Prevention Science

, Volume 19, Issue 6, pp 695–704 | Cite as

Lifetime Cost of Abusive Head Trauma at Ages 0–4, USA

  • Ted R. Miller
  • Ryan Steinbeigle
  • Bruce A. Lawrence
  • Cora Peterson
  • Curtis Florence
  • Marilyn Barr
  • Ronald G. Barr


This paper aims to estimate lifetime costs resulting from abusive head trauma (AHT) in the USA and the break-even effectiveness for prevention. A mathematical model incorporated data from Vital Statistics, the Healthcare Cost and Utilization Project Kids’ Inpatient Database, and previous studies. Unit costs were derived from published sources. From society’s perspective, discounted lifetime cost of an AHT averages $5.7 million (95% CI $3.2–9.2 million) for a death. It averages $2.6 million (95% CI $1.0–2.9 million) for a surviving AHT victim including $224,500 for medical care and related direct costs (2010 USD). The estimated 4824 incident AHT cases in 2010 had an estimated lifetime cost of $13.5 billion (95% CI $5.5–16.2 billion) including $257 million for medical care, $552 million for special education, $322 million for child protective services/criminal justice, $2.0 billion for lost work, and $10.3 billion for lost quality of life. Government sources paid an estimated $1.3 billion. Out-of-pocket benefits of existing prevention programming would exceed its costs if it prevents 2% of cases. When a child survives AHT, providers and caregivers can anticipate a lifetime of potentially costly and life-threatening care needs. Better effectiveness estimates are needed for both broad prevention messaging and intensive prevention targeting high-risk caregivers.


Child abuse Shaken baby syndrome Economic analysis DALY Breakeven 


Compliance with Ethical Standards


The authors’ work was supported in part by grants from the Annie E. Casey Foundation (TM, RS, BL, and MB) and a Canada Research Chair in Community Child Health Research (RGB). Neither funder was involved in decisions regarding design, analysis, or interpretation of study results. The findings and conclusions in this report are those of the authors and do not necessarily represent the official positions of the Centers for Disease Control and Prevention or of the funders.

Conflicts of Interest

The National Center on Shaken Baby Syndrome (NCSBS) and RG Barr jointly registered the trademark for the Period of PURPLE Crying. Graham Consulting Ltd. consults and provides grants for child abuse prevention and child development programs. It owns the royalties that are a minor share of the net profits from the sale of the Period of PURPLE Crying program. RG Barr and M Barr sit as two members of its uncompensated Board of Directors. M Barr was the former Executive Director of the NCSBS, a 501(c)3 non-profit organization. Both are uncompensated members of the International Advisory Board of the NCSBS. The other authors have no financial relationships or potential conflicts of interest relevant to this article to disclose.

Ethical Review

All protocols and instruments for the broader study that included this paper were approved by Pacific Institute for Research and Evaluation’s institutional review board. The study was performed in accordance with the approved protocol and with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was obtained from all individual participants included in the study.

Supplementary material

11121_2017_815_MOESM1_ESM.docx (34 kb)
ESM 1 (DOCX 33 kb)


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Copyright information

© Society for Prevention Research 2017

Authors and Affiliations

  • Ted R. Miller
    • 1
    • 2
  • Ryan Steinbeigle
    • 3
  • Bruce A. Lawrence
    • 1
  • Cora Peterson
    • 4
  • Curtis Florence
    • 4
  • Marilyn Barr
    • 3
  • Ronald G. Barr
    • 5
  1. 1.Pacific Institute for Research and EvaluationCalvertonUSA
  2. 2.Centre for Population Health ResearchCurtin UniversityPerthAustralia
  3. 3.National Center on Shaken Baby SyndromeFarmingtonUSA
  4. 4.National Center for Injury Prevention and ControlCenters for Disease Control and Prevention (CDC)AtlantaUSA
  5. 5.Child and Family Research InstituteUniversity of British ColumbiaVancouverCanada

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