Reducing the burden of road traffic injury: translating high-income country interventions to middle-income and low-income countries

Abstract

Objective: To increase seat belt restraint use in Guangzhou City, People's Republic of China. Design: Comparison group pre-test, post-test design. Setting: Guangzhou City. Interventions: Interventions to increase the prevalence of seat belt use in high-income countries (enhanced training and enforcement practices along with raising of public awareness) were adapted and implemented in Guangzhou. The prevalence of seat belt use was determined before and after the introduction of the 12-month intervention. Seat belt prevalence was also examined over the same time period in the neighboring city of Nanning, and an incremental cost-effectiveness analysis of the intervention was undertaken. Main outcome measures: Prevalence rates and incremental cost effectiveness ratios. Results: A 12% increase in seat belt use was observed in Guangzhou over the study period, increasing from a prevalence of 50% before (error range 30-62%) to 62% after (error range 60-67%) (p,0.001) the intervention; an absolute change difference between the intervention and reference city of 20% was achieved. The incremental cost-effectiveness ratio of the intervention was ¥3246 (US$418) per disability-adjusted life year saved. Conclusions: This city-wide intervention demonstrates that it is possible to increase the prevalence of seat belt use using similar methods to those used in high-income countries and, importantly, that such an approach is cost-effective.

Cost-effectiveness of interventions to prevent road traffic injuries in low- and middle-income countries: A literature review

“…Stevenson et al (2008) measured ICERs with the net costs and benefits of comprehensive seatbelt interventions compared with no interventions to promote seat belt use. Chisholm et al (2012) reported ICERs briefly in the table with no numerical value of ICERs provided.…”

“…All studies except Ditsuwan et al (2013) did not state the discount rate, or conduct sensitivity analyses. Three out of five studies had a time horizon of one year (Bishai and Hyder 2006;Ditsuwan et al 2013;Stevenson et al 2008), one study had time horizon of 10 years (Chisholm et al 2012), and one was unreported (Bishai et al 2008). All future costs and consequences (DALYs and/or life year saved) were discounted to present values at an annual rate of 3% by the studies that reported discounting in their studies (Bishai and Hyder 2006;Bishai et al 2008;Chisholm et al 2012;Ditsuwan et al 2013).…”

“…All studies expressed the CEA of intervention in the form of a cost per DALYs averted except Bishai et al (2008) who measured cost per life-year saved. Of five studies, three were undertaken from a societal perspective (Bishai and Hyder 2006;Chisholm et al 2012;Stevenson et al 2008) and one study each from the police department (Bishai et al 2008) and health sector perspective (Ditsuwan et al 2013). All studies except Ditsuwan et al (2013) did not state the discount rate, or conduct sensitivity analyses.…”

“…The included studies were published between 2006 and 2013 and were from China (Bishai and Hyder 2006;Stevenson et al 2008), Uganda (Bishai et al 2008), Thailand (Ditsuwan et al 2013), and WHO Sub-Saharan Africa (SSA) and SEA regions (Chisholm et al 2012). …”

“…ACCEPTED MANUSCRIPT 4 2012; Stevenson et al 2008), and the relative paucity of evidence of cost-effectiveness studies in LMICs (Peden et al 2004;Waters et al 2004), there is a need to better understand the current evidence arising from Cost-Effectiveness Analysis (CEA) of interventions to prevent RTIs in the context of LMICs. Wesson et al (2014) reported a systematic review of studies describing the economic burden of injury and trauma in LMICs.…”