title: Are large differences in "lifesaving" costs justified? A psychometric study of the relative value placed on preventing deaths.
abstract: Government actions to reduce risks to health have varied greatly in their cost per death prevented, frequently by 10-fold or even 100-fold. This research asks whether disparities of this magnitude are justified by citizens' preferences abut the relative value of reducing deaths from different hazards. Four samples were asked to rank the relative priority of preventing deaths through 8 realistic programs, each addressed to a different hazard, and then to rate how large the differences in spending should be. Subjects were not asked to give absolute values on preventing deaths and were asked only for their relative valuation of the benefits of preventing a death, not to weigh the benefits and costs or to determine an optimal spending level. We found that in all samples the median respondent valued his top-rated program 5 to 6 times more than his bottom-rated program. However, because individuals disagreed upon the relative priority for different programs, the aggregated rankings barely showed more than a 2-fold difference in the amounts that should be spent. Thus, for the important programs considered by these samples, a large variation in spending does not appear to be justified on the basis of differentials in the values placed on preventing different types of deaths. A more deliberative methodology like the one used here appears fruitful for providing insights to policymakers about preferences in this sensitive area.
authors.affiliation: School of Public Health, State University of New York, New York State Department of Health, Albany 12237.
authors.forename: J M
authors.initials: JM
authors.lastname: Mendeloff
authors.forename: R M
authors.initials: RM
authors.lastname: Kaplan
mesh_terms: D002140:California; D003362:Cost-Benefit Analysis / Q000379:methods; D003643:Death; D004467:Economics; D033161:Government Regulation; D006291:Health Policy / Q000191:economics; D011315:Preventive Medicine / Q000191:economics*; D011594:Psychometrics; D012044:Regression Analysis; D015895:Relative Value Scales; D040841:Resource Allocation; D018570:Risk Assessment; D012307:Risk Factors; D012945:Social Values; D026712:Value of Life