Mortality benefit of building adaptations to protect care home residents against heat risks in the context of uncertainty over loss of life expectancy from heat

We explore methodological issues core to the cost-benefit evaluation of building adaptations designed to protect against heat risks to residents of care homes in England in the context of the uncertainties relating to the loss of life expectancy in heat death. We used building physics modelling to quantify the impact of external window shading on indoor temperatures. We calculated associated heat mortality and loss of life expectancy under three sets of assumptions of life-shortening based on: (Method 1) an England & Wales (E&W) life-table, (Method 2) E&W life-table scaled to match observed average survival of care home residents and (Method 3) assuming that those dying of heat have a life expectancy of six months. External window shading was estimated to reduce mean indoor temperatures by 0.9 °C in a ‘warm’ summer and 0.6 °C in an ‘average’ summer. In a care home of 50 residents, the heat deaths and years of life lost (YLL) averted by such shading were estimated by the three life-expectancy assumptions (Methods 1, 2, 3) to be: 0.07, 0.47 and 0.28 heat deaths and 0.29, 0.76 and 0.14 YLL for the warm year and 0.05, 0.31 and 0.19 heat deaths and 0.20, 0.51 and 0.10 YLL for the average year. Over a 20-year time horizon and assuming an annual discount rate of 3.5%, the monetized benefit of reduced YLL would be around £90,000, £230,000 and £44,000 with the three life-expectancy assumptions. Although this range represents appreciable uncertainty, it appears that modest cost adaptations to heat risk may be justified in conventional cost-benefit terms even under conservative assumptions about life expectancy.