Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. 1994-1998 (doi:10.1542/peds.2006-1328)
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ARTICLE

Cost-Outcome Analysis of Booster Seats for Auto Occupants Aged 4 to 7 Years

Ted R. Miller, PhDa, Eduard Zaloshnja, PhDa and Delia Hendrie, MA, GradDipb

a Pacific Institute for Research and Evaluation, Calverton, Maryland
b School of Population Health, University of Western Australia, Crawley, Western Australia

OBJECTIVES. The purpose of this work was to analyze the societal return on investment in booster seats and in laws requiring their use in the United States. Booster seats reduce crash-related injury. Their use is mandatory for vehicle occupants aged 4 to 7 years in most of the United States. This study estimates the injury cost savings attributable to booster seat use.

METHODS. Seat cost came from pricing on the Web and at retailers. Costs of passing and enforcing a legal mandate were estimated as a percentage of the costs of seat use. Injury risk when belted absent a seat was computed from national probability samples of crashes in the last years before booster seats entered into general use (1993–1999). Published estimates were used of the percentage of reduction in injuries achieved with booster seats, the mix of diagnoses reduced, and injury cost by diagnosis. The computations used a 3% discount rate. We studied the net cost per quality-adjusted life year saved, benefit-cost ratio, and net savings per seat.

RESULTS. A booster seat costs $30 plus $167 for maintenance and time spent on installation and use. This investment saves $1854 per seat, a return on investment of 9.4 to 1. Even lower bound estimates in sensitivity analysis indicated that society would benefit from the use of booster seats. Seat laws offer a return of 8.6 to 1.

CONCLUSIONS. Belt-positioning booster seats offer a sound return on investment. Booster seat use laws should be passed, publicized, and enforced nationwide.

Key Words: benfit-cost • booster seat • QALY • cost-effectiveness • injury • crash

Abbreviations: QALY—quality-adjusted life year • NHTSA—National Highway Traffic Safety Administration • CDS—Crashworthiness Data System

Accepted Jun 28, 2006.


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