Speed cameras in an urban setting: a cost-benefit analysis

Systematic review of unintentional injury prevention economic evaluations 2010-2019 and comparison to 1998-2009

BACKGROUND

Health economic evaluation studies (e.g., cost-effectiveness analysis) can provide insight into which injury prevention interventions maximize available resources to improve health outcomes. A previous systematic review summarized 48 unintentional injury prevention economic evaluations published during 1998-2009, providing a valuable overview of that evidence for researchers and decisionmakers. The aim of this study was to summarize the content and quality of recent (2010-2019) economic evaluations of unintentional injury prevention interventions and compare to the previous publication period (1998-2009).

METHODS

Peer-reviewed English-language journal articles describing public health unintentional injury prevention economic evaluations published January 1, 2010 to December 31, 2019 were identified using index terms in multiple databases. Injury causes, interventions, study methods, and results were summarized. Reporting on key methods elements (e.g., economic perspective, time horizon, discounting, currency year, etc.) was assessed. Reporting quality was compared between the recent and previous publication periods.

RESULTS

Sixty-eight recent economic evaluation studies were assessed. Consistent with the systematic review on this topic for the previous publication period, falls and motor vehicle traffic injury prevention were the most common study subjects. Just half of studies from the recent publication period reported all key methods elements, although this represents an improvement compared to the previous publication period (25 %).

CONCLUSION

Most economic evaluations of unintentional injury prevention interventions address just two injury causes. Better adherence to health economic evaluation reporting standards may enhance comparability across studies and increase the likelihood that this type of evidence is included in decision-making related to unintentional injury prevention.

The effectiveness of introducing detection cameras on compliance with mobile phone and seatbelt laws: a before-after study among drivers in Riyadh, Saudi Arabia

BACKGROUND

Because Saudi Arabia (SA) has struggled with the burden of Road Traffic Injuries (RTIs) for decades, a new automated citations system was implemented in 2018 to improve compliance with seatbelt and mobile phone laws. Therefore, the purpose of this study is to evaluate the impact of the system on the prevalence of seatbelt and mobile phone use among drivers in Riyadh. This is an observational study conducted between 2017 and 2018. A Pre-Post evaluation was employed to determine the impact of a camera detection system on seatbelt and mobile phone use. Two research coordinators collected the observations at several highways and inner intersections around Riyadh (n = 3400). We evaluated differences in the prevalence of seatbelt and mobile phone use across the two time periods using a chi-2 test. In addition, we evaluated the association between the new intervention and traffic violation using a logistic regression model.

RESULTS

The overall seatbelt compliance increased significantly from 33.9% (95% CI = 31.7-36.2) to 75.8% (95% CI = 73.7-77.8; P < 0.01). In addition, mobile phone use declined significantly from 13.8% (95% CI = 12.2-15.5) to 9.8 (95% CI = 8.8-9.1; P < 0.01). We found the detection system to be associated with a significant increase in seatbelt use and also a significant decline in mobile phone use while driving. After implementing the intervention, drivers were 6.1 times (OR = 6.1, 95% CI = 5.2-7.0) more likely to wear seatbelts than before the technology went into effect. Similarly, drivers observed after implementing the cameras were 32% (OR = 0.68, 95% CI = 0.55,0.84) less likely to use mobile phones while driving than those seen prior to the intervention.

CONCLUSIONS

This study found a significant reduction in traffic violations following the implementation of a camera detection system in Riyadh. This positive impact is evidence for the role preventative structural strategies play to improve traffic safety and reduce RTI in SA. Therefore, these findings may facilitate further support for policymakers that public health interventions play a significant role to improve traffic safety. Seatbelt and mobile phone use while driving should continue to be monitored, and traffic police may evaluate whether increasing the fine is associated with a significant reduction in traffic violations and associated crashes.

Return on investment of public health interventions: a systematic review

BACKGROUND

Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions.

METHODS

We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries.

RESULTS

We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5.

CONCLUSIONS

This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.

