reduce snokilg by 5 p{cot dong people uder 18 yeds of 

age.In absolDt€ Mbes that codesponds to apprcxitutely 600 nes sokm less mually, 

shich vodd Esult i! 300 saved lives every yed. No$. the eved lives wodd not "show u!' 

util a rad€r dist nt tul*, ehm the adverse lelth efi4ts of moting slafi b rale ihen toils 

in faralilies. A mor€ optimistic eslinale of a 50 percent reduction h also prcsenled in rh€ re

Rdsberg & Sji'berg: The cosr-etr€div€ness of lifesavins inleN€nnors 

Tne cosl of legislation is negligible, but sociely wodd lave cosrs for inpldenlins th€ law 

md ecuils conplidce. No attenpl is nade 10 €stinare ihese costs in rhe Epon. but in ihe 

plsenr calculation they re 6smed lo be ofthe sme bagljtude d lhe cosrs fo! mnrJolling 

the aee limit on the sale of alcohol- PEstlx tne coDty loards @ rsronsible for conlrol 

iing mnpliece with the ase limit on alcoholic beveng€s. 

" ln 1994. tle couty bodds iad a 

toral larionwide cosr of apprcxitrEtely SEK 18.5 nillio! for atonol related issEs. Of l!is. 

abont 80 pse rclats b rhe admiristration ofpemission grdis for ile sale ofalohol ud 

about 20 psdt, or SEK 3.7 nillion, to the conirol of complimce [22] [5]. In l!€ following, 

SEK 3.7 nillion wil be u*d N a approximtion of the costs lor ensuing conplidce with 

@ age linil or the sale of lobrcm. Several objatioB ca b€ nisen against 1his alprcximation 

dd son€ factoB Fobably iend to trEke ir e ovdesrinalioni it is not fie sde althorili€s 

and nol rhe sm€ good thrt is beirs controlled &d lo sell alcohol a pemi! is required, rhich 

is &t the ce for tobac@. On rh€ oiher he4 a r€sistd of lob&co sale ouders will lave to be 

put up in all nmicipaldes dd th€ie de nmy norc odlets lor lobacco thd for alcohol. This 

fa.tor p&bably tendr ro nate the cosl liehei. 

Al$, &ere wodd be a decreae in rdenue non i,xalion of lobeco. In the nosl optinistic 

ce, qifi a 50 pmd rcdDclion in mokirg mong youlh, the redDction in revenues $ould 

moml to sEK 8 nillion eu,lly md wilh a s !@e!t reduction in snokins the Educed 

rflues would be SEK 800.000. Howevd. rd@d re!€nE fron laation is a cost for the 

covffiflr md nor for society. 

Oivd a 5 perceff !€dlclion in soking alpoxinatelt 300 lives would be saved drd ifthey 

de 6sued 1o be sav€d 40 yeds fton rcw lhal @ftslonds to 42 net lEsnt lives ar 5 per 

cml disoDr rare. wfth e mlal @st of sEK 3.7 nillion dr cosl H life saved is sE( 3., 

nillion/42 lives = SELS&000. 

Ar lne prest rime. i1setr 

ve.J liiely thal rhe pbposal will be acceFed dd a law is ex- 

All the tg@s rceardins borh th€ etrecls ed $e costs of tle age limit should b€ lr€ated cautiously. 

However. ir seems udilely that rbe cosl !d life eved should qced SEK 100,000, 

md it milnt rw well be lo@. 

57

RI{ZIKON: Risk R$eeh ReponNo.24 

campaign against smoking 

Sjobsg L & Ogddd T (1994) Att r?ldda iv - Koslbad* och effekr, Rappon dll ESO, Ds 

199414 [48] 

Lr a report fron the "Expen Cnoup for Snrdies in Public Ecoronics' (lSO), Sj6bde dd 

Osader hsre @npiled dala o. inveslnals in lifesaving for eight ditr€Ent 6es: the re-use 

of sMlin€ ss at seline stations. a cdlterl acai.si snoking, 1h€ rGsplmtaiion ofbonemamw, 

rhemosettir€ plstics in de workple, the ptveniive tue prclection al healrh-6€ 

i6tit!1ions. meass nr Fduce indoor ddon, eDdeco$ing barids, md salery lids on weUs. 

The c6e ofa cdpaign agatul smokins is p!€*nted heE. Tle cde ofdemosening plasrics 

in the *o*plc is exclnded becaus il is not i ended to save lives dd rh€ oder cdes de 

D!€s ed elswhft in this r@on. 

Snokins is the single lagest ontrihuror to pEmnN deadr in S*den todly. ft is lnoM to 

caw. or connibute to, crdioscd& disws, c&cer, chronic pulmonary condirions dd a 

ldee nmbd of odrer disees. These adv€se ef€cls de well docMented; d dlonishing 

60,000 studies rcgadjng ihe hc.lrh efects of soking hae beo published worldwlde, since 

the 1960's. h Sveden. 8.000 - 10,000 people e €stinaied ro die dery yer due 10 soking. 

Ov€i rhe last yeas, tlEre ha hd a declesing lrend in sdoking 1n ,my westem socieii€s, 

includins Sseder. Despite this hct, 30,000 youg polle lake up tobacco se every yed in 

Tbe edli€r a peMn lskes up snokjng. 1nc laig€r the nsks becone. Ior exdplq il'e nsk of 

lug cdc6 is fou tims highd when a pdson slarts snoki!8 before the ase of t 5, conpl*d 

b the isk for a pdson who stats aftq the age of 25. Furih€nore, 6 IIEy d 90 petent of 

all snoke$ sbrt befole th€ ase of 18. For dDse pmlle who have not started mokils befoF 

the age of 18, il is vely udikely ilEy wiU evd slait. 

In 1993, &e National Institue of Public gealih (For.la,ls,tariture, lauched a cdpaign 

asaist smokinc. The National lnstitute of Pnblic Heald is a soremenl orgdialion {nicn 

purpose is to prcnote public healrh ed to woik wiih Prevdtion. Tle cmpaig, consisted of 

advenisd€rts in diff€Ent media od pdphlels distibuled at phanrcies. 

The cmpaien w6 suc€ssni in that s ndy 6 6 nillion p@ple, oul of a populalion of 8,5 

nnlion, had noliced the cmpai$. Tle 6 million people included 2 nillion snokels. It is dii 

ficult 10 dsess de eFecl on belalior of a cmpaie!, but wiil a conseflative estinale it d !e 

6sued that appmximt€ly 0.I perced of rhe sokd quit d d eJlecl of lne cmpaicn. lha! 

would ned 2,000 p€ople: md if 25 peMr of the snoke6 e asued to die a Premtue 

d€alh, 500 lives lEve beer saved.

Rmb.rs & SjdbeB: Tbe @n{ffecnvo6s 

of Lif.saviig hrel@rioN 

fte @sl oflhe cmpaigl ts SEK 2.7 nnlon. Ihe osr p$ life sard 6 tben be caldlated 

s SEK 2-7 nillior/soo = SEK 5.400 n 1993 SEr! which is the fig@ prcented in Sjdldg 

md Oe{dd. Notie that the IMb€r of saved lives is not dis@uted 1o a prmt value, evo 

$onsn mosl of thco €d 6€ ssued & be sav.d n a distat tutN. lf it is &med that th€ 

liv€s N saved 40 y.s fton nd, 500 "tunr" lives coftspond 1o 70 "pr!gl' liv6, wirh a 

di*oEt nte of5 lqcdt. Tle @sr per life sav€d is thd SEK 2 7 nilion/7o = SEK iR 500 

59

RHZIKON: Risk Resedh ReeftNo. 24 

A tobacco quit and win contest 

TillCren, ? el al., (1993) Cost-eFectivmess of a lobaeo quir dd ejn cqres\ Health Polic, 

26rl:43-53 [57] 

Snokiry G rhe silsle lrs€st contibutor to pmde dearh tu Sseden b&y. Ir is knoM 1o 

caBe, or sniribule to, cddiosculd dis*s, 6cer, chodc pulmonary cordilios dd a 

ldge nmba of ot!€r dise6es. llese advese efreors de wll d@unenled: a .nonisning 

60,000 sttrdis regddinc th€ heath €trects of snokilg have be! publish€d worldwide, since 

the 1960's. h Sredeq 8,000 10.000 people @ estituled10 die every ya dE nr snokins. 

