Uncrewed aircraft systems versus motorcycles to deliver laboratory samples in west Africa: a comparative economic study.

BACKGROUND: Transportation of laboratory samples in low-income and middle-income countries is often constrained by poor road conditions, difficult geographical terrain, and insecurity. These constraints can lead to long turnaround times for laboratory diagnostic tests and hamper epidemic control or patient treatment efforts. Although uncrewed aircraft systems (UAS)-ie, drones-can mitigate some of these transportation constraints, their cost-effectiveness compared with land-based transportation systems is unclear. METHODS: We did a comparative economic study of the costs and cost-effectiveness of UAS versus motorcycles in Liberia (west Africa) for transportation of laboratory samples under simulated routine conditions and public health emergency conditions (based on the 2013-16 west African Ebola virus disease epidemic). We modelled three UAS with operational ranges of 30 km, 65 km, and 100 km (UAS30, UAS65, and UAS100) and lifespans of 1000 to 10 000 h, and compared the costs and number of samples transported with an established motorcycle transportation programme (most commonly used by the Liberian Ministry of Health and the charity Riders for Health). Data for UAS were obtained from Skyfire (a UAS consultancy), Vayu (a UAS manufacturer), and Sandia National Laboratories (a private company with UAS research experience). Motorcycle operational data were obtained from Riders for Health. In our model, we included costs for personnel, equipment, maintenance, and training, and did univariate and probabilistic sensitivity analyses for UAS lifespans, range, and accident or failures. FINDINGS: Under the routine scenario, the per sample transport costs were US$0·65 (95% CI 0·01-2·85) and $0·82 (0·56-5·05) for motorcycles and UAS65, respectively. Per-sample transport costs under the emergency scenario were $24·06 (95% CI 21·14-28·20) for motorcycles, $27·42 (95% CI 19·25-136·75) for an unadjusted UAS model with insufficient geographical coverage, and $34·09 (95% CI 26·70-127·40) for an adjusted UAS model with complementary motorcycles. Motorcycles were more cost-effective than short-range UAS (ie, UAS30). However, with increasing range and operational lifespans, UAS became increasingly more cost-effective. INTERPRETATION: Given the current level of technology, purchase prices, equipment lifespans, and operational flying ranges, UAS are not a viable option for routine transport of laboratory samples in west Africa. Field studies are required to generate evidence about UAS lifespan, failure rates, and performance under different weather conditions and payloads. FUNDING: None.

MOPEDS: The high cost of cheap and poorly legislated transportation for negligent drivers.

INTRODUCTION: This study evaluates the impact of moped crashes in North Carolina, a state with lenient moped legislation by(1) describing the characteristics of moped crashes and (2) estimating the cost burden of moped-related injuries. METHODS: Health and public records of moped crash subjects treated at our hospital were reviewed. Direct costs were billed hospital charges. Indirect costs based on age and outcomes were calculated. RESULTS: Between 2008-2013, 368 subjects were involved in 373 moped crashes. 52% of drivers were intoxicated. 38% of drivers had prior DWIs and 26% had prior revoked licenses. Hospitalized subjects (n = 305) had a combined 2687 hospital days, 695 ICU days and 449 trips to the operating room for treatment of their injuries. Average hospital charges were $70,561 per subject. Total direct and indirect costs of moped injuries were over $26 million and $81 million respectively. Medicaid absorbed most of the direct cost ($13.7 M). Estimated direct cost of moped crashes across the state totaled $133 million. CONCLUSION: Healthcare and financial ramifications of moped collisions are substantial. Laws governing moped drivers and stricter penalties for intoxicated drivers are needed.

Direct medical costs of motorcycle crashes in Ontario.

