Seatbelt use to save money: Impact on hospital costs of occupants who are involved in motor vehicle crashes.

OBJECTIVE: Seatbelt use is the single most effective way to save lives in motor vehicle crashes (MVC). However, although safety belt laws have been enacted in many countries, seatbelt usage throughout the world remains below optimal levels, and educational interventions may be needed to further increase seatbelt use. In addition to reducing crash-related injuries and deaths, reduced medical expenditures resulting from seatbelt use are an additional benefit that could make such interventions cost-effective. Accordingly, the objective of this study was to estimate the correlation between seatbelt use and hospital costs of injuries involved in MVC. METHODS: The data used in this study were from the Nebraska CODES database for motor vehicle crashes that occurred between 2004 and 2013. The hospital cost information and information about other factors were obtained by linking crash reports with hospital discharge data. A multivariable regression model was performed for the association between seatbelt use and hospital costs. RESULTS: Mean hospital costs were significantly lower among motor vehicle occupants using a lap-shoulder seatbelt ($2909), lap-only seatbelt ($2289), children's seatbelt ($1132), or booster ($1473) when compared with those not using any type of seatbelt ($7099). After adjusting for relevant factors, there were still significantly decreased hospital costs for motor vehicle occupants using a lap-shoulder seatbelt (84.7%), lap-only seatbelt (74.1%), shoulder-only seatbelt (40.6%), children's seatbelt (95.9%), or booster (82.8%) compared to those not using a seatbelt. CONCLUSION: Seatbelt use is significantly associated with reduced hospital costs among injured MVC occupants. The findings in this study will provide important educational information for emergency department nurses who can encourage safety belt use for vehicle occupants.

Patterns of seatbelt use in different socioeconomic communities in the Cape Town Metropole, South Africa.

UNLABELLED: BACKGROUND; Road traffic injuries are a leading cause of death and may be related to social inequality. OBJECTIVE: To establish whether patterns of seatbelt use vary between different socioeconomic communities in the Cape Town Metropole, South Africa. METHODS: Vehicles and their occupants at 7 high-volume crossings (3 in high-income areas) were placed under surveillance for 2 hours each during November 2010. All occupants were eligible for inclusion except occupants of non-motorised vehicles, two-wheel motorised vehicles, buses, taxis, heavy goods vehicles and emergency vehicles. Child seatbelt use was recorded only for children who appeared older than 3 years. RESULTS: A total of 4 651 vehicles with 6 848 occupants were surveyed. Rates of seatbelt use were 45.1% (n=3 090) for all occupants, 54.0% (n=2 513) for drivers, 33.1% (n=521) for front-seat passengers (adults 33.2%, n=452; children 32.7%, n=69) and 9.0% (n=56) for rear-seat passengers (adults 4.0%, n=13; children 14.4%, n=43). Occupants from high-income areas were more likely to wear seatbelts (odds ratio (OR) 4.35; 95% confidence interval (CI) 3.89 - 4.88). Use of child restraints was poor overall (22.3%, n=114), but also varied according to income areas (high income 40.9%, n=99; low income 0.03%, n=6; OR 26.77; 95% CI 11.44 - 62.63). DISCUSSION: The impact of road traffic injuries is significant, but can be decreased by using appropriate restraining devices. Seatbelt use in South Africa, although compulsory, is neither strictly adhered to nor enforced. Their use is proportionally lower in lower-income areas. Specific interventions are required to target these communities directly.

Costs and benefits to Sweden of Swedish road safety research.

This paper summarises a study designed to answer the following question: what are the benefits to Swedish society of road safety research in Sweden funded by the Swedish Transport Research Council and the programme for vehicle safety research during the period 1971-2004? The paper starts by discussing whether research can answer this question at all and explains why a well-controlled study was not feasible. A case study approach was selected, and five major research projects were examined in detail for the purpose of trying to estimate their effects on road safety. Estimates of safety effects were developed for four of the projects, indicating that road safety measures that were at least to some extent based on the findings of the research projects have made major contributions to reducing the number of road accident fatalities in Sweden. The estimates are not analytically rigorous and should be treated as qualified guesses only. Causal inferences are not possible. Nevertheless, if taken at face value, they show that the benefits to society of road safety research are large and outweigh by a wide margin the costs of the research, and of the road safety measures developed as a result of research. Thus, even if the estimated safety benefits exaggerate the true effects, the benefits of applied road safety research are likely to be greater than the costs of conducting this research and implementing road safety measures developed by research.