Over rhe lasr y€s, t!€re h6 ben a dededing tend in snotiDg i! nmy wesrem societies, 

in.lnding Sw€den. Despile rhis fad, 30,000 yoms people take up tobacco use dery yed in 

Suppon b Mokers who wdl to quit hd prc\€n to be m efrective my of EdnciDg tobacco 

se dd its eNuirg negalive healrh €ff€ds. One type of suppon is the s called "quil dd Nin" 

coltesl h which snokd who Irrmg€ lo abslah non all khds of iobacco for a @nain lenod 

olrime N elisible ro €l€ pd in a bnery. 

The tust Svedhh quft dd win ont$1 m corducted i! 1988. 11 ws a joilt efforl by sevenl 

orsdiatiotu, includlne rhe Stockloln Cffir PEvertion Prosrm. occupalioml health 

$nic€s, volutary orgdialions, local mujcipaiiti6 md social insmce ofiices. Tle coDtesr 

sbned $ilh a three sek remitrnent pedod. Parlicipmls were mruiied wilh a nalio.al 

n6s nedra mpaign dd wilh orgdiations dd conp&ies recruitjng intenaily. Prdici 

pdls who mined non-snokine for fou *€ks could win a ti! 10 Hawaii. In all, 12.840 

tobac@ 6ds participaled in the contest. 

Tle cosrs dd efecrs ofthis @ntest e evalMled in TillgM ei al. Twelve nonins aner tne 

contesr, .tara on the participdls dd the effd of the conlest sa obiained in a swet. Ir 

tmed oulliat rh€ percertage of smokds who seie still noNmoking atier 12 monlbs, d m 

effect of ihe oniest. v&ied between 6 pdml for nen as€d 25-3.1 yds md 23 peMnt for 

nd aged 3s-,14 y€ds. On the avmgq norc won€n sokeB emi.ed nonanokins after 12 

In rhe anicle. all cosls de expessed in 1988 US dollds md one US dolld h sajd b equ,l 

sEK 5.44. 

The bral dnecl @$s ofde proC@ weE $ 649,264. Ihis dobt inchdes the cosls tor persodel, 

cmpaisn mtenah, Fi4si ieni, administralion md the eval@lion of the proglm. 

Divided hy the nmbq of ldicipmts ihe cost m $ 99 per pe6on. ]l.le elings nade on 

avoided m€diqL c{e dd th€ nedical cosls ofadded life expeclancr $ere not included in thc 

60

Rtuberg & Sjoberg: fte ost€tr€clirffi 

of lif6svins ioiel@ti6 

Cost€66tiv@s is F€snl€d s "osl pd,€a of life gained" dd is .srim.t d to be $ 

1,183, if dE effect i! t.@ of swd lilqy6 is disuted (i!i.Est dte 5 F@at. rn SEK 

lbateor d be 6,436, Tne @e t@ber of srd lifcy@ fo! all ,g. grcuIE b aprrcxioan€ly 

339 viich impli€s a.ost!d lit wcd of sF( 21.816. 

61

RHIZIKON Risk Re*trh R€pod No 24 

Fire detectors in private homes 

rub B (1994) BrundrMare i bostiider. Sanhallsetohonhk l6hsuh,t?r, FoBkninssrapport 

94:2 Iliigsnoh i Kdlsrid [19] 

Ju& B & Mattsson B (1994) rarthadentnaaha\ser ar btun.ltiiklter, In: Mdtuinssverkel 

(1994) hEon bfah.lsakthet.FOU Rappon P2l-086/94 [20] 

E ery yed approxi@tely 30 peopl€ m killed in fires in nllifdily loses dd apprcnnately 

40 de killed in iEs in one-fdily houes, ir Sweden. Ite prcbabiliry of dyins in a 

nre in a on+fdilt houe is estinated ro be i4.6/1 nillion hones (that h 0.0000346) dd 

25/l nillion hones (ttrar is 0.000025) for nultifamily ho6es. 

ft h6 been prclosed that i! should be nade nddalory to have nft detecloE i! atl private 

nones. According 10 a EiioMl lne efety o€miariol! 87 percent ofthe people who innahn 

one-fmily hou*s alread' have a fiG ddedor od foi peolle Esidilg i! apetne s rle figue 

is 49 pdcmr. Nol all fat3l accideDts *ould be avoided ifdl hones w€le equipp€d with fir€ 

detectos, but th€ nmber would certailly be lower. For lhe nE detedor to b€ of my use n 

nul of couse nrdioD p!o!sly. bll sweys sugsest thal only about 75 percert of rhe batlery-opdared 

6re d€tectos re fiinctionine. fte pEdonilEt E6on why the det€doB de ror 

working t lhar lhe ows fail to chese the batteries in time. A mi$-openled dei{lor is 

fo. this re@r, mongst olhds, nore reliable ed is said io hare a nmtioning rcliability of 97 

Cmdy, no Swedish data is available or which !tr b$e m €slimation of tle possibb nsk 

redetion Aon inslallins a fire deletor. Howoer, Aom NoMgim md Americm dara it is 

estinaled dar fi€ reducrion is 45 percenr for batrery-opelated detecrois md 58 percent for 

naiN-opeated detecto6. 

Apan fion causiig injui€s ad faialilies. fres caus dmased pmperly dd rhese cosls cm 

also be reduced by fire der€dos. The expecied average reductios in lre rcla1€d costs for 

muLtifmily ho&s dd onsfmily honss. wilh batlely{peEted dele.tor or nains-opelated 

det4tor re pesented in Tahle 18. i! Malrson dd Juas the costs of fablities md injuies @ 

aiso included in the esdmrion, but they hare ben excluded in the present calculaiiors. 

ateruse reducrions in fte retated cask lor nuttifani\ horst md 

bafle4,-aperated detecto.s t nainvowrated detedots Ar .n\^ arc 

brttery-opent€d 

naim-opcmr.d d.r.ctor 

180 

60

Rasbert ,3. 5. ober s The . oi.etrecrn ene! ol lilesa\ ina brwmto' \ 

The costs of the fire detector m bed on th€ 4sMrtion lhallft detectoE re rceded in 

on€-fmily hones dd !ha,l only one detecto is needed in each hone in hultifdny louses. 

T!€ life sp& of the deleclor is 6sMed to be I0 yeas dd rhe discoul 61e is set st 5 pNent. 

Besides the costs of puchasi4 dd instdling the deEror dd mually chalgiDs the batteies. 

cenain tnsmtion cosls @ included. IEse cosis G Drsted in Table I9. 

'fabb 19, The .asr pd hane d battery-operatA ana mai$-oryrated Jire detectots, lor one 

fmilr ha*es ahd ntltifanilt, houses. AI usrs @e in 1993 SEK. 

batter!-opcmt€ddector nrios-opemt€d d€t€ctor 

\24 136 

15 

It cd now be seen thal insralling nE dete.tos, tot! nai!*ope6ted dd bat ery opd6led, in a 

one-fmib hos eiv€s d expe€ted surplus. Her€, th€ implied life value is < 0. For hones in 

nDltifamily hos* ho*ever, thde is m expecred net cosr socjated with installi4 a nE delecioi. 

ln the 6e of a nEns-opetaied deturor the nel 6st is SEK 15. md for a balreryopmted 

deEror ure net co$ is SE( 47. Givetr a ns! reduction of45 percefi with a batteryopmted 

derecto. lhe initial rist is redu€d by 0.00001 r25, which impiies a life value of SIK 

4.2 nillion. A mnFop@red detecrd is asmed lo reduce the nsk by 58 percen! or 

0.0000145, which cives d inlli€d life value of SEK I .03 nillio!. Th€ costs pq life saved for 

the ditrerdt altematiaes de shoM in Table 20. 