BACKGROUND: There is no reliable estimate of costs incurred by motorcycle crashes. Our objective was to calculate the direct costs of all publicly funded medical care provided to individuals after motorcycle crashes compared with automobile crashes. METHODS: We conducted a population-based, matched cohort study of adults in Ontario who presented to hospital because of a motorcycle or automobile crash from 2007 through 2013. For each case, we identified 1 control absent a motor vehicle crash during the study period. Direct costs for each case and control were estimated in 2013 Canadian dollars from the payer perspective using methodology that links health care use to individuals over time. We calculated costs attributable to motorcycle and automobile crashes within 2 years using a difference-in-differences approach. RESULTS: We identified 26 831 patients injured in motorcycle crashes and 281 826 injured in automobile crashes. Mean costs attributable to motorcycle and automobile crashes were $5825 and $2995, respectively (p < 0.001). The rate of injury was triple for motorcycle crashes compared with automobile crashes (2194 injured annually/100 000 registered motorcycles v. 718 injured annually/100 000 registered automobiles; incidence rate ratio [IRR] 3.1, 95% confidence interval [CI] 2.8 to 3.3, p < 0.001). Severe injuries, defined as those with an Abbreviated Injury Scale ≥ 3, were 10 times greater (125 severe injuries annually/100 000 registered motorcycles v. 12 severe injuries annually/100 000 registered automobiles; IRR 10.4, 95% CI 8.3 to 13.1, p < 0.001). INTERPRETATION: Considering both the attributable cost and higher rate of injury, we found that each registered motorcycle in Ontario costs the public health care system 6 times the amount of each registered automobile. Medical costs may provide an additional incentive to improve motorcycle safety.

Impact of Helmet Use on Injury and Financial Burden of Motorcycle and Moped Crashes in Hawai'i: Analysis of a Linked Statewide Database.

Helmet use reduces injury severity, disability, hospital length of stay, and hospital charges in motorcycle riders. The public absorbs billions of dollars annually in hospital charges for unhelmeted, uninsured motorcycle riders. We sought to quantify, on a statewide level, the healthcare burden of unhelmeted motorcycle and moped riders. We examined 1,965 emergency medical service (EMS) reports from motorcycle and moped crashes in Hawai'i between 2007-2009. EMS records were linked to hospital medical records to assess associations between vehicle type, helmet use, medical charges, diagnoses, and final disposition. Unhelmeted riders of either type of vehicle suffered more head injuries, especially skull fractures (adjusted odds ratio (OR) of 4.48, P < .001, compared to helmeted riders). Motorcyclists without helmets were nearly three times more likely to die (adjusted OR 2.85, P = .001). Average medical charges were almost 50% higher for unhelmeted motorcycle and moped riders, with a significant (P = .006) difference between helmeted ($27,176) and unhelmeted ($40,217) motorcycle riders. Unhelmeted riders were twice as likely to self-pay (19.3%, versus 9.8% of helmeted riders), and more likely to have Medicaid or a similar income-qualifying insurance plan (13.5% versus 5.0%, respectively). Protective associations with helmet use are stronger among motorcyclists than moped riders, suggesting the protective effect is augmented in higher speed crashes. The public financial burden is higher from unhelmeted riders who sustain more severe injuries and are less likely to be insured.

Motorcycle Helmets: The Economic Burden of an Incomplete Helmet Law to Medical Care in the State of Connecticut.

The lack of a mandatory motorcycle helmet law leads to increased injury severity and increased health care costs. This study presents a financial model to estimate how the lack of a mandatory helmet law impacts the cost of health care in the state of Connecticut. The average cost to treat a helmeted rider and a nonhelmeted rider was $3,112 and $5,746 respectively (cost adjusted for year 2014). The total hospital treatment cost in the state of Connecticut from 2003 through 2012 was $73,106,197, with $51,508,804 attributed to nonhelmeted riders and $21,597,393 attributed to helmeted riders. The total Medicaid cost to the state of Connecticut for treating nonhelmeted patients was $18,277,317. This model demonstrates that the lack of a mandatory helmet law increases overall health care costs to the state of Connecticut, and provides a framework by which hospital costs can be reduced to contribute to the economic stability of health care economics in the state.

Hospitalisation costs and duration of elderly motorcyclists' non-fatality crashes in Taiwan.

