National Institute for Public Health and the Environment, RIVM, Postbus 1, Bilthoven, 3720, BA, the Netherlands.
Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
BMC Public Health. 2020 Mar 30;20(1):413. doi: 10.1186/s12889-020-08544-5.
Traumatic brain injury (TBI) is the main cause of mortality and severe morbidity in cyclists admitted to Dutch emergency departments (EDs). Although the use of bicycle helmets is an effective way of preventing TBI, this is uncommon in the Netherlands. An option to increase its use is through a legal enforcement. However, little is known about the cost-effectiveness of such mandatory use of helmets in the Dutch context. The current study aimed to assess the cost-effectiveness of a law that enforces helmet use to reduce TBI and TBI-related mortality.
The cost-effectiveness was estimated through decision tree modelling. In this study, wearing bicycle helmets enforced by law was compared with the current situation of infrequent voluntary helmet use. The total Dutch cycling population, consisting of 13.5 million people, was included in the model. Model data and parameters were obtained from Statistics Netherlands, the National Road Traffic Database, Dutch Injury Surveillance System, and literature. Effects included were numbers of TBI, death, and disability-adjusted life years (DALY). Costs included were healthcare costs, costs of productivity losses, and helmet costs. Sensitivity analysis was performed to assess which parameter had the largest influence on the incremental cost-effectiveness ratio (ICER).
The intervention would lead to an estimated reduction of 2942 cases of TBI and 46 deaths. Overall, the incremental costs per 1) death averted, 2) per TBI averted, and 3) per DALY averted were estimated at 1) € 2,002,766, 2) € 31,028 and 3) € 28,465, respectively. Most favorable were the incremental costs per DALY in the 65+ age group: € 17,775.
The overall costs per DALY averted surpassed the Dutch willingness to pay threshold value of € 20,000 for cost-effectiveness of preventive interventions. However, the cost per DALY averted for the elderly was below this threshold, indicating that in this age group largest effects can be reached. If the price of a helmet would reduce by 20%, which is non-hypothetical in a situation of large-scale purchases and use of these helmets, the introduction of this regulation would result in an intervention that is almost cost-effective in all age groups.
创伤性脑损伤（TBI）是导致荷兰急诊部门（ED）收治的自行车骑手死亡和严重发病的主要原因。尽管使用自行车头盔是预防 TBI 的有效方法，但在荷兰，这种方法并不常见。增加头盔使用的一种选择是通过法律强制执行。然而，对于荷兰来说，这种强制性使用头盔的成本效益知之甚少。本研究旨在评估通过强制使用头盔来降低 TBI 和 TBI 相关死亡率的法律的成本效益。
通过决策树模型来评估成本效益。在这项研究中，通过法律强制使用自行车头盔与目前不常使用的自愿使用头盔的情况进行了比较。模型包括了总共有 1350 万人口的荷兰自行车骑行人群。模型数据和参数来自荷兰统计局、国家道路交通数据库、荷兰伤害监测系统和文献。包括的效果是 TBI、死亡和伤残调整生命年（DALY）的数量。包括的成本是医疗保健成本、生产力损失成本和头盔成本。进行敏感性分析以评估哪个参数对增量成本效益比（ICER）的影响最大。
干预措施预计将减少 2942 例 TBI 和 46 例死亡。总体而言，每避免 1）一例死亡、2）一例 TBI 和 3）一例 DALY 的增量成本估计为 1）€2002766、2）€31028 和 3）€28465。65 岁及以上人群的 DALY 每避免一例的增量成本最有利，为€17775。
每避免一例 DALY 的总成本超过了荷兰对预防干预成本效益的 20000 欧元的意愿支付阈值。然而，对于老年人来说，每避免一例 DALY 的成本低于这个阈值，这表明在这个年龄段可以达到最大的效果。如果头盔价格降低 20%，在大规模购买和使用这些头盔的情况下，这并非假设，那么引入这项规定将使所有年龄段的干预措施几乎具有成本效益。