7^bh 20. 118 cost per life tated with banert-operated and maid-opqated fue delectors, Jt 

ore lanily ho66 and nultildnily hoes. AI costs ne in njlron 1993 SEK. 

bait ry-openred ddetor n.insopemt€d det€ctor 

REIZ'KON: tusk Resedh RepodNo 24 

Sprinkler systems in private homes 

Juns B & Mattsson B (1994) r,rtm.lsklttaanalyw a brandt.tkshet,ln: Ri.nhingsverket 

119 ) Lagon brandtak Aet.FOU RapportPzl-086/94 [20] 

Eleiy y€d apprcxinEtely 30 leopl€ de knbd in tfts h ndtifmily houes and aplroxirEtely 

40 re killed in 6Es in onsfmily houd, in Sweden. Tne plobahilitr of dying in a 

firc in a onefanily houe in ay yer is esdMred ro b€ 34.6/l million homes (0.0000346) 

dd 25ll millior hones (0.000025) for mrftifdih nouses. 

Tle folowing esnnares e bsed on data from the USA dd Cdad.. since 1h@ is no data 

It h6 bed prcposed that it should be nade nddarory lo have tft dele.toB in all Fivate 

hom€s. To turtha incre safety, it is po$ible to als i$lall a slrintld syslm, a neMe 

that h very uEual jn pnvate homes i! S*deI! but is ued to sone exleni in for exdpk tne 

USA. In a lone wheF a tue deledor is alEady insidl€4 a spnnud systen is $timted to 

rduce the noltglity is! by 55 pdcelt fld Flee lhe expered @sls of damged pro!€rty by 

64,9 p€rcmr- fte initial mu,l norraliry nsk of 0.0000346 for one'fmily homeq is r€dmd 

100.000019 with lh€ nE deteclo, md e additional 55 percent of thjs h 0.0000105. 

lhe cosl ofbnyins ad i.sLlling a srrj..kler system for m aveEse Swdish onefdily-hose 

is SEK 18.400. With e €xpecr.d life spm of 30 yes. a discout la1e of 5 peicenl, e dual 

cost of SEK 220 for conlrols dd a 20 pdenr valE added &x, the mua.l cosl of the inveslnenr 

is calcdated to b€ sEK 1.700. 

Apart from casing injuies md falalilies. tues ee damsed prop€nr dd thse costs ce 

al$ be redlced by +iinu6. The e4ected avemee mual redudior in nre-Elated cosls for 

orefanily houses, wiln a spnrHer syslen in additioD to a tu€ .letedor d compftd 1o rtr€ 

det€cro! only. ls SEK 25?. ln Marbson dd Jues the msts of fai!.lili* dd injui$ e also 

included in the estiMrioll. but they have bm exciuded in the present calcdalios 

The resulting cost of islalli4 a spnnt]d system in addidon to a ire detector is thus SEK 

1,700 , SEK 257 = SEK 1,4,13, Ihis inplies a life ral@ of 1.443/0.0000105, which equls 

SEK I 3? nillio.. 

In the report fiom R;iddnhgsverke! Ju& &d Mattsson conclude ilat spnnkld svst€ms cdol 

he Imlm€trded lor on€-fanily hose9 Howevd, rcte thal UEy be their calculatios on d 

expticit value of saved lives ad reduced injuies, which is the sde d the valEs used for 

cost-beneft dtlysis of load salety ndr6.

Rmsbe|g & Sjiibere: fte 6st-effe.tiv.ms 

of fifesavins interentios 

Preventive fire proteclion at health-care institutions 

Sjoterg L & Osdds T (1994) An rdd.ta liv KosEFder ocn eFekld, Rapporr liU ESO, Ds 

1994:14 [48] 

In a relort non ine 'Expen Grcup for Studies iD tublic E@onios" (ESO), Sjiibery ad 

Ogddd hav€ mnlil€d dala or investDmts in lifesavitrg for eielt difremi 6*: th€ E use 

of gdolie es at gsoline siatio6, a cdpdgn aeain$ shokitrg, the uospldtation of bone- 

Ilrmw, themo*ttins pllrtics in lhe worl?le, the lEvdrive nE prctecrion at heafth-cre 

irslitutions, n€a$€s to Educe indoo! radoD, CEde-ftssi4 bui6, dd sfety lids on rells. 

The cs ofprventile tu€ pmlatior al nesllh-re iNtitutiors is presented h€!e. T!€ c$e of 

tnmosefiiDe lldtics in 1ne m*dace is excluded baaNe il is nol iltended 10 sare liv€s dd 

tne other css e fts@led €lseshm in this @or! 

Ev€ry ye thee de alploximalely 32,000 tues in Swder Thes tues cause 100-150 fatalilies, 

500 s€v€!€ injuies, dd 1000 l€s sevft injEies. Fnm 1984-1992, tues in lealth{de 

instinrd@ caused. on the avedge, 7.4 fatalities mually. Ile nMb€r of falalitis per 1000 

In Swden, aI nuicilatities have a so called liE Prot€ctior ad Civil Def€rse Bodd (BClo 

wlich is resloBible for fie prevotion. Amo4 ornd things, ihe BCN p€Ifom nre ispecrions. 

rcviews buildins !emir., ad giv€s advice on lE Fot€ctio!. Sone tue plot€clion 

ne6u€s re rcsulaled bt law for all huildings. Al rhen EEde 6E ilspectios. the BCN @ 

aie dmmd speial sf€ty n€dues lor cdtain q?es of eslablislmenrs. mors them h@!h 

@ insliturios. Ile safety neams r€quiEd d€ d€6!€d in a tuei$pe.do! odinmce The 

ains of the tre prwention meaws m PrimiLy to pEv€rn tue ad s4ondarily ro Educe 

ad estict the @Bequencs ofnts. fte nedms m ona diEcled tosErds secuing a sfe 

*@uatior dd lacilitatins the 6re-den's woik in c6e ofa trc. Sjiib.g md Osddd ue the 

exmple offiE pr€ve otr al Sodesjuthwl in Slockholn, whicn is a ldse enelsercy hospi 

rll sith 800 beds, ro illshale what a tE-prct4tion ordinme cm na in ctl life. The 

hospiiar n6 hen order€d to lnstrli automlic spri.bers in sne *ards dd d auiomatic nE 

fte nsk rduclion achiwed wilh 1ne EE insDection dd other n6lm is not looM md 

probably vdies mons the individu,l 6es. llowevq, expen€ne shows lhat firc inspeclion 

ed othq fire psdtior nedues subslanlially Educe the ieqtncy dd seveniy of tEs 

Wirh 8OO beds, the *pe.ted muar nmber offatalities i! S0d6jlt]rset is 0.04184. Sjiibere 

sd Osodd assue a nsk reducrion i! tne i €ral 50 peto!100 pecsi. H@ w€ will s 

sme that ir is ?s peGnt, whicl gives 0.03138 sved lives tu!,llt. 

65

REIZIKON: Risk R6esn RAon No. 24 

The BCN ft not rquired to take @sls i.to 6@'et rta a*ilg 6E efcty. For a ler6- 

.@ ilstituti@ ltEt gEts o ddd! the ost my be $bstadial- h lh. ce ofsoddjuLhuet 

th€ @ual @sr of fie pBatioD is .stiD.i.d to be alprexi@tely SEK 2 ftilliol Th€ @r 

pd lif. $ved is lh6 SEiK 2 DiUi@/0-03138 -- sEK 6l-7 nirlion. 

