Cost-Efficiency of Remediating

Arsenic-Contaminated Sites in

Sweden - Written & Prepared

by Hafez Shurrab

I

ABSTRACT

This report reviews an analysis to the one of environmental issues that cost-

efficiency plays a significant role in. Many remediating activities are carried out by the

Swedish government to reduce the effects of contaminants by the industrial activities on

the environment and human health. The risk analysis the Swedish EFA adopts is an

explicit one that compares the levels of contaminants concentrations in each site to

predetermined guideline values. The analysis reviewed in the report discusses an implicit

approach, environmental medicine approach, which considers the actual exposure to the

risk, and therefore, the reduction in the risk to human health could be quantified and then

studied to examine several alternatives that may lead to more cost-efficient outcomes.

The analysis is based on studying 23 arsenic-contaminated sites, as arsenic is classified as

a primary contaminant. The reduction of risk is measured by the number of saved lives,

which implies that the risk assessment method is driven by health effects. The results

indicate that at 23 contaminated sites, the cost per life saved varies from SEK 287 million

to SEK 1,835,000 million, and show that the level of ambition is high. Thus, it is

recommended to open deep discussions on cost-efficiency methods of risk assessment

before going further any remediation, to achieve the objective in more cost-efficient

ways, prioritize the right sites that have more hazardous levels, and increase the number

of lives to be saved allocating similar amounts of resources.

II

TABLE OF CONTENTS

ABSTRACT ................................................................................................................................ I

TABLE OF CONTENTS ...........................................................................................................II

LIST OF TABLES .....................................................................................................................II

1. INTRODUCTION ..........................................................................................................- 1 -

2. BACKGROUND ............................................................................................................- 2 -

3. THEORY ........................................................................................................................- 3 -

3.1. Arsenic Concentrations ....................................................................................................... - 4 -

3.2. Exposure .............................................................................................................................. - 5 -

3.3. Accessibility and Land Use ................................................................................................. - 5 -

4. METHODOLOGY .........................................................................................................- 5 -

4.1. Risk Assessment .................................................................................................................. - 5 -

4.2. Calculating the Number of Cancer Cases Avoided ............................................................. - 6 -

5. RESULTS .......................................................................................................................- 7 -

6. CONCLUSIONS .............................................................................................................- 9 -

1. REFERENCES .............................................................................................................- 10 -

LIST OF TABLES

Table 1 - The cost per life saved for primary prevention measures .......................................- 2 -

Table 2 - Site-specific characteristics. ....................................................................................- 3 -

Table 3 - Site-specific characteristics .....................................................................................- 4 -

Table 4 - Quantified cancer risks, descriptions and sources. .................................................- 7 -

Table 5 - Number of saved lives, costs and comparisons ......................................................- 8 -

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1. INTRODUCTION

Some of industrial activities leave pollutants that have serious impacts on human

health and the environment. The level of pollutants varies among the contaminated sites.

Since there are sites that have the seriously harmful levels of pollutants to human health

and the environment in terms of contaminant concentrations, the Swedish Environmental

Protection Agency (EPA) has prioritized 1500 sites to be remediated as part of striving to

mitigate the risk to human life. A plan has been set so that all those contaminated sites

have to be remediated by 2050. The most harmful sites required remediation may cost

SEK 60,000 million approximately cost to mitigate the potential risks (Swedish EPA,

2008). The government allocates around 10% of the annual national funds for

environmental protection to remediate the contaminated sites, which are estimated at

about 455million per year (Gov. Bill, 2007). The Swedish EPA adopts a method of risk

assessment in which they set standards (guideline values) that represent the worst

acceptable exposure situation to risk on an individual. This means that the actual

exposure to the risk by individuals in such sites is not the main concern, which may result

in remediating locations where there is no actual exposure, and hence spending much

money ineffectively. The valuation of risk reduction is not possible in this case, since the

expected risk is not quantified. Therefore, the estimation of how much money a specific

amount of risk reduction costs is not possible.

The main objective of this paper is to review an analysis (Forslund et al., 2010) on

the remediation of arsenic-contaminated by valuing the risk implicitly. The effect to be

studied is the cancer cases that arsenic-contaminated sites may cause (Forslund et al.,

2010). The main purpose is to see the arsenic risk management in wider perspective of

live-saving interventions. The large risks should not be given a same attention as small

risk. The remediation of contaminated sites cost much money. Thus, any overestimation

of risk on lifesaving contributes in reducing the cost-effectiveness. Lifesaving is used as a

measure to reflect the amount of reduced risk. The analysis includes a method for the

estimation of site-specific cancer risks and calculations of cost per life saved. The results

show that the remediation costs much higher per life saved than that associated with other

primary prevention measures, which indicates that the ambition level of Swedish

remediation may be too high.

