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Janet E. Gans, PhD; Beth Alexander, MD, MS; Rose C. Chu, MBA; Arthur B. Elster, MD

Arch Pediatr Adolesc Med. 1995;149(11):1226-1234.

Abstract
Objectives
To address the need for clinical preventive services for 11- to 21-year-old males and females and provide cost estimates for those services under a fee-forservice system. Preventive services include screening, health promotion, and immunizations.

Design
The prevalence of adolescent morbidities was derived from national surveys. Estimated costs of these morbidities were obtained from published data and adjusted for 1992 dollars using the Consumer Price Index. The estimated costs of preventive services for adolescents under a fee-for-service system were derived from a 1993 survey of nine Blue Cross and Blue Shield plans and four insurance companies.

Main Outcome Measures
The cost of adolescent morbidities includes only direct medical costs for a single year and excludes long-term and indirect costs. The cost of clinical preventive services is calculated at 100% participation levels.

Results
Each year, an estimated $33.5 billion is spent on medical treatment for select adolescent morbidities, approximately $859 per adolescent per year; this is a conservative estimate. The average cost of clinical preventive services per adolescent per year would be approximately $130 in a fee-for-service system, although these are not entirely "new" costs because payers already incur screening costs for some conditions.

Conclusion
The cost-effectiveness of clinical interventions for various health risk behaviors among adolescents is unknown. It appears that preventive interventions would have to eliminate 15% of adolescent morbidities overall to break even in economic terms.

(Arch Pediatr Adolesc Med. 1995;149:1226-1234)

Author Affiliations
From the Department of Adolescent Health, American Medical Association, Chicago, Ill (Drs Gans and Elster); the Department of Family Practice, Michigan State University, Lansing (Dr Alexander); and Actuarial Research Corporation, Annandale, Va (Ms Chu).

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