This paper investigates the relationship between medical treatment costs and the length of hospital stays resulting from motorcycle crashes involving the elderly. The World Health Organization defines 'elderly' as people more than 65 years old. The sample for this study consisted of data for the year 2007 collected by the Bureau of National Health Insurance, Taiwan. We develop models for predicting medical costs and the length of hospital stays based on diagnosis, hospital and user types. The seemingly unrelated regression equation (SURE) model was applied first to investigate the relationship between medical costs and the length of hospital stays. The SURE model shows that the type of injury (e.g. head injury) is statistically significant and has positive effects on medical costs for motorcycle crashes involving the elderly in Taiwan. Due to the statistical insignificance of the dependency between medical costs and length of hospital stays, two separate simple linear regression models were subsequently estimated. For motorcycle crashes, patients over 80 years old had the highest medical costs. The findings reinforce the need for transportation authorities to focus on preventing certain types of injuries that are particularly serious and costly for the elderly in Taiwan.

A dynamic analysis of motorcycle ownership and usage: a panel data modeling approach.

This study aims to develop motorcycle ownership and usage models with consideration of the state dependence and heterogeneity effects based on a large-scale questionnaire panel survey on vehicle owners. To account for the independence among alternatives and heterogeneity among individuals, the modeling structure of motorcycle ownership adopts disaggregate choice models considering the multinomial, nested, and mixed logit formulations. Three types of panel data regression models--ordinary, fixed, and random effects--are developed and compared for motorcycle usage. The estimation results show that motorcycle ownership in the previous year does exercise a significantly positive effect on the number of motorcycles owned by households in the current year, suggesting that the state dependence effect does exist in motorcycle ownership decisions. In addition, the fixed effects model is the preferred specification for modeling motorcycle usage, indicating strong evidence for existence of heterogeneity. Among various management strategies evaluated under different scenarios, increasing gas prices and parking fees will lead to larger reductions in total kilometers traveled.

Average out-of-pocket healthcare and work-loss costs of traffic injuries in Karachi, Pakistan.

The objective of this study was to assess the average out-of-pocket healthcare and work-loss costs of road traffic injuries (RTI) in Karachi. In this cross-sectional study, RTI patients presenting to the five trauma centres in Karachi were contacted using stratified sampling to report their inpatient and outpatient expenses, the time spent in hospital and their average monthly income. These costs were compared among different categories of patient-related variables using analysis of variance test. Out of 341 RTI victims, two wheelers accounted for the majority of injuries (77.2%, N = 256) followed by pedestrians (14.2%, N = 48). Almost half of the sample patients were breadwinners (N = 135, 45.2%), with 87.4% (N = 118) earning less than US$ 248. Average out-of-pocket healthcare costs were US$ 271 (SD = 440.9), which were significantly higher (P ≤ 0.026) for pedestrians (US$ 442), moderate (US$ 341.7) or severe (US$ 553.8) injury, and treatment in private hospitals (US$ 451.7). Similarly, average work loss was US$ 67.1 (SD = 132.1), which were significantly higher (P = 0.001) for breadwinners (US$ 99.1), moderate (US$ 130.0) or severe (US$ 157.1) injury, and treatment in private hospitals (US$ 150.0). Study results clearly showed the need to advocate RTI prevention measures in Pakistan as any such event could lead to a difficult economic situation for those involved and their family.

Gasoline prices and their relationship to rising motorcycle fatalities, 1990-2007.

Motor vehicle accidents are the leading cause of death among young adults. Although automobile fatalities have declined in recent years, motorcycle fatalities are rapidly increasing. The purpose of our research was to quantify the relationship between changing fuel prices and motorcycle fatalities. Our findings suggest that people increasingly rely on motorcycles to reduce their fuel costs in response to rising gasoline prices. We estimate that use of motorcycles and scooters instead of 4-wheeled vehicles results in over 1500 additional motorcycle fatalities annually for each dollar increase in gas prices. Motorcycle safety should receive more attention as a leading public health issue.

Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: do they reduce delay and what do they cost?

OBJECTIVES: To assess whether motorcycle ambulances placed at rural health centers are a more effective method of reducing referral delay for obstetric emergencies than a car ambulance at the district hospital, and to compare investment and operating costs with those of a 4 wheel drive car ambulance at the district hospital. METHODS: Motorcycle ambulances were placed at 3 remote rural health centers in Malawi. Data were collected over a 1-year period, from October 2001 to September 2002, using logbooks, cashbooks, referral forms, and maternity registers. RESULTS: Depending on the site, median referral delay was reduced by 2-4.5 hours (35%-76%). Purchase price of a motorcycle ambulance was 19 times cheaper than for a car ambulance. Annual operating costs were US dollars 508, which was almost 24 times cheaper than for a car ambulance. CONCLUSIONS: In resource-poor countries motorcycle ambulances at rural health centers are a useful means of referral for emergency obstetric care and a relatively cheap option for the health sector.