Outcomes of road traffic injuries before and after the implementation of a camera ticketing system: a retrospective study from a large trauma center in Saudi Arabia

BACKGROUND

Road traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Because speed is a major risk factor for severe crash-related injuries, a camera ticketing system was implemented countrywide in mid-2010 by the traffic police in an effort to improve traffic safety. There are no published studies on the effects of the system in Saudi Arabia.

OBJECTIVE

To examine injury severity and associated mortality at a large trauma center before and after the implementation of the ticketing system.

DESIGN

Retrospective, analytical.

SETTING

Trauma center of a tertiary care center in Riyadh.

PATIENTS AND METHODS

The study included all trauma registry patients seen in the emergency department for a crash-related injury (automobile occupants, pedestrians, or motorcyclists) between January 2005 and December 2014. Associations with outcome measures were assessed by univariate and multivariate methods.

MAIN OUTCOME MEASURE(S)

Injury severity score (ISS), Glasgow coma scale (GCS) and mortality.

RESULTS

The study included all trauma registry patients seen in the emergency department for a crash-related injury. All health outcomes improved in the period following implementation of the ticketing system. Following implementation, ISS scores decreased (-3.1, 95% CI -4.6, -1.6) and GCS increased (0.47, 95% CI 0.08, 0.87) after adjusting for other covariates. The odds of death were 46% lower following implementation than before implementation. When the data were log-transformed to account for skewed data distributions, the results remained statistically significant.

CONCLUSIONS

This study suggests positive health implications following the implementation of the camera ticketing system. Further investment in public health interventions is warranted to reduce preventable RTIs.

LIMITATIONS

The study findings represent a trauma center at a single hospital in Riyadh, which may not generalize to the Saudi population.

What is the effect of reduced street lighting on crime and road traffic injuries at night? A mixed-methods study

Background

Some local authorities have reduced street lighting at night to save energy, but little is known about impacts on public health or about public concerns about impacts on well-being.

Aim

To evaluate the effect of reduced street lighting on crime and road traffic injuries.

Design

A mixed-methods study comprising a rapid appraisal, a controlled interrupted time series analysis and a cost–benefit analysis (CBA).

Setting

England and Wales.

Target population

Residents and workers in eight case study areas; road traffic casualties and victims of crime.

Interventions evaluated

Switch-off (i.e. lights permanently turned off), part-night lighting (e.g. lights switched off between 12 a.m. and 6 a.m.), dimming lights and white lights/light-emitting diodes (LEDs).

Outcomes

Public views about implications on well-being; road traffic injury data (STATS19:http://data.gov.uk/dataset/road-accidents-safety-data) obtained for the period 2000–13; crime data (Police.uk:data.police.uk) obtained for the period December 2010–December 2013. Detailed crime data were obtained from one police force for a methodological study of the spatial level at which Police.uk data are valid for analysis.

Statistical methods

Road traffic collisions were analysed at street segment level. Regression models were used to estimate changes in daytime and night-time collision rates associated with lighting interventions. The ratio of night-time and daytime changes was considered the best estimate of change in night-time collisions following each lighting intervention. Police.uk crime data were found to be reliable when analysed at middle super output area (MSOA) level. For crime, the analysis used the proportion of total km of road in each MSOA with each lighting intervention. Regression models controlled for yearly and monthly trends and were fitted in each geographical region and police force. Effect estimates were pooled in random-effects meta-analyses.

Results

Public concerns centred on personal security, road safety, crime, fear of crime, sleep quality and being able to see the night sky. Street lighting reductions went largely unnoticed or had only marginal impacts on well-being, but for a minority of people switch-off and part-night lighting elicited concerns about fear of the dark, modernity and local governance. Street lighting data were obtained from 62 local authorities. There was no evidence that reduced street lighting was associated with road traffic collisions at night. There was significant heterogeneity in the estimated effects on crime at police force level. Overall, there was no evidence that reduced street lighting was associated with crime. There was weak evidence for a reduction in crime associated with dimming [rate ratio (RR) 0.84, 95% confidence interval (CI) 0.70 to 1.02] and white light (RR 0.89, 95% CI 0.77 to 1.03). The CBA suggests that part-night lighting may represent a net benefit to local authorities.

