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Cost-Outcome Analysis in Injury Prevention and Control: Eighty-Four Recent Estimates for the United States

Miller, Ted R. PhD*; Levy, David T. PhD

Original Articles

Objectives. The objectives of this study were to review cost-outcome analyses in injury prevention and control and estimate associated benefit-cost ratios and cost per quality-adjusted life-year.

Data Sources. Medline and Internet search, bibliographic review, and federal agency contacts identified published and unpublished studies from 1987 to 1998 for the United States. Studies of low quality and analyses of occupational, air, rail, and water transport safety programs were excluded.

Measures. Selected results were recomputed to increase discount rate, benefit category, and benefit estimate comparability and to update injury incidence rates.

Results. More than half of the 84 injury prevention measures reviewed yielded net societal cost savings. Twelve measures had costs that exceeded benefits. Of 33 road safety measures analyzed, 19 yielded net cost savings. Of 34 violence prevention approaches studied, 19 yielded net cost savings, whereas 8 had costs that exceeded benefits. Interventions with the highest benefit-cost ratios included juvenile delinquent therapy programs, fire-safe cigarettes, federal road and traffic safety program funding, lane markers painted 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 heavy drinkers, and a comprehensive safe communities program in a low-income neighborhood. Studies of cost-saving measures do not exist for several injury types.

Conclusions. Injury prevention often can reduce medical costs and save lives. Wider implementation of proven measures is warranted.

*From the Pacific Institute for Research & Evaluation, Landover, Maryland.

From the University of Baltimore, Baltimore, Maryland.

Supported by National Institute on Alcohol Abuse and Alcoholism grant AA09812-02, National Highway Traffic Safety Administration grant DTHN22-97-8-55072, and Office of Maternal and Child Health Children's Safety Network contract MCJ-113A36-01.

Address correspondence to: Ted Miller, PIRE, 8201 Corporate Dr, Suite 220, Landover, MD 20785. E-mail:

Received May 18, 1999; initial review completed July 8, 1999; accepted December 15, 1999.

© 2000 Lippincott Williams & Wilkins, Inc.