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ARTICLE:
Barbara Law, Catherine Fitzsimon, Lee Ford-Jones, Noni MacDonald, Pierre Déry, Wendy Vaudry, Elaine Mills, Scott Halperin, Andrea Michaliszyn, and Marc Rivière
Cost of Chickenpox in Canada: Part I. Cost of Uncomplicated Cases
Pediatrics 1999; 104: 1-6 [Abstract] [Full text] [PDF]
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[Read P3R] Societal Costs with a Human Face
David Bishai   (9 August 1999)

Societal Costs with a Human Face 9 August 1999
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David Bishai,
Assistant Professor
Department of Population & Family Health Sciences, Johns Hopkins School of Hygiene and Public Health

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Re: Societal Costs with a Human Face

dbishai{at}jhsph.edu David Bishai

The cost of illness approach to chickenpox that Law et al. carry out is a technical masterpiece. It measures all of the standard elements of the standard cost of illness (COI) model with rigor and thoroughness, but it is missing something. There is no itching, no tears, no calamine on the carpet. When a child is sick with chickenpox, the child is miserable, the parents are miserable. If the authors were cloistered economists, I would understand an exercise in measurement that ignored the itch, but the authors clearly know clinical chickenpox extremely well.

If the goal is to answer to the question "What dollar amount measures the well-being of a Canadian Society without chickenpox?" the answer given by the standard COI approach is incomplete. Society's parents don't like having sick children, and the medical bills and the lost work are only a (small) part of the lost well-being. By staying inside the tired COI paradigm, the article lost an important opportunity to advance the field by putting a human face on the costs of chickenpox. Such a human face could have been achieved by designing clinical vignettes of chickenpox (with and without lost work and medical bills) and applying willingness to pay (WTP) techniques to assess parents readiness to trade money for changes in the probability that their child would enter such a state of misery. Indeed, in a functioning private market for chickenpox vaccine, the money would be traded to avoid not just medical costs and lost work but because of an altruistic concern for children's well-being. A society made up of homo economicus parents like those in your model would be dreary and unpleasant.

Physicians and the public often find economics distasteful precisely because the prevailing model of human behavior and human value has such little correspondence with life. The economists of the world are looking to the clinicians for leadership here. Clearly, the standard answers are wrong. WTP gives the outline of the road ahead, but we are still waiting for a doctor to pick up the torch.