Projecting the health and economic impact of road safety initiatives: a case study of a multi-country project.

OBJECTIVE: The Road Safety in 10 Countries (RS-10) project will implement 12 different road safety interventions at specific sites within 10 low- and middle-income countries (LMICs). This evaluation reports the number of lives that RS-10 is projected to save in those locations, the economic value of the risk reduction, and the maximum level of investment that a public health intervention of this magnitude would be able to incur before its costs outweigh its health benefits. METHODS: We assumed a 5-year time implementation horizon corresponding to the duration of RS-10. Based on a preliminary literature review, we estimated the effectiveness for each of the RS-10 interventions. Applying these effectiveness estimates to the size of the population at risk at RS-10 sites, we calculated the number of lives and life years saved (LYS) by RS-10. We projected the value of a statistical life (VSL) in each RS-10 country based on gross national income (GNI) and estimated the value of the lives saved using each country's VSL. Sensitivity analysis addressed robustness to assumptions about elasticity, discount rates, and intervention effectiveness. RESULTS: From the evidence base reviewed, only 13 studies met our selection criteria. Such a limited base presents uncertainties about the potential impact of the modeled interventions. We tried to account for these uncertainties by allowing effectiveness to vary ± 20 percent for each intervention. Despite this variability, RS-10 remains likely to be worth the investment. RS-10 is expected to save 10,310 lives over 5 years (discounted at 3%). VSL and $/LYS methods provide concordant results. Based on our estimates of each country's VSL, the respective countries would be willing to pay $2.45 billion to lower these fatality risks (varying intervention effectiveness by ± 20 percent, the corresponding range is $2.0-$2.9 billion). Analysis based on $/LYS shows that the RS-10 project will be cost-effective as long as its costs do not exceed $5.14 billion (under ± 20% intervention effectiveness, the range = $4.1-$6.2 billion). Even at low efficacy, these estimates are still several orders of magnitude above the $125 million projected investment. CONCLUSION: RS-10 is likely to yield high returns for invested resources. The study's chief limitation was the reliance on the world's limited evidence base on how effective the road safety interventions will be. Planned evaluation of RS-10 will enhance planners' ability to conduct economic assessments of road safety in developing countries.

[Health promotion: a profitable investment? Economic efficiency of preventive interventions in Spain]. / Prevención en salud: 'inversión rentable? Eficiencia económica de las intervenciones preventivas en España.

OBJECTIVE: To examine the quantity and quality of economic evaluations analyzing preventive interventions in Spain to September 2005, with the further goal of extracting conclusions for further research and the design of future programs. METHODS: We performed a systematic review of the evidence. First, we defined the criteria for including studies in our review. Second, a search was conducted of specialized search engines (Pubmed, NHS EED, DARE, HTA, HRSPROJ, IME, EMBASE) and a manual search was performed of journals and the web sites of Spanish public health organizations. In a third phase, the characteristics relevant to our analysis were extracted from the selected articles. Lastly, the characteristics collected were analyzed through uni- and bivariate analyses. RESULTS: Forty-nine articles were found that complied with the inclusion criteria, of which 40 were reviewed. The technique most extensively used was cost-effectiveness analysis (60% of all articles). Twenty-eight evaluations (70%) focused on immunization campaigns. The quality of publications increased overtime, from an average score of 4.21 (1985-1995) to 6.38 (1995-2004), although several methodological areas still require improvement. Lastly, 72.5% of the studies supported the universal use or expansion of the policy analyzed. CONCLUSIONS: The Spanish research community should increase efforts to improve the quantity and quality of economic evaluations in preventive health. Three basic strategies are suggested: a) evaluation of the preventive programs currently in place in Spain and dissemination of the results; b) efforts to publish and index articles in international scientific journals; and c) adherence to international economic evaluation guidelines and manuals.