Cost-effectiveness of traffic enforcement: case study from Uganda

Abstract

Background:In October 2004, the Ugandan Police department deployed enhanced traffic safety patrols on the four major roads to the capital Kampala.Objective:To assess the costs and potential effectiveness of increasing traffic enforcement in Uganda.Methods:Record review and key informant interviews were conducted at 10 police stations along the highways that were patrolled. Monthly data on traffic citations and casualties were reviewed for January 2001 to December 2005; time series (ARIMA) regression was used to assess for a statistically significant change in traffic deaths. Costs were computed from the perspective of the police department in $US 2005. Cost offsets from savings to the health sector were not included.Results:The annual cost of deploying the four squads of traffic patrols (20 officers, four vehicles, equipment, administration) is estimated at $72,000. Since deployment, the number of citations has increased substantially with a value of $327 311 annually. Monthly crash data pre- and post-intervention show a statistically significant 17% drop in road deaths after the intervention. The average cost-effectiveness of better road safety enforcement in Uganda is $603 per death averted or $27 per life year saved discounted at 3% (equivalent to 9% of Uganda’s $300 GDP per capita).Conclusion:The costs of traffic safety enforcement are low in comparison to the potential number of lives saved and revenue generated. Increasing enforcement of existing traffic safety norms can prove to be an extremely cost-effective public health intervention in low-income countries, even from a government perspective.

Cost-effectiveness of interventions to prevent road traffic injuries in low- and middle-income countries: A literature review

“…All studies except Ditsuwan et al (2013) did not state the discount rate, or conduct sensitivity analyses. Three out of five studies had a time horizon of one year (Bishai and Hyder 2006;Ditsuwan et al 2013;Stevenson et al 2008), one study had time horizon of 10 years (Chisholm et al 2012), and one was unreported (Bishai et al 2008). All future costs and consequences (DALYs and/or life year saved) were discounted to present values at an annual rate of 3% by the studies that reported discounting in their studies (Bishai and Hyder 2006;Bishai et al 2008;Chisholm et al 2012;Ditsuwan et al 2013).…”

“…All studies expressed the CEA of intervention in the form of a cost per DALYs averted except Bishai et al (2008) who measured cost per life-year saved. Of five studies, three were undertaken from a societal perspective (Bishai and Hyder 2006;Chisholm et al 2012;Stevenson et al 2008) and one study each from the police department (Bishai et al 2008) and health sector perspective (Ditsuwan et al 2013). All studies except Ditsuwan et al (2013) did not state the discount rate, or conduct sensitivity analyses.…”

“…The included studies were published between 2006 and 2013 and were from China (Bishai and Hyder 2006;Stevenson et al 2008), Uganda (Bishai et al 2008), Thailand (Ditsuwan et al 2013), and WHO Sub-Saharan Africa (SSA) and SEA regions (Chisholm et al 2012). …”

“…It is important to note, however, that Bishai and Hyder (2006) measured cost-effectiveness in terms of cost per DALYs averted using a societal perspective while Bishai et al (2008) measured it in terms of cost per life year saved, from a police perspective.…”

“…CEAs of traffic safety enforcement in the urban and rural areas of LMICs (Bishai and Hyder 2006 [+]) and Kampala, the capital of Uganda (Bishai et al 2008 [+]), which showed that at 3% discount rate, the intervention was cost-effective. It is important to note, however, that Bishai and Hyder (2006) measured cost-effectiveness in terms of cost per DALYs averted using a societal perspective while Bishai et al (2008) measured it in terms of cost per life year saved, from a police perspective.…”