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John D. Graham, PhD; Kimberly M. Thompson, ScD; Sue J. Goldie, MD, MPH; Maria Segui-Gomez, MD, MPH; Milton C. Weinstein, PhD

JAMA. 1997;278(17):1418-1425.

Abstract
Context.
—Motor vehicle crashes continue to cause significant mortality and morbidity in the United States. Installation of air bags in new passenger vehicles is a major initiative in the field of injury prevention.

Objective.
—To assess the net health consequences and cost-effectiveness of driver's side and front passenger air bags from a societal perspective, taking into account the increased risk to children who occupy the front passenger seat and the diminished effectiveness for older adults.

Design.
—A deterministic state transition model tracked a hypothetical cohort of new vehicles over a 20-year period for 3 strategies: (1) installation of safety belts, (2) installation of driver's side air bags in addition to safety belts, and (3) installation of front passenger air bags in addition to safety belts and driver's side air bags. Changes in health outcomes, valued in terms of quality-adjusted life-years (QALYs) and costs (in 1993 dollars), were projected following the recommendations of the Panel on Cost-effectiveness in Health and Medicine.

Participants.
—US population-based and convenience sample data were used.

Main Outcome Measure.
—Incremental cost-effectiveness ratios.

Results.
—Safety belts are cost saving, even at 50% use. The addition of driver's side air bags to safety belts results in net health benefits at an incremental cost of $24 000 per QALY saved. The further addition of front passenger air bags results in an incremental net benefit at a higher incremental cost of $61 000 per QALY saved. Results were sensitive to the unit cost of air bag systems, their effectiveness, baseline fatality rates, the ratio of injuries to fatalities, and the real discount rate.

Conclusions.
—Borh air bag systems save life-years at costs that are comparable to many medical and public health practices. Immediate steps can be taken to enhance the cost-effectiveness of front passenger air bags, such as moving children to the rear seat.

Author Affiliations
From the Center for Risk Analysis, Harvard School of Public Health, Boston, Mass.

Footnotes
Reprints: John D. Graham, PhD, Harvard School of Public Health, 718 Huntington Ave, Boston, MA 02115 (e-mail: jgraham@hsph.harvard.edu).

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