Costs of surviving vs not surviving a condition - 3 examples

The Cost Ledger — Survival, Death, and the Value of Prevention

Vitamin D · societal-cost argument · working instrument

The cost of surviving a condition,
the cost of not surviving at all

A per-case ledger for three outcomes linked to low vitamin D — very preterm birth, childhood asthma, and autism — built to make one thing hard to dodge: whether an early death looks "cheap" depends entirely on whether you count the life it ends. The prevention case does not need the death comparison to hold. Every figure below carries its source; every contested assumption is a control you can move.

Two ways to count a death

Each strip is a logarithmic cost scale for one condition. Green marks what society spends if the child survives with the condition. The three death markers show the same early death priced three ways: immediate costs only, lost lifetime earnings (human-capital method), and the value agencies actually assign to a prevented death (VSL). Watch the death marker travel from far left to far right as you widen the lens.

What prevention is worth

This is the argument that stands on its own. Preventing a case avoids its entire lifetime cost — no death comparison required. The load-bearing unknown is how much of each condition vitamin D actually prevents, so that is a slider, not a hidden constant. Defaults are deliberately conservative and are placeholders for your own estimates.

Expected avoided cost per person supplemented = baseline incidence × risk reduction × lifetime cost of the condition. "Number needed to supplement" = one prevented case ÷ (incidence × risk reduction). Move any control; everything recomputes live.

Supplementation cost / person ($)

A year of prenatal or childhood vitamin D runs a few dollars — edit to your figure.

Sources, method & the honest caveats

The causal link is where this argument is attacked — not the cost figures. The lifetime-cost numbers are well-established. What varies is how much of each condition vitamin D actually prevents. Vitamin D and preterm birth is genuinely contested: one pooled analysis found supplementation alone cut preterm-birth risk (RR 0.57, 95% CI 0.36–0.91), while the 2019 Cochrane review found a null effect. Asthma shows a ~20% reduction in the VDAART and COPSAC trials that missed statistical significance in the primary analyses. Autism rests mainly on observational data. Present the three at their real evidence tiers; the preterm row gains credibility, not loses it, when the autism assumption is openly discounted.

Lifetime cost of surviving with the condition

Very preterm (<32 wk), ~$334,000/child (2024–25): apportioned and inflation-adjusted from Waitzman, Jalali & Grosse, Semin Perinatol 2021 — the 2016 US cohort averaged $64,815 across all preterm births; very-preterm cost is a large multiple of that blended figure because late-preterm dominates the counts but not the cost.
Childhood asthma, ~$53,000/case: present discounted value of lifetime healthcare cost + lost productivity per new case = $36,500 in 2010 dollars (Chhabra et al., "Estimating Lifetime Cost of Illness: An Application to Asthma," Ann Am Thorac Soc), inflation-adjusted ~×1.45.
Autism, ~$1.9M (no intellectual disability) to ~$3.2M (with ID): Buescher et al., JAMA Pediatr 2014 — $1.4M / $2.4M in 2015 dollars, inflation-adjusted ~×1.33. Broader estimates (Cakir et al. 2020) reach ~$3.6M.

Pricing the death

Immediate cost (~$15,000): illustrative placeholder for direct/near-term costs only — no future output counted. This is the only lens under which early death looks "cheap."
Lost lifetime earnings (~$1.5M): order-of-magnitude human-capital figure (present value of forgone earnings); method- and age-dependent. Shown as illustrative.
Value of a Statistical Life (~$13M): US DOT guidance $13.2M (2023$), raised to ~$13.7M for 2024; HHS central estimate $13.1M (2023$). This is the willingness-to-pay figure federal agencies use to value a prevented death.

Incidence defaults (editable)

Very preterm <32 wk ≈ 1.6% of US births · Childhood asthma ≈ 8.4% of children · Autism ≈ 3.2% (≈1 in 31, recent CDC surveillance). Adjust to your preferred source.

On the "10×–100×" framing. Against immediate costs only, survival does run ~3× (asthma) to ~130× (autism) the price of a quick death — the ratio is real. But your own note is the rebuttal: count the lost life consistently and the death becomes the far more expensive outcome in nearly every case. Because the framing inverts under consistent accounting — and reads badly when quoted out of context — the durable argument is Section 02: cheap prevention against large, certain, avoidable lifetime cost.