Cost-outcome analysis in injury prevention and control - Eighty-four recent estimates for the United States

OBJECTIVES. The objectives of this study were to review cost-outcome analys es in injury prevention and control and estimate associated benefit-cost ra tios and cost per quality-adjusted life-year. DATA SOURCES. Medline and Internet search, bibliographic review, and federa l agency contacts identified published and unpublished studies from 1987 to 1998 for the United States. Studies of low quality and analyses of occupat ional, air, rail, and water transport safety programs were excluded. MEASURES. Selected results were recomputed to increase discount rate, benef it category, and benefit estimate comparability and to update injury incide nce rates. RESULTS. More than half of the 84 injury prevention measures reviewed yield ed net societal cost savings. Twelve measures had costs that exceeded benef its. Of 33 road safety measures analyzed, 19 yielded net cost savings. Of 3 4 violence prevention approaches studied, 19 yielded net cost savings, wher eas 8 had costs that exceeded benefits. Interventions with the highest bene fit-cost ratios included juvenile delinquent therapy programs, fire-safe ci garettes, federal road and traffic safety program funding, lane markers pai nted on roads, post-mounted reflectors on hazardous curves, safety belts in front seats, safety belt laws with primary enforcement, child safety seats , child bicycle helmets, enforcement of laws against serving alcohol to the intoxicated, substance abuse treatment, brief medical interventions with h eavy drinkers, and a comprehensive safe communities program in a low-income neighborhood. Studies of cost-saving measures do not exist for several inj ury types. CONCLUSIONS. Injury prevention often can reduce medical costs and save live s. Wider implementation of proven measures is warranted.