Fourth, ACE PAFs were multiplied by estimates of total annual medical spending and number of disability-adjusted life-years (DALY), a measure of lost life-years owing to ill health, disability, or early death, associated with the analyzed conditions among adults (aged ≥20 years) to estimate each state’s ACE medical spending and ACE DALY burden. Total US medical spending estimates (public insurance including Medicare, Medicaid, and other government programs; private insurance; or out-of-pocket payments) by health condition were inflated to 2019 US dollars (from original reporting as 2016 US dollars), and apportioned by US state using total medical spending by state of residence from the US Centers for Medicare & Medicaid Services.24,25,26 Disability-adjusted life-years by health condition for each US state were obtained from the 2019 Global Burden of Disease (GBD) study online query system.27 Each DALY (which represents the loss of 1 year of equivalent full health) was valued at $540 000.28,29 This value from the US Department of Health and Human Services is derived from quality-adjusted life expectancy and value of statistical life, a monetary estimate of the collective value placed
