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The cost effectiveness of three programs to increase use of bicycle helmets among children |
Hatziandreu E J, Sacks J J, Brown R, Taylor W R, Rosenberg M L, Graham J D |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Economic study type Cost-effectiveness analysis.
Study population Children aged 5 to 16 years old.
Setting Community. The economic study was performed in Howard County, Seattle and Oakland County, USA.
Dates to which data relate Effectiveness data were extracted from studies published over the period 1991-1992. The resource costs were estimated from program personnel resource figures for 1995 and from a 1987 study. 1992 prices were used.
Source of effectiveness data Review of previously completed studies.
Outcomes assessed in the review Head injuries and deaths from bicycle related crashes.
Study designs and other criteria for inclusion in the review Observational surveys (1987-1992), and pre- and post-intervention telephone surveys of parents' reports of their children's helmet ownership and usage.
Sources searched to identify primary studies Literature searches and injury researcher interviews (not specified).
Criteria used to ensure the validity of primary studies Methods used to judge relevance and validity, and for extracting data Number of primary studies included Two observational surveys (one in the legislative and one in the community approach) and one pre- and post-intervention telephone survey (school-based approach).
Methods of combining primary studies Studies were not combined.
Investigation of differences between primary studies Results of the review Post-programme helmet use was 47%, 33% and 8% in the legislative community and school programmes respectively. The increase in helmet use due to the introduction of the programmes was 43% (legislative), 28% (community) and 6% (school).
Measure of benefits used in the economic analysis Lives saved, head injuries avoided and years of life saved.
Direct costs Costs and quantities were not reported separately. Costs were discounted at 5% over a four year period. Costs were inflated to 1992 using the general Consumer Price Index. Costs included programme costs (personnel, printing material, mailing, etc.); medical costs (hospital, nursing home care, physician service, drugs); helmet purchase costs. Costs were in part based on actual data and in part on the authors' assumptions.
Sensitivity analysis Sensitivity analysis assessed the effects of changing:
(i) helmet costs and wearer to buyer ratios;
(ii)programme and health care costs;
(iii) crash head injury risk for non-helmet wearing cyclists, and hospitalisation rates after bicycle-related head injury;
(iv) programme effectiveness and steady state assumptions;
(v) application of the Oakland program on a county level;
(vi) discount rate.
Estimated benefits used in the economic analysis Head injuries avoided (discounted at 5% over 4 years) were:
24.72 for the legislative programme
115.84 for the community programme and
and 17.54 for the school programme.
The figures for deaths avoided (discounted at 5% over 4 years) were 0.05 (legislative), 0.25 (community) and 0.04 (school), with years of life saved (discounted at 5% over 4 years) totalling 1.04, 4.87 and 0.76 respectively.
Cost results Total intervention costs (startup, 4 year maintenance and helmet purchase) were:
$974,694 for the legislative programme
$4,693,025 for the community programme
$2,583,227 for the school programme.
(All post-startup costs were discounted at 5%.)
Synthesis of costs and benefits The incremental cost-effectiveness ratios were as follows (costs and benefits discounted at 5%):
Costs per head injury avoided were $36,643, $37,732 and $144,498 for legislative, community and school programmes respectively.
Cost per death avoided was $17,935,341, $18,468,909 and $65,549,315 for legislative, community and school programmes respectively.
Cost per year of life saved were $934,904, $961,958 and $3,417,551 for legislative, community and school programmes respectively.
Authors' conclusions The percentage increase in helmet adoption was from 4-47% (almost immediate) in the legislative program, and from 2-8% in the school programme. The legislative programme appeared to be the most cost-effective from these results.
CRD Commentary 1) More information regarding the literature search(es) would have been useful (e.g. criteria used to ensure the validity of the primary studies, etc.).
2) The authors' acknowledge that the most effective approach to increase bicycle helmet adoption may be a combination of all 3 programmes, because no adoption rate exceeded 50%. This level would be in accordance with the US government's year 2000 health objectives.
3) The authors also note that the assessed programmes differed methodologically (for example, differing age groups, baseline helmet usage; differing post-intervention helmet usage evaluation time periods; the stable percentage of helmet wearers was incorrectly assumed, as was an evenly distributed risk of bicycle-related head injuries among all cyclists, and so forth).
4) Direct cost estimates for fatal/non-fatal head injuries were obtained from a 10 year old study of average head injury costs, not specific to children of 5-16 years old, and/or injuries from bicycle crashes.
5) The legislative programme did not include the costs of enforcement. All the factors described above may have introduced elements of bias into the analysis.
Implications of the study A cost utility analysis may be appropriate for the analysis with regard to morbidity and disability.
Bibliographic details Hatziandreu E J, Sacks J J, Brown R, Taylor W R, Rosenberg M L, Graham J D. The cost effectiveness of three programs to increase use of bicycle helmets among children. Public Health Reports 1995; 110(3): 251-259 Indexing Status Subject indexing assigned by NLM MeSH Adolescent; Bicycling /injuries /legislation & Child; Child, Preschool; Cost-Benefit Analysis; Costs and Cost Analysis; Craniocerebral Trauma /economics /mortality /prevention & Head Protective Devices /economics /utilization; Humans; Program Evaluation; Risk Factors; Safety; Sensitivity and Specificity; United States /epidemiology; control; jurisprudence /statistics & numerical data AccessionNumber 21995000810 Date bibliographic record published 26/03/1997 Date abstract record published 26/03/1997 |
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