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Appendix Q

Attachment 1 lists eight generic categories of clinical consequences that may be associated with each disease and vaccine that we are considering. From the CDC and other sources we are compiling estimates, for each disease, of the annual number of days of morbidity in Categories A through C and of the annual number of events in Categories D through H. In order to develop a composite measure of the health impact of the various diseases, it is necessary to gauge the relative importance, or disutility, of the various categories of morbidity and mortality at different ages.

Each member of the committee is being asked to prepare a personal assessment of the relative weights to be assigned to each of the eight categories. Because the relative values may depend upon the age of the afflicted population, we will be attempting an assessment for morbidity in each of six age groups: (1) infants under 1 year of age; (2) children from 1–4 years old; (3) children from 5–14 years old; (4) adolescents and young adults from 15–24 years old; (5) adults from 25–59 years old; and (6) adults 60 years of age or older.

There are a number of different ways we could approach this problem of assessing relative values. For the sake of consistency, we ask that each committee member try to work through the thought exercise in the same way as described below.

Attachment 2 is the recording form to be filled out.

Instructions for Completing the Recording Form

To understand how to complete the form consider column 1 of Attachment 2 which refers to episodes of illness or of the consequences of illness occurring in infants under 1 year of age. The unit measure for morbidity in Categories A through C is a day of morbidity in a patient, in Categories D through G, the unit measure is (usually) a lifelong episode. Category H means death in the near term.

Your task will be to estimate the number of units in each morbidity category that you consider to carry the same disutility as one death. For example, consider morbidity state E, moderate to severe chronic disability. You might think such a disability would be dreadful for an infant of under 1 year to incur, nearly as bad as dying. In this case

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