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Updated 5:00 PM March 16, 2007




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A year of added life more valuable for the young

Many important health policy issues, such as the allocation of avian flu vaccine in a pandemic or mandatory HPV (human papillomavirus) vaccinations for young women, require policy makers to decide health care priorities for different age groups.

Yet economic methods used to allocate health care dollars and other resources substantially may undervalue childhood interventions, a new University study suggests. This undervaluation occurs despite evidence that people place as much as three times greater value on health gains for children and adolescents, relative to adults or seniors.

Daniel Eisenberg, assistant professor in the School of Public Health, and Dr. Gary Freed, director of the Child Health Evaluation and Research Unit in the Division of General Pediatrics, reviewed a series of separate survey studies that show society favors early childhood intervention. Despite studies that suggest a year of life added for a 15-year-old should receive 2 to 3 times more weight than a year of life added for an 80-year old, however, standard economic methods used to direct resources do not account for age or the fact that societies, as they become richer, tend to value health more over time.

The U-M study suggests policy makers must rethink how health care dollars and other resources are used across age groups, by adjusting economic formulae to better reflect society's values.

"Our paper reviews recent studies related to how society values health gains for people of different ages," Eisenberg says. "These studies generally suggest that health gains for people at younger ages should receive higher priority than equivalent health gains for older people. When we incorporate these values into standard cost-effectiveness analysis methods, then interventions for young people, such as recently developed vaccines for HPV or meningitis, look significantly more appealing from a cost-effectiveness perspective."

Eisenberg and Freed illustrated the findings with examples of recently evaluated vaccine interventions. The paper, "Reassessing How Society Prioritizes the Health of Younger People," appears in the March/April edition of Health Affairs.

"This study illustrates that the way we have been performing cost-effectiveness studies devalues the effect of interventions on children relative to adults and seniors," says Freed, who also has an appointment in the school of public health.

"As a nation, we must take a fresh look at how we measure the benefit of interventions focused on children. Likely, they represent the best investment we can make in our country's health now and in the future."

The paper does not suggest that society should divert health care from adult and senior programs, Eisenberg stresses.

It is unknown how often economic methods such as cost-effectiveness analysis actually are used to allocate health care dollars. Many other factors contribute to the decision making process, particularly in a decentralized health system such as ours, he says. Rather, the study suggests that age should be accounted for in future economic calculations and that the evidence on societal values for this issue should continue to be developed.

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