Cost of crashes related to road conditions, United States, 2006.

This is the first study to estimate the cost of crashes related to road conditions in the U.S. To model the probability that road conditions contributed to the involvement of a vehicle in the crash, we used 2000-03 Large Truck Crash Causation Study (LTCCS) data, the only dataset that provides detailed information whether road conditions contributed to crash occurrence. We applied the logistic regression results to a costed national crash dataset in order to calculate the probability that road conditions contributed to the involvement of a vehicle in each crash. In crashes where someone was moderately to seriously injured (AIS-2-6) in a vehicle that harmfully impacted a large tree or medium or large non-breakaway pole, or if the first harmful event was collision with a bridge, we changed the calculated probability of being road-related to 1. We used the state distribution of costs of fatal crashes where road conditions contributed to crash occurrence or severity to estimate the respective state distribution of non-fatal crash costs. The estimated comprehensive cost of traffic crashes where road conditions contributed to crash occurrence or severity was $217.5 billion in 2006. This represented 43.6% of the total comprehensive crash cost. The large share of crash costs related to road design and conditions underlines the importance of these factors in highway safety. Road conditions are largely controllable. Road maintenance and upgrading can prevent crashes and reduce injury severity.

Children in taxis: an opportunity for pediatricians and emergency physicians to save lives?

OBJECTIVE: Child safety devices (infant seats, booster seats, and seat belts) are effective in curbing the risk of injury; however, there remains a pattern of parental nonuse or misuse of safety seats. The aim of this study was to assess the level of knowledge and compliance of parents with children presenting for emergency care of the National Highway and Traffic Association safety seat guidelines in private cars and taxicabs. METHODS: Two hundred forty-two caregivers of children (ages range, 2 weeks to 19 years) presenting for care in the pediatric emergency department of an urban university hospital were approached to complete an interviewer-administered questionnaire, and 225 participated. The questionnaire included knowledge, attitude, and behavior questions on protective equipment for various aged children. RESULTS: Eleven (47.8%) of 23 children 1 year or younger were reported to use infant seats often or always while riding in private cars, compared with 8 (22.2%) of 36 children 1 year or younger were reported to their use while in taxis (P < 0.05). Seventeen (85%) of 20 children older than 8 years were reported to have used seat belts often or always in private cars versus 10 (41.7%) of 24 in taxis (P < 0.01). One hundred fifty-four (99.3%) of 155 subjects knew the National Highway Traffic Safety Administration recommended position for the safety seat for their child. Most parents believed in the efficacy of child safety seats in preventing vehicle injuries and reported they would be more likely to use safety devices if they received information on their use in the emergency department. CONCLUSIONS: Data from this survey show that use of safety seats is lower in taxis than in private automobiles and that this is attributable to the inconvenience of carrying these seats to and from the taxi rather than financial considerations or lack of knowledge about their effectiveness. Strategies should be sought to increase availability of child safety devices in taxicabs. The emergency department, as well as the pediatrician's office or clinic, can be a locus for an educational intervention to parents and caregivers on child passenger safety.

The burden of noncompliance with seat belt use on a trauma center.