66

Rdmbqs & s oberF: T}e @t-e ner ti r mess of lifee\ ine inten ention' 

Electrical safety 

Verbrl commiqtion: willim PeNarer, National Eleclrical SaJetv Board, Julv 17. l99s 

[41] 

t\e;vedLD_o () Dspled Uleo In el.mi-al d.'der'in Sveoer '' loa3 r @'ve 

l99aii"Ns;"mddin l'rq) "eveopeopet"dbfl nledLPuu.bemonLhor oc@b' 

ir 

Tl'r€e 10 fou of these fabl eiddts occu on toP of hain, whw n is possible to cone in 

contacr with hleh aolt ge lires. ftffiilv, it is plavins chjldM md drun*o Psple qlo sut: 

fs tlns tr"€ oiaccident. This t}!e of acciddb m ndd 10 avoid with re$lalioN Th* m 

also otLe; eid€ s wil]r hich lolbee (rLlmt t€laied nr' for exmPle indutial work 

Sone d€ads re dle lo donestic accidenls, invoivins lo{ voltase cLlBt' 

It hs bem DbDosed that a R€sidul Cue Device (RCD) shodd b€ nuie ffidalorv in ax 

ori\ ale hou6 A Fr D is t saieu aev'ce |nd i: pntui J int' m lor Ls€ce'd pri\ ale hom* 

;u i r, al.o usd .o protubn e\.de.'r in dp dg nk rd o'fuuor si e" lr b& bee! 

esrinated thal aDproxinalely two to 6ree faial &cidenls cd be avoided ev€rv ved ifall pri_ 

vate hoDs6 se; €quitped with a RCD In sone coutri*, ircluding Dmk dd Fmce 

RCDS de usd fd nore nequennt ev€n in ldvale hones Ue r']Et thev d€ iD Swed6 

The cosl ofilsl,llilg a RcD is approximatelv SEK 2.ooo 3,000 md il all 2 2 miliion pnvaie 

houss i! Swed@ w;E to inst3l on€, the tota.l cosl murd be more lhd SEK 4 000 nillior 

Divided ovd lO yec, dre 6st MUld be SEK 4OO millioa muallv vhicn sies d implied 

life *lue of sEK l3l_200 million 

In Sweda a RCD is onlv a conllenenlarv safet dsice, not inlended to repl@ otlq safet] 

-**.. i' rqqr. ,he n"ri".J Bodd of Eldiricsl safetv cme to de conclBion rlar the 

hieh cos! pe! life saved @de a hw requiring RCDS in all Pfiale hou*s indeltrible Anoder 

imD;tu fador 6 L\ar h'Bom is rquitd o %\e a \eD

RHIZKON RiSk Res4h Repod No 24 

Electromagnetic fields and cancer 

leychtiq M & A bon A (1993) Ma$etic neus sd @cer in childFn Esidins ned 

Swedish hish-yoltage power lines. Aneritun Joutul oI Epidniolost, 134: 1i 461-4ar 0l 

gabne E ( 1995) KFfledning gravs ned, Dagens Nyhete., 951109 Page D5. l9l 

There is m onsoilg debat€ aboul the lossible derrinenbl health eEe.rs of elecrronagleric 

nelds. One of th€ prcpo*d etrecls is that weat, exll€Eely low frequercy eleclromaslelic 

fields. snch s the orcs foud Nud niC! voltlee poFer liles, nay €use leuk€nia in chil 

dar. TleF do* nol sm to be dy msensus in the *imtific colmuity on this issue 5l. 

A Swedish snrdy found tLal the risk of leulmia M twice 6 biC! for chil.lren exposed ro 

noF thd 0.2 nidor€sla electonasneiic 6€lds. 4 compftd 1o children qposed 10 up lo 0.I 

nicotesla [7].In th€ study, no ditrm€s i! ircidence could be idertifi€d fo! adults or for 

h ihe olmuiry of BergsbarE4 in Solna nortn of Stocknolrn, l,\ft is a 200 kv. power line 

passing ngh ovq residdf.n ea. inclDding fou cnild-de coi€s. This bas caued nuch 

wony md m interse debale in die coImhiry. Appioximt€ly 2,000 ?mple live ned the 

powd line in Berss\am [9] 

L€utmia ued to have a noi,lity nt€ close lo 100 !€rcent for all srcups ofpatimts. but today 

the expect€d tue-y{ sNival is @ the av€nge mud 35 p.E and for childr€n 6 

hid 6 ?5-80!€rcefi. Ev€ry red there m abont 1.000 new cd$ of leulenia i! Sweden ed 

lsually 60 of1n€e re childrq. Thus, the probabilrry ol ac{tnirine leDk€nia t ap!rcxinalely 

t8000. 

If rle d@ographic distribuiion h Bereshma is dsmed io be 1ne sm€ 6 the distribulior in 

fie coutry 6 a whole, one @uld expect 2000* l/8000 = l/4 ces of lenlenia il Bersshma 

€very yed. Ofthese, l/4 * 6/100 = 3200 will be children. (This nems thal lhere will be one 

cde ol leutenia every fourlr yed, dd one cse ol cLiLhood leul€nG aery 67jh yee.) 

Assming rhal rh€ risk of childhood leDl€nia is donbled i! Bersshm. be€6e of the pover 

line, ihe expe€r€d nmber ol chil.thood leukenia c$es is 3/100 evsy yed. Given a swivtl 

6te of75 p€rcent, the trcreue in the expected Mbd of deads non childhood le!*enia is 

3/800. 

The cities of Solm ed Stocklolm have d*ided to buy the pow€r li!€ in the CIoDd, which 

wiu cready Edm the elecnotuFetic neld. This inlenenlion is h* 6smed to redce the 

nmber of ces of childhood leu.k€nia with 31200 €very yq, which @uld ned l/800 

]!e targer group is childJe!, 6ui nmy aduhs N also *oried lbout the etrects of electJoms-

Rdsbers & Sjdhete: Tlte cost effecdvene$ oflif€saving int*driors 

'I!e @st of Enoving th€ powr 1i@ ard luiing il i! the sroud is Alinabd ro be SEK 60 

nillion. Calculalilg rnis investm€nt 6 d Muity over ,O y€ars, th€ @Ml @sr huld be 

SEK 3.497 nillion. In one yed. 3/800 d*tbs dE to childhood l€ukaia would be avoirled 

ed thu. tn€ @s1!.r life ev€d mdd be 3,497l(3/800) = sFK 932 5 nillion- 

-fte issue ol electronasnetic fields ed cdd is very @ltovqsial od should be ii@ted 

Gltiously. It is hard 10 v*ify ilE ris* esiimtes p$ented he!€. Tne !€sn thjs 6e is inclu

RIiZIKON: Risk Recmb Repon No 24 

Safety lids on wells 

Sj6b€ry L & Oeedq T (1994) Atr riidda liv - Kosinadd @h efekter. Ralport till ESO, Ds 

1994:14 [48] 

In a eport ion the 'Er?ed GrcDp for Siudies i! Plblic E@noni6" (ESO), Sj6bns md 

Ocede! have conpiled dala on investnmls in lifeevjng for eieht dif@l 6s: the E-ue 

of gdoline g6 at edolire sradons, a cm?aign aeaiGt sftoking. the rEnspletation of borc- 

Ilrmq llemosetline plaslics in rne workplace, the Fverlve fie Fote.tiotr st heajth-cs 

ilslinnios, ne6@s to reduce indoor ndoq giade-do$ing bdie8, dd efety lids o! rells. 

The cse of safety lids on wells is ?6ented h@. Ir 6e of themosettins plstics in the 

worlplace G exclud€d tecaue it is not lntnded to save lives dd the oths c6es re pr€sdted 

Every y@ th€r€ de a trmber of ecide s wilh clndrE fallilg into w€Is. Or the average, 

drc childrd d&M €very yer in S{€den, dd one of these droms h a wll. Eowver, tle 

last l0 y4 fewd childid hav€ drom€d i! w€lls, dd the rDbd ha or rle avdag€ ba 

?radicslly all eideds with w€lls cm be avoided if the wlls have sufrci€nt lids. On the 

mket, th* de sevenl bodeh of lids that Fovides a secue seal oftn€ well. IE Nanonal 

Bodd of Aosing, Building ed ?lMing (B,wl", ns the r.gdalory rcspomibility fo! s- 

cidenls in &d ned hones. The safety ofwlls @ be resrlat€d by law od the National Bodd 

ofEousing, Buiiding dd Plming proposd such a iaw in 1993. 

