title: Medicaid-based child restraint system disbursement and education and the vaccines for children program: comparative cost-effectiveness.
abstract: OBJECTIVE
  Low-income children are disproportionately at risk for preventable motor-vehicle injury. Many of these children are covered by Medicaid programs placing substantial economic burden on states. Child restraint systems (CRSs) have demonstrated efficacy in preventing death and injury among children in crashes but remain underutilized because of poor access and education. The objective of this study was to evaluate the cost-effectiveness of Medicaid-based reimbursement for CRS disbursement and education for low-income children and compare it with vaccinations covered under the Vaccines For Children (VFC) program.
  
  
  METHODS
  A cost-effectiveness analysis was performed of Medicaid reimbursement for CRS disbursement/education for low-income children based on data from public and private databases. Primary outcomes measured include cost per life-year saved, death, serious injury, and minor injury averted, as well as medical, parental work loss, and future productivity loss costs averted. Cost-effectiveness calculations were compared with published cost-effectiveness data for vaccinations covered under the VFC program.
  
  
  RESULTS
  The adoption of a CRS disbursement/education program could prevent up to 2 deaths, 12 serious injuries, and 51 minor injuries per 100,000 low-income children annually. When fully implemented, the program could save Medicaid over $1 million per 100,000 children in direct medical costs while costing $13 per child per year after all 8 years of benefit. From the perspective of Medicaid, the program would cost $17,000 per life-year saved, $60,000 per serious injury prevented, and $560,000 per death averted. The program would be cost saving from a societal perspective. These data are similar to published vaccination cost-effectiveness data.
  
  
  CONCLUSIONS
  Implementation of a Medicaid-funded CRS disbursement/education program was comparable in cost-effectiveness with federal vaccination programs targeted toward similar populations and represents an important potential strategy for addressing injury disparities among low-income children.
authors.affiliation: School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. jessegoldstein@alumni.upenn.edu
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: Flaura K
authors.initials: FK
authors.lastname: Winston
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kallan
authors.forename: Charles C
authors.initials: CC
authors.lastname: Branas
authors.forename: J Sanford
authors.initials: JS
authors.lastname: Schwartz
mesh_terms: D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D006266:Health Education / Q000191:economics; D005102:Health Expenditures; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007223:Infant; D015370:Infant Equipment / Q000191:economics* / Q000600:supply & distribution; D007231:Infant, Newborn; D008484:Medicaid / Q000191:economics*; D017059:Models, Econometric; D011314:Preventive Health Services / Q000191:economics; D014481:United States; D014947:Wounds and Injuries / Q000517:prevention & control