INTRODUCTION: It is well-known that noncompliance with seat belt use results in worse injury. The impact of noncompliance on hospital resource consumption and hospital charges is less well known. This study was carried out to examine the economic burden of noncompliance with seat belt use. METHODS: Trauma registry data were reviewed for patients involved in motor vehicle crashes in 2003 and 2004. Routine demographic data were analyzed. Outcome data included hospital length of stay, intensive care unit length of stay, number of ventilator days, and mortality. Hospital charges, rate of collection, hospital use (measured by need for admission), operating room use, and intensive care unit use were calculated to determine the burden of noncompliance with seat belt use. RESULTS: There were 3,426 patients identified for analysis. Of these patients, 1,744 (51%) were compliant with seat belt use (SEAT) while 1,682 were not compliant (NO SEAT). Patients in the NO SEAT group were significantly younger (31.2 versus 37.4 years old) and significantly more severely injured (Injury Severity Score of 11 versus 7) than those in the SEAT group. Patients in the NO SEAT group had a significantly longer hospital length of stay (4.4 versus 2.2 days) and intensive care unit length of stay (1.4 versus 0.3 days), as well as significantly more ventilator days (1.2 versus 0.2 days) than those in the SEAT group. Mortality was more than doubled in the NO SEAT group (2.2 versus 0.9%) as compared with the SEAT group. Resource consumption was significantly greater in the NO SEAT group, as evidenced by increased hospital use (64.9 versus 39%), increased critical care unit use (22.9 versus 10.3%) and increased operating room use (9.2 versus 4.9%) when compared with the SEAT group. Subsequently, hospital charges were significantly higher in the NO SEAT group ($32,138 versus $16,547) than in the SEAT group. Charge collection rate was lower in the NO SEAT group (30.5 versus 42.5%) than in the SEAT group. CONCLUSIONS: These data quantify the burden placed on a trauma center by noncompliance with seat belt use. This information should drive more focused education and injury prevention programs. It should also be clearly articulated to legislators to stimulate more support for more stringent legislative policy and improved trauma center funding.

A cost benefit analysis of an enhanced seat belt enforcement program in South Africa.

OBJECTIVE: To examine whether a program to increase the wearing of seat belts in a South African urban area would be worthwhile in societal terms. DESIGN: A cost benefit analysis of a one year enhanced seat belt enforcement program in eThekwini (Durban) Municipality. METHODS: Data were drawn from two main sources--a 1998 study of the cost of road crashes in South Africa and, given the absence of other data, a meta-analysis of the effectiveness of various types of interventions to reduce road crash casualties in the United States--and were analyzed using cost benefit analysis. RESULTS: A program designed to enforce greater wearing of seat belts, estimated to cost 2 million rand in one year, could be reasonably expected to increase seat belt usage rates by 16 percentage points and reduce fatalities and injuries by 9.5%. This would result in saved social costs of 13.6 million rand in the following year or a net present value of 11.6 million rand. There would also be favorable consequences for municipal finances. CONCLUSIONS: Investment in a program to increase seat belt wearing rates is highly profitable in societal terms.

A maternity hospital-based infant car-restraint loan scheme: public health and economic evaluation of an intervention for the reduction of road traffic injuries.

AIMS: The results of an infant car-restraint loan scheme and evaluate its cost-effectiveness are presented. METHODS: The intervention programme was initiated in 1996. Car-restraints, donated by manufacturers, were lent for a six-month period to eligible prospective parents for a modest fee. Specially trained health visitors performed in-person interviews with the participating parents. The data were collected and recorded on a pre-coded questionnaire. Cross-tabulations and multiple logistic regression were performed to analyse the data. Subsequent purchase of a next-stage car restraint, suitable for older children (up to four years of age) was considered as a proxy measure of the success of the programme. This information, along with the detailed operational and financial data collected during the implementation phase of the programme, was used to develop a model to assess the cost-effectiveness of a countrywide intervention. RESULTS: During a two-year period 188 families participated in a survey. On return of the infant car restraint, 92% of the participants reported proper use of the device and 82% had already purchased the second-stage car restraint. Parental age, gender, or educational status was not predictive of positive parental road safety practices for the newly born, whereas history of parental seat-belt use--as a proxy of personal road safety behaviour--was positively correlated with the likelihood of purchasing a second-stage car-restraint device. The cost-effectiveness ratio varies between 418.00 euro and 3,225.00 euro per life-year saved, depending on whether the modest administrative fee is considered. CONCLUSIONS: On the basis of plausible assumptions, a loan programme of infant car-restraints was shown to be particularly cost effective.

Child and family safety device affordability by country income level: an 18 country comparison.