Tnc cosr of leo$hucting one lid is alproximtely SEK 1,000. Tle National B@d ofEou 

ing, Buildins od Plming asmes that 700,000 wus Deed rccoNtrudirs. slich resuhs in a 

roral os1 0f sEK 700 nillion. T!€rc is also m iritial osl 0f i.fonsrion of sEK 3 million, 

but lhe Educed cost of health cre dd sick lesv€ foi paenis is of alsoximately the sme 

st€. Tle cosr per life saved t calculal€d 1o be lEK-lj[:Ei]lioD in l99l prjces. wilh a dis- 

@mr mre of 5 percent ad a lif€ span of20 ye6 for the investnent. 

70

Rdrb. g& srbb-g fte.o ef.r_v6. (of 'i.'.virc ii@r'on 

Reducing gasoline gas pollution 

Sjiibers L & Ogmda T (1994) An redda lir - Kosilad€r och eEeker, Rapport rili EsO, Ds 

1994:14 [18] 

In a ieport Aon the'Expen Group for Studies in Public Emnonics (ESO), Sjdb€rg dd 

Oseder have conpiled dala on inveslrnents in lilesavilg for eiett dif*Dt casesr 1n€ E-use 

ofsdoline gd at erdolin€ stios, a cmpaign a8ailsl mokine.lhe trsplmlation of bon+ 

mamw. i\mosetring plNrics in tne sorkplace, th€ protiv€ ltre lrolatior at hslth-ce 

insritutioB. nedwes !o rcduce indoor iado4 gEde-crcssine bmieB. md safety lids on weus 

fte cde of E-ue of gsolhe s6 at gdoline siations is pi€sted here. fte cde of fnmoening 

plaslics in tie workplace is *chded becae il is not inlended to save liv€s ed fie 

oder ces m pEsenled €lswh* in ltris iepon. 

volatile orgdic subslaGs. so called vOCs, de oft€n rcle4€d in rhe bm.tling of g6olin€. 

All of these substarces de beliwed 10 have negaiive efecls on lne dvnomenr md sevdal 

de lelieved to nav€ rcsative efecls al$ on ine hullm h$lth. Tne probably best hom of 

these subslances is bererc, vhich is knoM lo cause leu!€nis md lhal is the o.ly health ef' 

f@t included in the ples @lysis. One suce of exposre to VOCS is sasoline slations. Of 

the 7,500 tons ofVOC that vas Elebed i! Sweden in 1987. 287 lons wre Elesed al gM- 

In 011. one to three ces of l€ulenia F€r yeu @ be anributed 10 bdhne in d)e eDviomen! 

bur ir is not endrety .ler lDw nmy of these re caused by be@ne Eleded fion gasoline 

s1alio6. Both .stoners filling 1hen cas dd leople .esidiig ned gsoline slations m exposed 

to the vOC. Acording to on€ Swedish studt, appoxinat€ly one cde ofleutemia in 6 

y@s cm be athibuled lo hme rele&d fron gAoline slaiions, for p€opl€ filling 1h€n m 

[]41. ID addition. it is sliruled that berde fiod gdoline slalions causes molhd cde of 

leutemG every six yed in p€opl€ r€sidins led gdoline stations. In Sjoberg dd Ogdd€r, ir 

is ihus assmed that approxinalelr on€ c6e of leukmia every $ird yed cd be atlrib en lo 

b€Ene €l6ed Gon easoline st!tio6. lurdremoE. it ls 6smcd rhat the mortaliry Ete for 

thc leulemia cased by bwen€ is one-hu&ed percent. 

fte exDosue !o beDene m be redeed by insiallins Slss' or all gsoline pmps Nbicn 

makes i! possible to re-use the sdoline ges. ftus. nol ody does the sleeve prolect hmm 

helth dd the aviom€n! bu1 n also saves sdoline tlEt olhwiF would lave b*n wasied 

fte etrectiven€ss of the sysien is report€d lo be 90 percenl. In 1990, de Swedish Envircn_ 

oenlal Potecrion Aeency decided thal all gasolire sr3iom thal sell nore tid 2000 n' of 

ssoline mually de Equired 10 insbll sleeves. Il nusl be noied thai the nain dgmeni bo_ 

hind ihh rcquiEnenl w6 nol the possibl€ lealth benefils. In$e!4 n ws a step towards 

lcnieving the r€duction in vOC rcledes thal Sw€den hd comitted lo i. inreMtional trea- 

'11

RHIZIKON Risk Reseeb Repon No. 24 

Otha medues hav€ bem taken to reduce the relede of beIlz@ io the ewiromdt 6om 

ersline deposirs dd other parts in the dtlribDrion chain for gsoliie. Tlse nedu€s N nol 

included in rhe olesdt analvsis. 

he cosr of ilstall'ng a systen to reduce gMline gd lollution is alproxinately SEK 150,000 

for a medim-sized gelire station. Tlis ost includes the cosl ftr all necessary equipde 

ed co.slruotion $ork. T!ft is als a sb,ll mu,l cosr for swice dd baiite@ce of the 

sysren, bur ilat h6 no1 be6 included. fte tol,l msl lbr all gao1ire stalioru in S*den h 

SEK 1,000 million 1,500 million. wftn a depr€ciarion 6ne of l0 ye! s dd a djscout dte of 

l5 pN€trl, the @st!q life sav€d is appiorioalely sEK 250 nillion. " 

Sone obiections cm b€ raised a€8insi the @lculatior of dre cost per life sred in ire c6e of 

educisg gsolift CN pollutiol It c& be asu€d that the nesue h6 orher obj4rives ths 

jut to save livs, such 6 redlcins cerr.in ervircmenlal loblms. Tlis loini is of suse 

nentiored also in Sji'bds ad Osude!. fte nosl proniretrt mvircmeDtai ptublm €used 

by vOC is lrobably oxiddts. such d oaft, wlicl d{Ege L\e veser.dotr. The obne afects 

e@lodically in?oiter vegelalion such s lne foEs! ad cBps.ll is difEoult 1o ir.olporate 

the €fects on &e dviromefi in the calculatios, stue iild€ is knoM about the actusl siz of 

the &mages. Other pdamteE could also atrect the cost per life sav€d i! the calcuhrioN. 

Beiow w€ pesent in wnal diEtion some chdses h ruid pmmeteB would chage the cost 

Envnomatal ddaee frcn oxiddls 

Eff.d on oe ps life sa\ ed 

Depreialion tim€ ldg€i thm l0 yds 

Othd health bmefits included 

Discout rale low fid 15% 

Deat! rale of L€nkenia less tth 100% 

As e illurraliv€ eMple consider a calcdladon whm a s peicdl disoul Et€ is used, the 

mual cosi of envircmental ddage due lo o{idznls is Educ€d by SEK 20 mnloa dd finally 

thd sie as trEy lives, conpared wirh 1he mieinal ssMPtio6. re satd. fte @si 

d life sav€d would thm be SEK 166 nillion. Ilis snom 1hat lhe calculslions indeed m 

Fsitive 1o 1!e dsuptions that nav€ b€en nade. Horever, sire no reliable tL{a on enviom€nt 

l danase od so forth e available, the calculaiion p!€stsl above will lave to 

suffce s a Esomble approxiDarion of the upFr boud of lhe @sl pd life saved Res{ding 

the loM boud. th€r€ is no e4o! to beliwe il sould fau b€low, say SEK 100 milio! pd 

'' lx. rin*spm ad di*our de n. 

ihen ebularions Lh.y f the Flrydr iiers 

7Z

Rmibere&

RHIZIKON &sk Reamh Repon No. 24 

In both Srockvik aid Srenugsud,lh€ ompdies have lak€n iniliatives lo r€d@ il€ erlo 

su€ 10 viryl chlonde for wo!ke4. Olhd inpodor &lore irclude d€ local dd naliodl nade 

eions and th€ conpdies' h€lth cde senices. In addition, tlE Colement intfleDed by 

slring standdds for rn€ nqinm allowed level of exposE ro vinyl cdonde. Me6Ns 10 

inprcve i1E condilios fo! worke$ egarding vinyl cliodde inctude neouing exposue, per 

foming nedical controls ofwdkes, dd clargidg the prod&tion techniques. ReCrding the 

prcduction !€cnniqne, rhe nost impor&nl me6ue is to crate a clord systm of prcducrion. 

