Making the economic case for injury prevention and safety promotion: a systematic review of the literature
Background: In the European Union alone, not only do injuries claim over 230,000 lives per year, but they also place a major economic burden on those health and social welfare services that provide immediate treatment and rehabilitation. Objectives: A systematic review was undertaken to map what is already known about the cost effectiveness of strategies to promote safety and prevent injuries, both intentional and unintentional, in Europe. We also considered whether strategies evaluated elsewhere might be applicable to a European context. Methods: A range of databases were searched, complemented by examination of grey literature, academic and government websites and a handsearch of key journals. Papers were independently reviewed and cross-checked by the authors; relevant studies were coded for findings and assessed using a economic evaluation checklist. Results More than 5000 papers were examined with more than 1100 meeting our initial inclusion criteria. The most common areas for economic analysis related to fall prevention (25%), transport safety (22%) and workplace injury prevention(21%). Most analyses took the form of simple cost effectiveness/ cost-consequence analyses although cost benefit analyses were often used for transport and enviromental interventions; we also identified a number of regulatory and legislative interventions where the cost of implementation had been considered e.g. the mandatory use of seat belts in motor vehicles. Conclusions: Across many areas of injury prevention, actions could be identified that were not only cost effective but often cost saving because of future costs avoided. Less is known on the economic case for complex interventions which require behavioural change to be effective. The majority of work has been undertaken in the US; a high degree of caution needs to be exercised in transferring these interventions to a European context. There is however much scope to retrospectively adapt and add economic analysis to exisiting effectiveness studies of actions to prevent injuries and promote safety.