OBJECTIVE: To compare availability, urban price, and affordability of child/family safety devices between 18 economically diverse countries. DESIGN: Descriptive: urban price surveys by local safety organisations or shoppers. SETTING: Retail stores and internet vendors. MAIN OUTCOME MEASURES: Prices expressed in US dollars, and affordability measured by hours of factory work needed to buy a child safety seat, a belt-positioning booster seat, a child bicycle helmet, and a smoke alarm. RESULTS: Prices of child and family safety devices varied widely between countries but the variation for child safety seats and bicycle helmets did not relate strongly to country income. Safety devices were expensive, often prohibitively so, in lower income countries. Far more hours of factory work were required to earn a child safety device in lower income than middle income, and middle income than higher income, countries. A bicycle helmet, for example, cost 10 hours of factory work in lower income countries but less than an hour in higher income countries. Smoke alarms and booster seats were not available in many lower income countries. CONCLUSIONS: Bicycles and two-axle motor vehicles were numerous in lower and middle income countries, but corresponding child safety devices were often unaffordable and sometimes not readily available. The apparent market distortions and their causes merit investigation. Advocacy, social marketing, local device production, lowering of tariffs, and mandatory use legislation might stimulate market growth. Arguably, a moral obligation exists to offer subsidies that give all children a fair chance of surviving to adulthood.

Is seat belt use associated with fewer days of lost work after motor vehicle collisions?

BACKGROUND: Seat belt use has consistently been shown to reduce motor vehicle collision (MVC)-related morbidity and mortality. The goal of this study is to determine whether seat belt use is associated with fewer lost workdays among occupants involved in MVCs. METHODS: The 1995 to 2000 National Automotive Sampling System (NASS) data files were used. The NASS is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. Occupants' lost workdays, which are routinely collected as part of an NASS investigation, were compared according to seat belt use. RESULTS: During 1995 to 2000 in the United States, surviving occupants involved in MVCs lost a total of 42.1 million workdays (approximately 7.0 million lost workdays per year; 2.4 lost workdays per person). The overall difference in lost workdays between the belted and unbelted occupants was 1.59 days (1.99 days vs. 3.58 days, respectively; p < 0.001). After adjusting for potentially confounding factors, belted occupants had 1.52 fewer lost workdays compared with unbelted occupants (p < 0.001). This translates to an estimated 7.3 million lost workdays and an associated $566 million in lost wages and $1.25 billion in work-place costs attributable to lack of seat belt use in the United States during 1995 to 2000. CONCLUSION: Lost workdays attributable to MVCs in the United States have sizable financial implications. Furthermore, seat belt use significantly reduces lost time at work and is associated with a significant cost savings. The national impact of unbelted driving on work productivity is dramatic, and further efforts to promote appropriate seat belt use should continue as part of the national safety agenda.

Cost-effectiveness of a ROPS retrofit education campaign.

A community educational campaign implemented in two Kentucky counties was effective in influencing farmers to retrofit their tractors with rollover protective structures (ROPS) to protect tractor operators from injury in the event of an overturn. This article reports on the cost-effectiveness of this program in the two counties when compared to no program in a control county. A decision analysis indicated that it would be effective at averting 0.27 fatal and 1.53 nonfatal injuries over a 20-year period, and when this analysis was extended statewide, 7.0 fatal and 40 nonfatal injuries would be averted in Kentucky. Over the 20-year period, the cost-per-injury averted was calculated to be $172,657 at a 4% annual discount rate. This cost compared favorably with a national cost of $489,373 per injury averted despite the additional program cost in Kentucky. The principle reason for the increased cost-effectiveness of the Kentucky program was the three-fold higher propensity for tractors to overturn in Kentucky. The cost-per-injury averted in one of the two counties was $112,535. This lower cost was attributed principally to incentive awards financed locally for farmers to retrofit their tractors with ROPS.

Effects and costs of requiring child-restraint systems for young children traveling on commercial airplanes.

CONTEXT: The US Federal Aviation Administration is planning a new regulation requiring children younger than 2 years to ride in approved child-restraint seats on airplanes. OBJECTIVES: To estimate the annual number of child air crash deaths that might be prevented by the proposed regulation, the threshold proportion of families switching from air to car travel above which the risks of the policy would exceed its benefits, and the cost per death prevented. DESIGN: Risk and economic analyses. RESULTS: Child-restraint seat use could prevent about 0.4 child air crash deaths per year in the United States. Increased deaths as a result of car travel could exceed deaths prevented by restraint seat use if the proportion of families switching from air to car travel exceeded about 5% to 10%. The estimate for this proportion varied with assumptions about trip distance, driver characteristics, and the effectiveness of child-restraint seats but is unlikely to exceed 15%. Assuming no increase in car travel, for each dollar increase in the cost of implementing the regulation per round trip per family, the cost per death prevented would increase by about $6.4 million. CONCLUSIONS: Unless space for young children in restraint seats can be provided at low cost to families, with little or no diversion to automobile travel, a policy requiring restraint seat use could cause a net increase in deaths. Even excluding this possibility, the cost of the proposed policy per death prevented is high.

