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Valuing Health for Regulatory Cost-Effectiveness Analysis (2006)
Board on Health Care Services (HCS)

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. "4 Beyond Ratios: Ethical and Nonquantifiable Aspects of Regulatory Decisions." Valuing Health for Regulatory Cost-Effectiveness Analysis. Washington, DC: The National Academies Press, 2006.

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Valuing Health for Regulatory Cost-Effectiveness Analysis

BOX 4-2
Risk-Related Considerations for Regulatory Decisions

Characteristics of Risks: Do the risks averted by the rule have characteristics that affect the value society places on reducing them but that are not reflected in the quantified effectiveness measures used to assess the policy? For example:

  • Are the risks not subject to significant personal control?

  • Are the risks particularly dreaded?

  • Are the risks undetectable by the senses?

  • Are the effects of the risks delayed, rather than immediate?

  • Are the risks not well understood?

We use the three case studies—on food safety, air quality, and child restraints anchoring—to provide examples of how risk-related concerns might be summarized in a regulatory impact analysis.


Food safety. Personal control and detection: In the absence of regulation, consumers generally lack the ability to determine whether a particular batch of juice contains pathogens. Understanding: Information about these risks emerges gradually as outbreaks occur, and the probability of individual exposure is relatively slight. Thus consumers may not fully understand the potential consequences.


Air quality. Personal control and detection: Air emissions from nonroad engines and sulfur in diesel fuel can severely affect many individuals whose ability to detect and avoid exposures in the course of daily life may be very limited. Dread: The associated risks include a relatively high rate of premature death and may include forms of cardiac and respiratory illness (e.g., congestive heart failure, emphysema) that are particularly dreaded.


Child restraints anchoring. Dread: Not only are children’s lives and well-being highly valued in general, but severe injuries from motor vehicle crashes, such as traumatic brain injury, are particularly dreaded by parents and others. Understanding: The high rate of improper installation of child restraints in the absence of the rule suggests that attachment requirements were not well understood.

disaggregate information on impacts, if the underlying research on risks and effects supports separate estimates. However, standard analytic practices in BCA and CEA generally do not weight the results to reflect societal values across these dimensions. For example, a QALY decrement of 0.2 is not adjusted to reflect a preference for averting illnesses among particularly vulnerable groups. Similarly, values assigned to risk reductions of a given magnitude in a BCA generally do not depend on the distribution of impacts.

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