The value of life and accident costing: a willingness-to-pay study amongst motorcyclists in Malaysia.

Motorcyclists constitute a large proportion of total road casualties in Asian countries Unfortunately, studies conducted for the purpose of evaluating the cost of traffic crashes, and cost-benefit analyses of safety interventions, are almost nonexistent in these countries. The loss-of-output approach to valuing life has been used for many years, yet this method has also long been criticised as it results in significant resource misallocation. This study attempts to overcome this problem by estimating the value of a statistical life among motorcyclists using the willingness-to-pay method that is commonly used in developed countries. The study recommends adopting a value of MYR1.1 million (almost five times the previous estimate) per statistical life for public policy analysis involving motorcycle safety.

Which are the relevant costs and benefits of road safety measures designed for pedestrians and cyclists?

This paper discusses the current state-of-the-art with respect to impact assessment and cost-benefit analysis of measures designed to improve safety or mobility for pedestrians and cyclists. The study concludes that a number of impacts that are likely to regarded as important for pedestrians and cyclists are not included in current impact assessments and cost-benefit analyses as these are made in Norway. Impacts that are not currently included in impact assessments and cost-benefit analyses are: (a) changes in the amount of walking and cycling; (b) changes in travel time for pedestrians and cyclists; (c) changes in road user insecurity (feeling of safety); and (d) changes in road user health state. In order to include these effects in impact assessments and cost-benefit analyses, more needs to be known about their occurrence and monetary value. Hypothetical examples of ideally designed cost-benefit analyses are given, based on highly preliminary monetary values for travel time, insecurity and generalised costs of travel for pedestrians and cyclists. These analyses indicate that inclusion of these effects in cost-benefit analyses could make a major difference for the results of those analyses.

Motorcycle helmet use and injury outcome and hospitalization costs from crashes in Washington State.

OBJECTIVES: The incidence, type, severity, and costs of crash-related injuries requiring hospitalization or resulting in death were compared for helmeted and unhelmeted motorcyclists. METHODS: This was a retrospective cohort study of injured motorcyclists in Washington State in 1989. Motorcycle crash data were linked to statewide hospitalization and death data. RESULTS: The 2090 crashes included in this study resulted in 409 hospitalizations (20%) and 59 fatalities (28%). Although unhelmeted motorcyclists were only slightly more likely to be hospitalized overall, they were more severely injured, nearly three times more likely to have been head injured, and nearly four times more likely to have been severely or critically head injured than helmeted riders. Unhelmeted riders were also more likely to be readmitted to a hospital for follow-up treatment and to die from their injuries. The average hospital stay for unhelmeted motorcyclists was longer, and cost more per case; the cost of hospitalization for unhelmeted motorcyclists was 60% more overall ($3.5 vs $2.2 million). CONCLUSIONS: Helmet use is strongly associated with reduced probability and severity of injury, reduced economic impact, and a reduction in motorcyclist deaths.

Medical and economic parameters of motorcycle-induced trauma.

A retrospective study was conducted on all patients injured in a motorcycle accident who were admitted to the authors' institution during a one-year period. The 71 patients evaluated averaged 26 years of age; 79% were men, 75% were not wearing a helmet, and 24% were legally intoxicated. Sixty-six percent required surgical intervention and 36% a second procedure. There were 167 fractures, with an average of 2.4 per patient. The 27 patients requiring a blood transfusion averaged 10.5 units per patient. Motorcyclists not wearing a helmet had an increased risk of head injury (p less than .01). Those with head injuries had an increased need for intensive care (p less than .0001) and a ventilator (p less than .001). Patients with head injuries more commonly sustained fractures about the shoulder (p less than .015) than fractures to the lower extremity (p less than .005). The average hospital stay was 13 days, with a cost of $16,408 per patient. The cost was significantly higher in patients with a head injury ($21,945) than in patients without a head injury ($11,941). Patients sustaining a head injury were less likely to return to baseline functioning (p less than .001).