Benefits of seat belt reminder systems.

This study sought to determine whether fitting a more aggressive seat belt reminder system to new vehicles would be cost-beneficial for Australia. While seat belt wearing rates have been observed around 95% in the front seat, non-wearing rates in casualty crashes are as high as 33% among persons killed and 19% among seriously injured occupants. Benefits were computed for three device options (simple, simple-2 and complex) and three introduction scenarios (driver-only, front seat occupants and all occupants). Four levels of effectiveness were assumed, from 10% to 40%, depending on the type of device fitted. Unit benefits were computed assuming a 5% discount rate and a 15yr fleet life. Various industry experts provided the costs. The findings showed that Benefit-Cost-Ratios ranged from 4.0:1 at best (simple device for the driver only) to 0.9:1 for all seating positions. These figures are conservative, given the assumptions made and the discounted human capital methods used.

Reducing injuries among Native Americans: five cost-outcome analyses.

This paper presents cost-outcome analyses of five injury prevention efforts in Native American jurisdictions: a safety-belt program, a streetlight project, a livestock control project, a drowning prevention program, and a suicide prevention and intervention program. Pre- and post-intervention data were analyzed to estimate projects' impact on injury reduction. Projects' costs were amortized over the time period covered by the evaluation or over the useful life of physical capital invested. Projects' savings were calculated based on estimated reduction in medical and public program expenses, on estimated decrease in lost productivity, and on estimated quality adjusted life years saved.All projects yielded positive benefit-cost ratios. The net cost per quality adjusted life years was less than zero (i.e. the monetary savings exceeded project costs) for all but one of the projects.

The effect of seatbelt use on injury patterns, disposition, and hospital charges for elders.

OBJECTIVE: To study the relationships between seatbelt use and injury patterns, hospital charges, morbidity, and mortality in elder motor vehicle crash victims. METHODS: A retrospective review of individuals at least 65 years old presenting to an urban emergency department (ED) after a motor vehicle crash. RESULTS: Over a two-year period, 339 patients had documentation of seatbelt use or non-use at the time of the crash. Of these, 241 (71%) patients had been wearing a seatbelt and 98 (29%) had not. Elders not using seatbelts were more likely to require hospitalization (29% unbelted vs. 17% belted) and had a higher mortality rate. Injury patterns were different in the two groups. Emergency department charges were significantly different between belted and unbelted elders ($351 vs. $451, p = 0.01) and head computed tomography (CT) utilization was higher in the unbelted group (25.6% vs 12.7%, p = 0.005). CONCLUSIONS: Improved seatbelt compliance in elders can reduce injuries, hospitalization rates, ED charges, and mortality resulting from motor vehicle crashes.

Validating benefit and cost estimates: the case of airbag regulation.

Preregulation estimates of benefits and costs are rarely validated after regulations are implemented. This article performs such a validation for the mandatory automobile airbag requirement. We found that the original 1984 model used to estimate benefits became invalid when 1997 values were input into that 1984 model. However, using a published 1997 cost-effectiveness model, we demonstrate, by replacing the model inputs with the values from 1984, that the 1997 cost-effectiveness ratios, based on real-world crash data and tear-down cost data, are less attractive than what would have been originally anticipated. The three most important errors in the 1984 input values are identified: the overestimation of airbag effectiveness, the overestimation of baseline fatality/injury rates, and the underestimation of manual safety belt use. This case study, which suggests that airbags are a reasonable investment in safety, shows that the regulatory analysis tools do not always produce findings that are biased against health, safety, and environmental regulation. Future validation studies of health, safety, and environmental regulation should focus on validation of benefit and risk estimates, areas where we found significant error, as well as on cost estimates.