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2. BACKGROUND

One of the most important issues in cost-effectiveness is the resources allocation. It

is very critical to spend money so that to save as many lives as possible. Since the life

valuation is controversial issue, the analysis is based on estimating the number of saved

lives implicitly, rather than using some predetermined explicit values. The average cost

of lifesaving varies from USD 470 to USD 1,245,000 (in 1993 prices) (Ramsberg &

Sjöberg, 1997). Table 1 shows the cost per life saved for primary prevention measures.

The implicit cost per life saved is, on average, SEK 66.6 million, with a large variation

among different sectors from SEK 68,000 to SEK 675 million. The median cost per life

saved is approximately SEK 12 million. The comparison between such method and the

guideline values, the Swedish EPA uses, shows that there are 100–1000 times higher

accepted risks in working and housing environment than contaminated sites (Rosén et al,

2006).

Table 1 - The cost per life saved for primary prevention measures in Swedish crowns, SEK (2007 prices) (source: (Forslund et al., 2010)).

The allocation of resources is considered to be cost-efficient when the marginal cost

is equal to the abatement cost (interventions). Thus, if the marginal costs differ, resources

should be reallocated to the sector with the lowest marginal costs. It would be possible in

the US to save an additional 60,000 lives per year through a more cost efficient allocation

(Tengs & Graham, 1996).

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3. THEORY

The government gives the priority to sites, out of the 1500 contaminated sites,

contaminated with the most hazardous contaminants, which are called primary

contaminants. Arsenic (26%) has been identified as the most hazardous carcinogenic

(IARC, 2004, 2008) contaminant among other metals. Table 2 & 3 lists the 23 arsenic-

contaminated sites with either completed (10 sites) or on-going measures (13 sites).

The exposure to arsenic increases the risk of developing cancer (U.S. Department of

Health and Human Services, 2007). There are many industrial activities that produce

arsenic contaminants such as glasswork and sulphate and metal industries, wood

impregnation, and from sawmill.

Table 2 - Site-specific characteristics (source: (Forslund et al., 2010)).

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Table 3 - Site-specific characteristics (source: (Forslund et al., 2010)).

3.1. Arsenic Concentrations

Since the exposure to arsenic is a harmful in the long term, the arsenic concentrations

have been collected before the remediation to estimate the average concentrations of

arsenic in the 23 sites (Forslund et al., 2010). The remediation should reduce such

concentrations to specific safe limits. There are some factors that play a significant role in

the determination of safe limits of arsenic concentration such as the number of

individuals exposed, geographical locations of the sites, the accessibility (open or

enclosed), and the land use (housing, recreation, or industry) (Forslund et al., 2010). As

shown in Table 2 & 3, there safe limit of objectives of the average concentration

correspond the Swedish EPA's guideline values for either sensitive, i.e. 15 mg/kg, or less

sensitive, i.e. 40 mg/kg, land use (Forslund et al., 2010).

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3.2. Exposure

The exposure is estimated by gathering information about the individual population,

which is of course available in the municipal bodies. The population of individuals

exposed to the contaminated sites is divided into three classes, 1–10, 10–100 and 100–

1000. Other types of information have been gathered such as the land use and the number

of children aged from 0-3 years (Forslund et al., 2010).

3.3. Accessibility and Land Use

As the accessibility to the contaminated sites is divided into open or enclosed sites,

the daily exposure is estimated to be 1 h for recreational activities, 24 h for individuals

residing on or adjacent to a site, and 5.7 h for occupational activities. In case that these

factors are neglected, the underestimation possibility of risk for some sites results in

overestimating the number of lives saved, and, in other words, underestimating the cost

per life saved (Forslund et al., 2010).

4. METHODOLOGY

The cost-effectiveness analysis is a primary part in the overall analysis, as the

environmental effects were not quantified by the Swedish EPA. Moreover, the cost-

benefit analysis is also important to include other environmental benefits may be brought

by the remediation (Forslund et al., 2010).