Limitations

The study did not account for the impacts of other safety/crime prevention initiatives (e.g. improved road markings; closed-circuit television), and so associations may be partly attributable to these initiatives. The CBA was unable to include potentially important impacts such as fear of crime and reduced mobility.

Conclusion

This study found little evidence of harmful effects of switch-off, part-night lighting, dimming or changes to white light/LEDs on levels of road traffic collisions or crime in England and Wales. However, the public were also concerned about other health outcomes. Research is needed to understand how lighting affects opportunities for crime prevention and how these vary by context. Research is needed also on other public health impacts of light at night.

Funding

The National Institute for Health Research Public Health Research programme.

Costs of traffic injuries

OBJECTIVE

The aim of this study was to analyse the socioeconomic costs of traffic injuries in Denmark, notably the healthcare costs and the productivity costs related to traffic injuries, in a bottom-up, register-based perspective.

METHOD

Traffic injury victims were identified using national emergency room data and police records. Victims were matched with five controls per case by means of propensity score, nearest-neighbour matching. In the cohort, consisting of the 52 526 individuals that experienced a traffic injury in 2000 and 262 630 matched controls, attributable healthcare costs were assessed using Danish national healthcare registers. Productivity costs were computed using duration analysis (Cox regression models). In a subanalysis, cost per severe traffic injury was computed for the 12 995 individuals that experienced a severe injury.

RESULTS

The socioeconomic cost of a traffic injury was €1406 (2009 price level) in the first year, and €8950 over a 10-year period. Per 100 000 population, the 10-year cost was €6 565 668. A severe traffic injury costs €4969 per person in the first year, and €4 006 685 per 100 000 population over a 10-year period. Victims of traffic injuries are younger and generally worse off, compared to the general population.

CONCLUSIONS

Prevention of traffic injuries could result in societal savings. The bottom-up, register-based approach renders more precise figures for these savings. The socioeconomic profile of injury victims differs from that of the general population on most parameters.

Cost savings associated with 10 years of road safety policies in Catalonia, Spain

OBJECTIVE

To determine whether the road safety policies introduced between 2000 and 2010 in Catalonia, Spain, which aimed primarily to reduce deaths from road traffic collisions by 50% by 2010, were associated with economic benefits to society.

METHODS

A cost analysis was performed from a societal perspective with a 10-year time horizon. It considered the costs of: hospital admissions; ambulance transport; autopsies; specialized health care; police, firefighter and roadside assistance; adapting to disability; and productivity lost due to institutionalization, death or sick leave of the injured or their caregivers; as well as material and administrative costs. Data were obtained from a Catalan hospital registry, the Catalan Traffic Service information system, insurance companies and other sources. All costs were calculated in euros (€) at 2011 values.

FINDINGS

A substantial reduction in deaths from road traffic collisions was observed between 2000 and 2010. Between 2001 and 2010, with the implementation of new road safety policies, there were 26 063 fewer road traffic collisions with victims than expected, 2909 fewer deaths (57%) and 25 444 fewer hospitalizations. The estimated total cost savings were around €18 000 million. Of these, around 97% resulted from reductions in lost productivity. Of the remaining cost savings, 63% were associated with specialized health care, 15% with adapting to disability and 8.1% with hospital care.

CONCLUSION

The road safety policies implemented in Catalonia in recent years were associated with a reduction in the number of deaths and injuries from traffic collisions and with substantial economic benefits to society.

Cost benefit analysis of 20 mph zones in London

Evidence suggests that 20 mph zones are an effective intervention to reduce casualties from road traffic crashes in urban areas. This analysis compares the costs of construction of the 20 mph zone intervention in high and low casualty areas in London to the value of casualties avoided over 5 and 10 year time horizons. Probabilistic sensitivity analyses were conducted to quantify uncertainty in the results associated with model parameters. Results indicate a net present value (NPV) of £18 947 (90% credible limits -£75 252 to £82 021 2005 prices) after 5 years and £67 306 (£-29 157 to £137 890) after 10 years when 20 mph zones are implemented in areas with one or more casualty per kilometre of road. Simulations from our model suggest that the 'threshold of casualties' where NPVs become positive using a 10 year time horizon is 0.7 casualties per kilometre.