Tle iotal cosc for intenenlios ir lhe 6e ofailyl chonde e apprcxinately SEK 20 hil 

lior Tle @st pei life saved is calculated sing a di$out rale of20 ldcenl dd a de!Eci!- 

tion tine of 15 yem. ll is rct mtiEly cLed now ihe calcdation in the wesie@k study w4 

cmi€d oul but the rc$lting cost per life $ved is SEK 22 milion. 

3) A*.nic. In the We$erdd* smdy, exposue ro dsmic is studied in a specific nelalselring 

pld! ,R't.m&t/rdrt€,, wheE dsenic b relesed a a by-Prcduct Aon rhe spper 

selting. Olhd the lhaq asic is sed lor the im!re8@tion ofwood. A6eric €ues lug 

6cer ad EtrosDective studies have foud rhal about 30 cses of cme! (in 40 yed) dong 

worlres in the Rdmktusverko cm he Ncribed lo the workirs condilioN. Sone doubts cd 

be nised whelher ihe 6cq cdes ar Rdmk?irsv€rlen have ben caused by melic orny, or 

by 6eni in conbielion eith othd substances. 

Orer the y@s. a wiety of intedentio6 lave been usd ro imprcve wo*ine conditjons in 

Ritnnsliasvdken @d lo reduce the incidene ot @cd caBed by Nenic ad olher sub 

slan€s. Idervdlions includ€, msuine expos@, perfordng nedicsl controls of worke$, 

md chusinc lhe productior iechliqu€s. 

Themtal cosr ofthese inteae ions eouis to appmnmtely SEK 100 niUion.Ihe cosl pd 

life sav€d is cabnabd usins a discout mt€ of20 percent md a depr€ciaiion tine of I5 yeds 

It is not entnely cler how rhe calculation in dre westmrk study M cnied out, but the 

rcsdrins cost H lile saved is SEK 6 million. 

4) Polvorlic nrg.nic n.tter\- seb 6 polycyclic hydmcdbom, ee eleed at, mong ofteB, 

rlminu pldrs. Thft is o.ly orc alminm pler in Swed€!, in Sudslall, md cose 

q@nlly, thG pldt \8 studied by Vestemak. A deoreiical estimalion oflhe nmb€r orcmer 

css at the plet in Sudsvdl h alpioximrely 20 c6es in 15 ,ds However, Wester 

@k rcporls that lhw is a scientific @ntoversy ovd ihe cNinogenic efecls ofpolvcvclic 

Tlo produclion le.iinique ha bed cndged ad one pldt hd beo closed doM

Rmbers & Sjobss: The co${fectvdes 

or l .qvbe'dhsrro6 

Tn€ rotal costs for the iltdmtios de alpoximately SEK 50 milljor The cosl pa lfe eved 

is crlcular€d 6ing a discout Fie of20 ld€nl dd a depEciation time of i5 y@s. h is not 

drircly dd bow the calculation i! the w€stemrk study m cui€d out, blt the !€sdlins 

cosl pd life saved is SEK 7 nilion. 

TaL,L 21. Cost p.r life s@ed' far intenariN ta redu@ cmct in the Swedish in&aty 

cNed bt u ain subnMes. Allcosts Ne in nillion 1983 SEK 

Corl pcr life s.r.il MSEK 

5 

22 

6 

'7 

Polycyclic orgdic mlt€r 

5 Yffi, usi4 6 ind$ Fr. of 20 Percmt 

h lhe repod. w€st€mk stresss that the ieu$ mEmiDs the cost pd life saved @ ap_ 

lroxitute dd oDly shodd be rlkd 6 a rr@E of the ordd of dae tude olthe inv$nadt

RHZIKON tusk R€$ch Repori No 24 

Security packages 

tukspolisstyrehetr (1993) artrdkswtkMhet ned ltualdsstrd.lJnt hotade ttihhor n n -en 

tegaihgsrpp.lrag, FJS Rapport 1993:6 l42l 

Ev€ry yer a ldge nDber of woss de bane€d. 't\e tn1 wahah batery 

(bin"onisshdhdeq is nanillr lrl€o to mee battery asailsl womaq indoors, b,' a lerpeha 

1or &quin(d with the victin [25]. In i 991, tb* w* a lotal of 40.500 r€ports of seult dd 

banery in Sweden. of which 3s percen! tbat is 14,500, wee agailst won€n [25]. Oul of 

ihese, 9,338 were womd batlery, according lo the defilitio! above, ed 7 p€Mnt, or 654. ol 

the wonen banery ces see reloned b be severe. Th€ figrE fd 1993 md 1994 e Fe- 

*nted in Table 22, wh* it cd be sd that the nubd of reports of 6ed1 dd batery 

aeainst wonen in 1993 had ircreased to 1?,928 md in t994 to 18,567. Tlis @ftsponded ro 

16,622 dd 15.961 cses, respectiyely (lhe nuber of rspalrr ed .6er ditrer becaw the 

me relort cd mncen morc thm ore ircid€nt of Gsault md balt€ry). A ldge mjoniy ol 

rhe p€ryetrators, 78 peMD! w* &q@inred wftn th€n victims and nosr oftne asadrs bok 

place indoos. In all, 10,455 c6es of mlm banery ser€ r€loned i. 1994, dd 705 wd€ re 

loned 6 sevft. Besu$ the sde wolrH 6 nate norc rhm on€ €lon in a yed, ed ofren 

dat is th€ cas€ wir! don€stic violace. the nmbd ofwonen subj€led lo dsarni dd batlerl 

js not 1oom. A reasomble eslimaiion ofthe nmber of !€porls pr wonm is 1.2, whicn nem 

tlEt apprcximt€ly 8.700 woner r€ported wolrn batlery in 1994 [36]. 

'lable 22. Astatlt and batte,t- againt vonen, nMber of repofts and hMb- af.ases ih t 993 

Asault dd brnrry .grirsr wobo r993 199,t 

t7,q2813,56? 

15,961 16.622 

svere dsault dd batlery, nmbd of 1,236 

seveE ssault md banery, nuld of I,173 

assauh md battol indoos, pelpelia- 1t,721 t2.t96 

!trr eq@inte.l, nmber of repofis 

ssadr md battdt indoors. peeeira- 10.0r9r0,455 

1or acqDainted, nmber of cdes 

sdse dsadr ad baft€ry indoos, 918 861 

pdlerialor acqlainted, nmbei of 

sder€ 6sult dd batery indooB. 

perpetrabr &qlainted. nmbd of 

Itr 1991, l,ll caes ofhonicide/mslaughler wre reported 1o the lolie ad 32 p€.c@t, Lhal 

is 45, ofthe victim sele adult wono. Thfty, or 67 petd! of tbe eooe. had be€n killed 

by then husbmds (or q-husbeds, boyftimds, etc.). In 1992, which is the lal yed for which 

16

Rm bdC d SJob-g fl" @q ee.tu Jen.ss ol l.F. a\ us 

'D'we' .,or 

data qists, 36 woom disl non honicide. neslaughter or other 6eul! uordins to slalisrics 

Sweden s (SC4 tass of dealh sialisrjcs . SCB does not epon the qe of perperialorj 

oihd thm thal it M i! nosl 6es a peson with whom dre wonm had, or had nad. d i i 

mle Elaliomhip. Usually, il is said that about 20 wom€n die evw yer s a dircct conse 

quence of wolrfr ban€ly. but il should be notic€d that llat fisN misht be & ud@slioa 

1ion. The true Mber could be lighd il for iDstae, the tIIe @se of dealh is ml Evet€d ia 

all cases. Tne nubq of aulolsies hb deceded over lne l6t yed, sirirs o.e possible explmarion 

why rljs mishi be e increding !rcbleh. l lhe cdes whft s womfl comiis 

suicide 6 a result of onsoins ba!.qing, hd dearb is not rerofted 6 caued by dre banerirs. 