4.1. Risk Assessment

The main task of risk assessment is to determent the levels of arsenic exposure and

their effects on the environment and human health when additional contaminant resources

are present. The Swedish EPA classifies risk through estimating the contaminant level in

the site, site’s environmental sensitivity, and protection value (Swedish EPA, 2002). The

guideline values for contaminant are compiled in the soil for different for different types

of land use, to make the risk assessment more obvious. These are national values and

mark the levels that should not be exceeded. The sub questions arise then are what human

health risks arise at a specific level of exposure and what the actual exposure is at a

specific site (Forslund et al., 2010).

The health risk assessment could be estimated by referring to the tolerably daily

intake (TDI) that World Health Organization and other international bodies recommend.

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The TDI refers to the daily amount of a chemical that has been assessed safe for human

being on long-term basis (usually whole lifetime) (Forslund et al., 2010). There are two

categories for the sensitivity of land use, sensitive and less sensitive. For sites with less

sensitive land use, the types of exposure or exposure pathways include dermal contact

with contaminated soil, direct intake of contaminated soil and inhalation of dust from the

contaminated site. The relevant exposure pathways for sites with sensitive land are

dermal contact, direct intake of soil, intake of groundwater, inhalation and intake of

vegetables and fish. The Swedish EPA uses a precautionary principle to handle all

uncertainties in the risk assessment. In order not to underestimate the risks, three

considerations are taken including: (1) the contaminant levels should represent a ‘bad but

possible scenario; (2) possible but less probable circumstances that could increase the

risks are considered; and (3) conservative values should be chosen for the parameters in

the risk assessment (Swedish EPA, 2007).

The Swedish EPA does not quantify the expected risk reduction, which leads to a

need to value the risk before and after the remediation in terms of relevant measure, for

instance the number of cancer cases avoided (Forslund et al., 2010).

There are two main differences between guideline values approach, the Swedish

EPA adopts, and the medicine approach. The later one assesses the health risk to a larger

extent, but over shorter time period, two decades, while the Swedish EPA aims to strives

for long-term sustainability and argues that 100–1000 years should be considered

(Liljelind & Barregard, 2008). Another difference is that environmental medicine treats

high concentrations of contaminants on the surface more seriously than contaminants

deeper down that humans normally do not risk being exposed to, except for the case of

ingestion of ground water (Forslund et al., 2010).

4.2. Calculating the Number of Cancer Cases Avoided

The analysis studies the exposure through pathways including ingestion of soil,

inhalation of air, and skin contact, since the exposure through intake of vegetables is not

relevant for the contaminated sites, and the exposure through ingestion of groundwater is

limited to two of the sites. The exposure through all pathways is considered for

calculations. Every pathway has different method of calculation. For skin contact case,

the assumptions for skin absorption percentage when contacting an amount of soil guides

to draw calculations for the exposure to arsenic. The reaction between the type of soil and

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the air is assumed and studied to estimate the concentration of arsenic in air particles. For

ingestion of soil, the arsenic exposure is calculated based on assumptions of the amount

of intake during the exposure time. The uncertainties are expressed about in intervals of

certain factor so that the values of the intervals lead to the highest exposure, which

implies that the calculations are conservative. Using different method, the number of

saved cancer cases would be several times lower if mid-interval estimates are considered

instead (Forslund et al., 2010). The calculations are done in two steps, as the number of

saved cancer cases are calculated in case of the absence of the remediation for 30 years

(Viscusi et al., 1997). Then the risk is estimated in case of the presence of remediation,

according to the Swedish EPA's guideline values. The number of lives saved should be

adjusted since not all cancer cases lead to death. Since the future cancer cases are

unknown, they are not discounted (Hamilton & Viscusi, 1999). Table 4 shows the

quantified cancer risks in terms of concentration for each exposure pathway.

Table 4 - Quantified cancer risks, descriptions and sources (source: (Forslund et al., 2010)).

5. RESULTS

After doing the calculations to the 23 sites, the results illustrated in Table 5 shows

that the highest value of expected number of saved lives through the remediation are 0.03

live, 0.12 lives in total SEK 881 million. The cost per life saved on the arsenic sites varies

from SEK 287 million to SEK 1,834,000 million (Forslund et al., 2010). This widely

exceeds the value of a statistical life (VSL), which in Sweden is considered to be about

SEK 21million (SIKA, 2005). One more significant note is that 72% of the health effects

occur at three sites (Tvärån, Glasbrukstomten, Konsterud), where remediation costs

amount to 13% of the total remediation costs, which clearly shows the priority concern in

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the remediation work. The average cost is calculated as the quotient between the total

remediation cost and the total number of cancer cases avoided (or lives saved). The

number of individuals need to be exposed at each site in order for one life to be saved is

calculated as well, which results that of individuals exposed should increase from 10–

1000 to 2850–620,000 individuals. Such populations exceed the number of inhabitants in

the municipality in some cases. The calculations also reflect that the ambition level in

remediation is high, and in some cases unreasonably high. There may be other concerns

associated with the other risks arsenic may cause such as chronic diseases. The

environmental risks differ among sites and are very difficult to estimate and value. This

analysis explains why the cost per life saved varies so much between the sites.

