Aaron posts about the word on changing recommendations for child safety seats (when to face them forward; safer to stay rear-facing after age 1). He notes that if we used the standard of absolute mortality reduction, we would keep them rear facing for much longer, and would actually never put a kid in a car. What is needed is a meaningful discussion of the trade-off between harm reduction and the cost to achieve it. This reminded me of the paper by Tammy Tengs (ungated) “Five Hundred Life Saving Interventions and Their Cost Effectiveness.” They defined cost effectiveness as the net resources required to be spent per life year saved. There is incredible variation in what we are willing to pay to avoid a statistical life-year saved depending upon the context (from absolute savings to over $10 Billion/life year saved). In the realm of child safety a few quick examples of cost-effectiveness of life saving interventions (per life year saved, in 1993$):
- child safety seats in cars, $73,000
- flammability standards in upholstered furniture, $300
- flammability standards in children’s clothing, size 7-14, $15,000,000
- flammability standards in children’s clothing, size 0-6x, $220,000
- child resistant cigarette lighters, $42,000
- signal arms on school buses, $420,000
- influenza vaccine age 5+ $1,300
UPDATE: fixed a few typos.
