. "Appendix Q: Questionnaire for Assessing Morbidity-Mortality Trade-Offs." New Vaccine Development: Establishing Priorities: Volume I, Diseases of Importance in the United States. Washington, DC: The National Academies Press, 1985.
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New Vaccine Development Establishing Priorities, Volume I: Diseases of Importance in the United States
equivalent to one death could be many multiples of 25,000. For example, you might think that 150,000 days of moderate localized pain for an infant (under 1 year) (morbidity state A) would be equivalent to a single death in the same age category, and you would enter this number on Attachment 2 opposite Category A in column 1. Of course, your estimate might be higher or lower, in any of these estimates there is no universally “right” answer, only what seems to you to be the most balanced trade-off.
After you have completed your trade-off judgments for infants under 1 year of age (column 1, Attachment 2), carry out the analogous exercise for the other age categories (i.e., columns 2–6).
You may find it helpful to imagine yourself as a typical member of the population at risk for each of these morbidity categories. Thus, in a population of 100,000, one annual death would represent a 1/100,000 annual risk of death foryou. 100,000 days of moderate, generalized (Category B) morbidity would represent an average of one morbidity day foryou. An equivalence between one death and 100,000 days of morbidity Category B, then, would reflect an equivalence between 1/100,000 risk of death and one day of moderate morbidity.
In assessing these trade-offs, also bear in mind that these are intended to reflect the relative values you would attach to the health consequences (including physical and psychosocial aspects) of these outcomes, and not the direct economic consequences (i.e., treatment costs). The latter are being analyzed separately based on cost data being supplied by CDC and other sources. In other words, if you imagine yourself as a typical person at risk for these consequences, you should respond as though you were fully covered by health insurance in trading off the risks.
Instructions for Estimating Mortality Trade-off Across Age Groups
The lowest row on Attachment 2 asks you to indicate the relative trade-off among deaths in each age group. Here comparisons are against a single death in an infant under 1 year of age. The question is how many deaths in each of the other age groups would just balance one death in an infant. You might feel all deaths are equivalent, and mark a “1” in all the spaces for each age group. You might feel a death in an adult (25–59 years) is even worse than a death in an infant and assign a number smaller than 1.0 to such adult deaths (column 5). You might be willing to balance 10 deaths in the elderly (column 6) against one early death. Again, any trade-offs are legitimate so long as they reflect your best personal judgment.
Consider also the value you would assign to a first-trimester fetal loss compared to the death of one infant (up to one year of age). In other words, if you valued the loss of one fetus as severely as the death of an infant, your relative valuation would be 1.0. If you would be willing to accept 100 first-trimester fetal deaths as balancing one infant death, your relative valuation would be 100. If it would take even more fetal loss to balance one infant death, then your relative valuation would be higher. Of course, it could in principle be lower as well.