Hatziandreu E J, Sacks J J, Brown R, Taylor W R, Rosenberg M L, Graham J D
Battelle Medical Technology Assessment and Policy Research Center, Arlington, VA, USA.
Public Health Rep. 1995 May-Jun;110(3):251-9.
Each year in the United States, 280 children die from bicycle crashes and 144,000 are treated for head injuries from bicycling. Although bicycle helmets reduce the risk of head injury by 85 percent, few children wear them. To help guide the choice of strategy to promote helmet use among children ages 5 to 16 years, the cost effectiveness of legislative, communitywide, and school-based approaches was assessed. A societal perspective was used, only direct costs were included, and a 4-year period after program startup was examined. National age-specific injury rates and an attributable risk model were used to estimate the expected number of bicycle-related head injuries and deaths in localities with and without a program. The percentage of children who wore helmets increased from 4 to 47 in the legislative program, from 5 to 33 in the community program, and from 2 to 8 in the school program. Two programs had similar cost effectiveness ratios per head injury avoided. The legislative program had a $36,643 cost and the community-based one, $37,732, while the school-based program had a cost of $144,498 per head injury avoided. The community program obtained its 33 percent usage gradually over the 4 years, while the legislative program resulted in an immediate increase in usage, thus, considering program characteristics and overall results, the legislative program appears to be the most cost-effective. The cost of helmets was the most influential factor on the cost-effectiveness ratio. The year 2000 health objectives call for use of helmets by 50 percent of bicyclists. Since helmet use in all these programs is less than 50 percent, new or combinations of approaches may be required to achieve the objective.
在美国，每年有280名儿童死于自行车事故，14.4万名儿童因骑自行车导致头部受伤而接受治疗。尽管自行车头盔可将头部受伤风险降低85%，但很少有儿童佩戴。为了帮助指导制定在5至16岁儿童中推广头盔使用的策略，对立法、社区范围和基于学校的方法的成本效益进行了评估。采用了社会视角，仅纳入直接成本，并考察了项目启动后的4年期间。使用全国特定年龄的伤害率和归因风险模型来估计有无该项目地区与自行车相关的头部受伤和死亡的预期数量。在立法项目中，佩戴头盔的儿童比例从4%增至47%，社区项目中从5%增至33%，学校项目中从2%增至8%。避免每起头部受伤，有两个项目的成本效益比率相近。立法项目的成本为36,643美元，社区项目为37,732美元，而基于学校的项目避免每起头部受伤的成本为144,498美元。社区项目在4年期间逐渐实现了33%的使用率，而立法项目使使用率立即提高，因此，综合考虑项目特点和总体结果，立法项目似乎最具成本效益。头盔成本是对成本效益比率影响最大的因素。2000年的健康目标要求50%的骑自行车者使用头盔。由于所有这些项目中的头盔使用率均低于50%，可能需要新的方法或多种方法结合使用才能实现这一目标。