Hos large de nsk ofbeins knled 6 a Es of*ond batlery really is, delends plimily on 

rhe nMb6 of w€polt€d c6es. In liole qimq n is sually estinated that lhft re fou 

u epoied ces for every Epon€d cs. Eorever, rhre cncmstdces regardirs wolrH 

battely nales it resonable to ssue thal th€ nuber of Lmponed c6es is hisher for this 

l. Ile batery o@N in a closc Elalionship. 

2. The battery dd 4sarnt raLc place in a privat€ settin8. 

3. Thc vicrim's phlsical injuies de. m d' .drds, Dot enenrve. 

h dG ieport Aon RPS, diif@ eslinalioB oftne rario of wported cses (RUC) N dhcu$ed. 

R€fnirs to &la fton montmos sw€]s, it is estimled 10 be apprcxinately l0:l 

for oin€ in s€rcral dd 3: I lor violenl cdnes, bnt nuch moF for doneslic violace, espe 

cially l€ss severe c6es. A swedish fininoloeist has esliMled thal lhe t:le Duber of bai 

1ded wo.d in Sveden is 100,000, wlich nem a RUC of aboul 20: I [42]. EeE. il will be 

asMed thar 1he RUC G 7: I for sev€re aeDli md banery ad l5: I fo! less seveE c$es. Note 

that the ody tnolelical ertud fo! these asmllio$ is that they N in between the hishesl 

md lo$est RUCS €stiMted by exlens. 

11 @ be 6smed thal a ldge nMber of the woma thal re kiled in a rclatioslb }ave b*n 

subiecled ro sw* 6sauh dd battery pEviously. TheEfore, ir lhe pEse calculadons it is 

dsmed thar l0 of ihe 20 Bomd that de knled €vert yed, cone fion dre €roup lhat have 

bes slbject€d to severe 6saul @d lanerr. Edlid il re said that dre nmber of {onen dat 

Epon€d dsaulr ad banery. denned a wotlE batlery, $6 8,?00 in 1994, Of rhese Epons, 

587 wd€ sever€ baflqy cses od win a RUC of?:1 thlt nem 4,107 wo6€n. ad if l0 of 

these women tre killed the mud risk ofteing kill€d is 0.0024 in this group.'ft€ nmber of 

wonen lhat reponed less severc dsauft md hattery ws 8,11i, which do d coftsPond to 

121,700 women siven a RUC of l5:l. Tn€ mlal nsk of beine kiued is, for ihis eronp of 

wonen, 0.000082. For the *hol€ gronp th€n, the n* of bej.g killed ls (0 0024 t 0 067) + 

(0,000032* 0.93) = oQ!!24. 

The inretrertion udd sludy her€ is reclrirypadfrdsct. This is only ore of nmy possible 

neasws tlalcd be tak€n dd n is pnndily Ned in endgeDcy situlions, vhen $e nsk of

RttlZlKON: tusk R.sdch ReportNo.24 

dellt isjudeed ro be ligh. Odrr nedues that cd be us€d in acute situtioG jnclud€ body 

Blards or Mtch dogs, bu! these de uusual mesNs. 

Nonally. the n€sws discused h@ ee pan of a {noh sysren of sulpoding n6ws that 

m intend€d to soFe rhe batte.ed wonmt problm in a norc nndmst l My, Mediql, 

econonical, dd juidical help @ ekples of orhq trTes of support that ca be Civen be, 

sides prctecting the batteEd {ond s physical ad psycholosical inlegri\'. Mmy bail*d 

wond ai$ ser help ad suplorl fron i€lalires, social seni€s md batta€d wono's hones. 

As of tdy 1992, all police distiicts in Swden de equipped with secuiry p&kages to lend 10 

tu€tened wom6. ' The p&kage coEisis of a cae with d€ following protectile equipnent: 

I A p,otech\? phaa?. wt i.\ n " s!*idl\ !'ocffied.el 

u rpho 'e 

* An awerins na.hitu/tdpe tu orlel to iecoftt 1brcal6ing calls. Tlr eco.dings cd sub* 

* A sedlt{y proue, which tules jl po$ible for the qone to contad fie police fiom her 

hon€, by pushils a single bltton. 

. Ar dca"stic, 110 dB altn. 

In a pilot !roj€.t,200 of these pekases *ft disFibuted to three,tmed enen. In.tll, srd 

attacks on the womer weF resislred duine dre pbjec! bul ail could be warded off, *ithoul 

dyone heing injuei. Ihis does not ned thal the secunry p&kages will glve on.hudrcd 

.@ent orol*lion in all inslances. 

I€ cost of ore seuitt package is SE( 17,500. Since the police audonties pNhsed 280 

packag€s, the total puchding cost @ alproxinalely SEK 5 nillion. Apart Aon the puchdina 

ost thele is als d tuud opmling cost of SEK I30,000, for 280 packa8es. Assming 

dat the srcuily pakases @ be ued fo 5 yeds. in€ nel pr€sent cosl of the ilv€stnenr h 

SEK 5.32 miilion. The p&kages de ued on lbe avdag€ for a rhEe-no h penod by the 

wonm, which ma that 280 !&tages cd be ued lo prctect 1,120 woma mually. Given a 

nsk of 0.00024 of being killed dd dsming lnar 1he risL is r€duced to relo for the wonen 

who set rhe p{*ages, 0.2? liv€s will he saved mually. The net p!6m1 Mber of saved 

lives ovd 5 yes is then l.I7 wiln a discout nte of 5 p€rcent. 

Tne @sl per life saved is thls SEK 5.32 nillioil/l .l7 =jslK.l1'55-millio!' 

The nsk of b€ils killed njCh noi be coEe€tly €stimated, which would allsl tbe cabdated 

@sl per life saved. It is lbr €xmpl€ 6smed thal lhe nsk of being killed is rhe sm€ for rhe 

gou! wno leeiv* tle souiry packases 6 for the sroup ofbanered wond it gmenl. This 

could be d ud*$ination of tne risL sirce rhe prckases ae sllposedly given 10 women i! 

a hish-risk sit@tion. Sone possihle souces of eEor in the estimation de presdred in Table 

Li nre Drkals 

cd iko b. tr*d by nbE 

78

Rm,bere & Sji'beB: Tte co"l

RHZIKON Risk Rer&ch Repon No. 24 

References 

ll.Aheme,J. 

35(2J,16. 

F. (1993). IDlegaling ijsk analysis into public lolicrlakils- 

,,rn,re,4 

21. BeDetsson, H.. Bogqvist, D., Jmdlee, S.. Lindgen.8.. & PaseI! U, (1989). UltrasorqEphic 

s*ening for abdoninal aonjc eeurys: dalysh of sugical decnions for @st- 

.E cttuffiss. World Jowl of SwEer!, I3. 

31. Coheq B. L. (1980). Soci€ty s v.tlution of life svins i! Fdialion prcle.1ior md o1!er 

.onrdrs. Eea|h Physics, 38,33-51. 

41. Daubtck, B. ( r 995). Test ftir A?C-6isles lbE p-pill€GeF. Latetidningen, 92,4558- 

4561. 