Differences in environmental risk reductions between the sites could be one of the main

reasons for variety (Forslund et al., 2010).

Table 5 - Number of saved lives, costs and comparisons (source: (Forslund et al., 2010)).

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6. CONCLUSIONS

The remediation of the contaminated sites is a complicated process and associated

with many considerations. The Swedish EPA should adjust both the priorities given to the

sites and the level of ambition. The most hazardous sited should be prioritized. The cost

per life for the examined sites under a 30 year period amounts varies between SEK 287

million and SEK 1,835,000 million even though the calculations underestimate the cost.

The statistical life value amount to SEK 21 million (SIKA, 2008), while the average cost

per life saved amounts to SEK 7200 million, which is very high. It is highly

recommended to conduct a discussion about the allocation of resources across different

sectors to save lives. For the number of lives to be saved, the results shows that no more

than 0.12 lives will be saved during a 30 year period at a cost of SEK 880 million. The

approach that the Swedish EPA adopts in risk assessment is setting guideline values and

then assesses whether the contaminant concentrations exceed these values, while the

actual exposure at risk is not really taken into considerations. As there is absence of

estimating the reductions of remediation's risk, it is not possible then to quantify the

remediation benefits. This explains the low cost-efficient measures of remediation the

Swedish EPA adopts, as they are more costly measures than needed to reach acceptable

risk levels. This justifies the need to use a new method for making risk valuations.

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1. REFERENCES

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drinking-water disinfectants and contaminants, including arsenic (Vol. 84). World

Health Organization.

IARC. (2008). Overall evaluations of carcinogenicity to humans. International Agency

for Research on Cancer.

Forslund, J. Samakovlis E. Johansson M., & Barregard L. (2010). Does remediation save

lives? — On the cost of cleaning up arsenic-contaminated sites in Sweden. Science of the

Total Environment. 408 (16), 3085-3091.

Gov. Bill (2007). Budgetpropositionen för 2008.

Hamilton, J. T., & Viscusi, W. K. (1999). Calculating risks?: The spatial and political

dimensions of hazardous waste policy (Vol. 21). MIT Press.

Liljelind I. Barregard L. (2008). Hälsoriskbedömning vid utredning av förorenade

områden. Swedish Environmental Protection Agency Report (Vol. 5859).

Ramsberg, J. A., & Sjöberg, L. (2006). The cost-effectiveness of lifesaving interventions

in Sweden. Risk Analysis, 17(4), 467-478.

Rosén, L. Söderqvist, R. Soutukorva, Å. Back, P-E. Grahn, L., & Eklund, H. (2006).

Riskvärdering vid val av åtgärdsstrategi. Swedish Environmental Protection Agency

Report (Vol. 5537).

SIKA. (2005) Effektiva styrmedel för säkrare vägtrafik, 8. Swedish Institute for

Transport and Communications Analysis PM 2005.

Swedish EPA. (2002). Methods for inventories of contaminated sites. Swedish

Environmental Protection Agency Report (Vol. 5053).

Swedish EPA. (2007). Rapport riskbedömning av förorenade områden—En

vägledningfrån förenklad till fördjupad riskbedömning. Swedish Environmental

Protection Agency.

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Swedish EPA. (2008). Lägesbeskrivning av efterbehandlingsarbetet i landet 2007 —

Bilagor. Swedish Environmental Protection Agency official document.

Tengs, T., & Graham, JD. (1996). The opportunity cost of haphazard social investments

in life-saving. In: Hahn, RW. Risks, costs and lives saved. New York: Oxford University

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U.S. Department of Health and Human Services. (2007). Toxicological profile for

arsenic. Public health Service, Agency for Toxic Substances and Disease Registry.

Viscusi, W. K., Hamilton, J. T., & Dockins, P. C. (1997). Conservative versus mean risk

assessments: Implications for Superfund policies. Journal of environmental economics

and management, 34(3), 187-206.