Cost-Effectiveness of Traffic Safety Interventions in the United States

OBJECTIVE: In order to demonstrate the results of all available studies on cost-effectiveness and traffic safety, and report them in a comparable format, we conducted a comprehensive review of the literature on the subject. Knowledge of cost-effective (CE) traffic safety programs that result in reduced motor vehicle crashes and fatalities is essential to city planners, managers, and police. METHOD: Using a systematic approach to literature review, the relevant literature has been identified through the use of electronic databases, hand searching of journals, scanning reference lists, and consultation with corresponding authors and experts. Target populations were drivers, passengers and pedestrians in urban and rural roads. Studies on passenger vehicles, busses, and light trucks are included in this review. Studies were included with outcome measure such as cost per year of life saved (LYS), and cost per quality-adjusted life-year saved (QALY), or enough data on cost and benefit to estimate these measures. We followed the recommendations of the Panel on Cost Effectiveness in Health and Medicine (PCEHM) in our recalculations. Interventions are categorized based on the Haddon matrix. RESULTS: We found that despite the specific framework recommended by the PCEHM, the methods used to derive CE measures vary considerably among studies. The CE for these interventions vary enormously, from those that cost more than $1 million per QALY saved i.e. lap/shoulder belts in rear-center occupant; to those that save money i.e. mandatory use of daytime running lights, painting lines on roads, and compulsory helmet use in motorcyclists. Cost saving interventions are compared according to the major components of crash causation as demonstrated in the Haddon matrix. CONCLUSION: The design of cost benefit evaluations in road safety needs to be improved so that more comparable evidence can be obtained. Literature reviews on CE should be updated regularly to ensure relevance. Many life saving traffic safety programs are cost saving and many are more CE than other interventions to prevent cancer, heart disease, and other causes of morbidity and mortality. Investment in traffic safety measures can have a greater impact on population health than investment in other chronic diseases.