title: Helmet regulation in Vietnam: impact on health, equity and medical impoverishment.
abstract: Vietnam's 2007 comprehensive motorcycle helmet policy increased helmet use from about 30% of riders to about 93%. We aimed to simulate the effect that this legislation might have on: (a) road traffic deaths and non-fatal injuries, (b) individuals' direct acute care injury treatment costs, (c) individuals' income losses from missed work and (d) individuals' protection against medical impoverishment.
  
  
  
  We used published secondary data from the literature to perform a retrospective extended cost-effectiveness analysis simulation study of the policy. Our model indicates that in the year following its introduction a helmet policy employing standard helmets likely prevented approximately 2200 deaths and 29 000 head injuries, saved individuals US$18 million in acute care costs and averted US$31 million in income losses. From a societal perspective, such a comprehensive helmet policy would have saved $11 000 per averted death or $830 per averted non-fatal injury. In terms of financial risk protection, traffic injury is so expensive to treat that any injury averted would necessarily entail a case of catastrophic health expenditure averted.
  
  
  
  The high costs associated with traffic injury suggest that helmet legislation can decrease the burden of out-of-pocket payments and reduced injuries decrease the need for access to and coverage for treatment, allowing the government and individuals to spend resources elsewhere. These findings suggest that comprehensive motorcycle helmet policies should be adopted by low-income and middle-income countries where motorcycles are pervasive yet helmet use is less common.
authors.affiliation: School of Public Health, University of California, Berkeley, California, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Olson
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Harborview Injury Prevention and Research Center, Seattle, Washington, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Staples
authors.affiliation: Harborview Injury Prevention and Research Center, Seattle, Washington, USA Department of Global Health, University of Washington, Seattle, Washington, USA Department of Surgery, University of Washington, Seattle, Washington, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
authors.affiliation: World Health Organization, Hanoi, Viet Nam.
authors.forename: Nam Phuong
authors.initials: NP
authors.lastname: Nguyen
authors.affiliation: Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg, School of Public Health, Baltimore, Maryland, USA.
authors.forename: Abdulgafoor M
authors.initials: AM
authors.lastname: Bachani
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nugent
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Verguet
mesh_terms: D000063:Accidents, Traffic / Q000191:economics* / Q000706:statistics & numerical data; D000070642:Brain Injuries, Traumatic / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D006259:Craniocerebral Trauma / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D033161:Government Regulation; D006260:Head Protective Devices / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006291:Health Policy; D006801:Humans; D007182:Income; D009049:Motorcycles / Q000331:legislation & jurisprudence*; D011203:Poverty; D012189:Retrospective Studies; D014744:Vietnam / Q000453:epidemiology