An economic evaluation of setting up physical barriers in railway stations for preventing railway injury: evidence from Hong Kong
- 1Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong, PR China
- 2HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, PR China
- 3Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, PR China
- Correspondence to Dr C K Law, Hong Kong Institute of Asia-Pacific Studies, Room 507, Esther Lee Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, PR China
Contributors CKL (the leading author) designed the study, formulated the research questions, undertook statistical analyses with PSFY and wrote the first draft of the manuscript.
- Accepted 2 January 2011
- Published Online First 30 January 2011
Background Setting physical barriers, for example platform screen doors (PSDs), has been proven to be effective in preventing falls onto railway tracks, but its cost-effectiveness is not known. For economic evaluation of public health interventions, the importance of including non-health factors has been noted despite a lack of empirical studies. This study aimed to investigate the effectiveness and cost-effectiveness of PSDs, which are installed in part of the Hong Kong railway system, for preventing railway injuries.
Methods Data on railway injuries from 1997 to 2007 were obtained from the railway operators. Poisson regression was used to examine the risk reduction. Two incremental cost-effectiveness ratios (ICER) were calculated to assess the cost-effectiveness based on (1) disability-adjusted life years (DALYs) only and (2) DALYs with potential fare revenue and passengers' waiting time lost due to railway circulation collapse.
Results The PSD installation has effectively reduced railway injuries (adjusted 5-year average percentage change: −68.8%, p<0.0001) with no apparent substitution effect to the other platforms observed. To be cost-effective, the cost of gaining a healthy life year (ICER) should not exceed three times the per capita GDP (US$74 700). The PSD installation would only be cost-effective if the loss of fare revenue and passengers' waiting time, in addition to DALY, were included (ICER: US$65 400), while the ICER based on DALY only would be US$77 900.
Conclusion The challenges of complexity for economic evaluation appear in many community-based health interventions. A more extensive perspective for exploring other outcome measurements and evaluation methods to reflect a fair and appropriate value of the intervention's cost-effectiveness is needed.
- evaluation Research
- evaluation Methodology
- benefit-risk assessment
- cost effective pr
- economic evaluation
- evaluation me
- health impact assessment
Competing interests None.
Ethics approval Ethics approval was provided by the Human Research Ethics Committee for Non-Clinical Faculties of the University of Hong Kong.
Provenance and peer review Not commissioned; externally peer reviewed.