The economic impact of disease and injury has most often been calculated by examining the costs associated with the prevalence of the impairments in the reference year. An alternative accounting approach is to assign all disease costs to the year of incidence, an approach which entails present-valuing to the year of incidence both health care expenditures and lost productivity. The incidence approach is the more appropriate for gauging the economic gains achievable through prevention, immediate rehabilitation, and arresting progression. Incidence-based costs have been estimated for the United States in 1975 for cancer, coronary heart disease, motor vehicle injuries, and stroke. A noteworthy finding is the relative economic importance of motor vehicle injuries, which frequently have been overlooked in the ordering of public health expenditure priorities. After cancer, which generated approximately $23.1 billion in present-valued costs in 1975

Between 1976 and 1980, 28 state legislatures in the United States repealed or weakened their motorcycle helmet-use laws. This paper estimates the number of excess deaths attributable to this deregulatory activity, and the associated economic costs to society. Because of data limitations, no attempt was made to estimate the excess nonfatal injuries and associated costs. We applied a variant of log-linear contingency-table analysis to the monthly counts of motorcycle fatalities in the 48 contiguous states over the period 1975 through 1980. This analysis produced estimates of the total number of deaths, in each of 36 age-sex groups, that could be attributed to changes in the helmet laws. We then estimated the direct and indirect economic costs associated with fatalities in each age-sex group. Our findings indicate that 516 excess deaths occurred in 1980 in the 28 states that weakened or repealed their helmet laws. This represented 24 percent of the total motorcycle fatalities occurring in those states. Women and younger cyclists of both sexes comprised a disproportionate share of excess deaths. The economic costs to society that are associated with the excess fatalities resulting from the repeals of helmet laws total at least $180 million.

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We compare two methods for dividing an interrupted time-series study between baseline and experimental phases when study resources are limited. In fixed designs the baseline duration is chosen before the baseline begins. In flexible designs the baseline duration is not predetermined but made contingent on remaining resources and the degree to which the results match the prior expectations of the evaluator. Flexible designs are much pre ferred when the evaluator's priors are of good quality.