5l.Dmiehson,P.(1995).Inrni*. Stockholm: Civildelartenenrei 

61. Deaeq M. G. (1994). Jusifriry a folsiviq nthway. h ry,/isl,, an Roa&ide Wtr 

Featues 09-3 L l 994,. FERSI: 

1. Feychtins. M.. & Ambon. A. ( 1993). Mag@lic fields &d @cd in childr€n Esidin8 Ded 

Swedis hish-voltage power lin€s. Anericah Jomal ofEpideniolog), I 38, 167441 . 

81. FokM$innjtutet (1995). lue^sit^ 

rd tobd*tftdtttjhihs? Gobaksprcsrm€ts Gk- 

91. l{6lne. E. (199s, 9s/l l/09). KFftledDiDg Cxevs ned. Das.a /q4da4 p. Ds. 

l0l.Herlrnm,K.O.,&Ste org,L. \'t991). Smtui lekDnoniskpriorittiryaioJ)l6akerhetsdtgattuler 

Htwdrupport ('IFB & vTl Resedch No. ?). Linldping, SNeden: Swedish 

Road dd Tra6c Resach lftlitule (vTI). 

111. Hellbon, K. {r995,95/11/30). Anbuldsvrrd sldsd med tid. DaCe Nrheter, p. A6. 

121. HeUqvisl, B., Juis, B., (dlsson. C., Matisson, B., & lhompsn, S. (1982). vatd*iraa 

rkten ftr pasa8kador En janftr@de tt"die ae inpli.ita ach e,?ltcta vdde, (second ed.). 

Cdleborg: Narional€kommiska istjtutiono vid C.'t€borss uiveBnet 

l3l'Ja1d6t\ P. (199r. Ealsoelehahisla inteedinsstalkller i Svqise 1975 t 989 atr 

perd6 (Workins Paper Senes No. l l/1992). Lud: lEE. 

1,11. Eaiema4 c. 1., Lindlolnr, A., & Akerblon, o. (1995). oveskattade nster m€d blodn^sfrsion, 

LdkartidnikEen, 92, 1999-2004. 

151. Ja@hen. J. R.. & Mflin, L H. (1991). T!€ e?iddioloey of el"os@ 1o electomagn€lic 

nelds: An ov€riew of dllle recent lltdnr.. Jawnal oJclihical Epideniolog, u, a9s-906.

Rmsberg&

RHiZIKON: tusk Resscn Repm No 24 

331. MoEll, J. F. (1986). A rcview of lhe Fcod. nesalario,, ((NovD€c)), 25-3a. 

341. Nils$., R., Nordlindd, R., & Jiinholm, B. (1993). Hinsoriskd vid bosinldrding. 

Inkatidninsq, 90, 1553-1557 . 

351. OdliDd, V., BysdetrEl M., & Mlsm, L (1995). P-piller i pdspekiv - Nrita- 

^ke-dddiuq. Latartidninaen, 92, 45474549. 

361. Olsson, M. (1995). Inl€triew. Slocklolm: BrottsnjEbysdd€ reder. 

371. PeEsoa U., SvNd, P., & OdesaEd. K. (i994). Sdrrrltu,itnohiska kastha.let 

areekde alqAiska beein J.'f botl/yM i Sverige | 983J 993 (Arbd$appon No. 1994J). 

Lud: lHE. 

381.t6sorlU'&Svensson,M.(.199D.Bdiikninqo,Aibga7ti:Sanhalsekononiskprjofiieriry 

@ iafkiit@hettutgbder (TFB & vTI eseeh No. 7:1 . l99l ). 

391. Pds$n. U., & WiBlot! L. (r99s). Vilka fisktaldzh 6d hutuntird.b) uil dtutindos i 

iwesteringslal|ler i iarkeh? @dl€tinNo. 128). Lmd: Deparlrnol olTrafrc Plming 

ed Engiftding, Univdiiy of Lud. 

401. Pdsoa U., 6deeaa-d. K., &Bnstu.R. (7994). Etnnanitt 6pekq pa herkopterunbulM 

i sjulrdrdstjdnst .-Atuas €pport No. i994:4). Lud: IHE. 

411. Pdsater. W. (1995). Inr€ryiew Nation l Electrical Safety Bodd. 

421. Rikslolisstyi€len 0 99). abTr'tirv,rirMhet ned livtaldsswd jtn hatade kvimar n.n 

ei ftgeinCsrypdrcg @JS Rappon No. 1993:6). 

43). Rons, P. (19871. In|IuMaccinerinE i SveriEe. En tust ads-,/t -a,ats (Meddeldde 

No. 1987:3). Lnnd: IIIE 

441- SBU (,1994t. Mbnigt tbrhdjt D/drr'.t (Repon No. 12D. SBU. 

451. SBU (r99s\. i,lNsndqs.ilotinsfu prostatamcer (SBV-rEpon No. i 26). Stockbolh: 

Statds beredning ntr utv:ird€rins av nedicinsk netodik. 

,161. Shon Jr., J. r.. & Clarke, L . G.A.). (1992)- Orsaniations, un@tainties, akd isk. Botl- 

471. Sjobdg, L. (r 995 (ln p!€$D. Rjsla*reption by polni.id8 ahd the Ptulic ). Sto.tnolm: 

Centd for Rrsk R*dch, Stocknoh Sc!@l of Econonics. 

481 sjdbers, L., & osddd, T. (1994). An ra.tda ti - Kashdder ach efek- @.appoltn 

ESO No. Dsl994i l4). Srocknoln ESO. 

a2

Rd"bere & Sidbdc: I he cos eFeq vems of li lesavins itrren eotions 

491. Soby, B. A., Ban, D. J., & lves, D. P. (1993). Safety inv*tnmt md the value of life ad 

iajvr. Risk ahalysis, I 3, 365. 

501. Socialdeparlen€nlet (1995). lldqsgraw id tobal'knp (DsNa. 1995:66). 

5ll. Stlrens strilskyddsinsrjtn ( t992i. la.l fu shrdd not eldlning och andra rist r kost,? 

s2l. $alers Sdlskrddsilnini (1993). Radon 1993 En nPPolt bval /.ia?r(SSl rappon No. 

93-10). Stock]lolrn: SSL 

531. Siarislics Sweden (1994). t atistical ,eatbaot alsve.len 95 sbckholm: st tisli* sw€_ 

541. SmdsrEn,H. (1995).,4tDlmhelikaptat i V6te onldhdt t 991-1995: 4 ufiarderinS 

Lddsring€l Vais1modlmd 

551. S!de, G., & Tombers. S. (1996. 1996/018 D 'Briistcmcerddd 6kd 40 prc@nf 

561. TsCs, T., & et al. 0 995). Iivehudied lifesavins inteflenlios md lhen cos! 

eEeclivtuss. Xi*,1E Ja, 1J, 369-391 

5?l. Tillgren, P.,Rosgn, M., Ajnetdin, T.. Haglud, B, Lindloln, L, & gd4 L E (1993) 

Cost-effectivdess of a lobacco quit dd win conlest in S*eden ,'1? alt h Poli.r ' 26lr), 43's1 

s8l. TFfiksht*hetsradet (r 990) . Trafksaik2fhets\agm I990: kgitr&Plan Jbr dre, | 991 

591. TrcllfoB, B. (1994). Cosl-beneilr analysis of senehl vaccimtiotr aaaiN hadophllB 

initu@ type b i! S*den,. S.e din@iah Ja"mdl of Infect Dke6es, 26,611 614. 

601. w€stemdk, T. (1984). Iyra fallstudid _ cdcdjukdon hos induhiansidlld4 oh 

gihingsnsker, atgrrder. kosl]ladd. ln Sociald@anmat€r (Ids ), Ndqra fallstdier rtnmde 

dt:jdtdq nat .d"cdrisk Sra.tu olrn: Socialdepartm€ntel 

611. Vegedket (199,1).,{ar'o,,/& nafksakerhetsprosM: t 495-2400 

3l

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