Background: Road traffic injuries (RTIs) are the second largest cause of death in Thailand in 2004-2005 and ranked second in terms of disability-adjusted life years lost in 1999. Alcohol is an important contributing factor of road traffic crashes that cause injuries, disabilities and deaths. Several interventions are currently implemented to reduce alcohol-related RTI, but information on cost-effectiveness is limited. Aims: This thesis aimed to fill gaps in the evidence base related to the burden of RTI and the effectiveness and cost-effectiveness of measures to prevent road traffic crashes involving alcohol in Thailand. Structure: This thesis ends with the cost-effectiveness analysis in Chapter 6; the earlier chapters prepare the way by providing the required information. First, in Chapter 3 we examined the long-term consequences of RTIs. Chapter 4 uses this information to update the burden of RTI. In Chapter 5 the effectiveness of interventions and policies concerning alcohol-related RTI in Thailand is reviewed. Methods and Results: Chapter 3 examined the long-term consequences of RTI using the follow-up data of a cohort of 24,354 non-fatal RTI of which 697 cases considered at risk of permanent disabilities. The incidence of long-term disability was determined and the functional abilities of these victims were mapped and transferred into EuroQol (EQ-5D+) to enable the calculation of disability weights (DWs). Chapter 3 showed that 1.8% of non-fatal RTI resulted in long-term disability. The average DW of long-term injury was 0.57 (95% uncertainty interval (UI): 0.51, 0.65). These empirical DWs are compared with the corresponding conventional global burden of diseases and injuries DWs and proportions, which are based on expert judgement. Chapter 4 aimed to update burden of RTIs in 2004 using the long-term disability associated with RTIs in chapter 3 and corrected causes of death in 2004-5. These new mortality data were based on a verbal autopsy study and include estimates of the uncertainty related to the years of life lost. It also examined trends in the burden of injury in Thailand by comparing the results with those of the first burden of diseases and injuries study in Thailand, 1999. The results show that the DALY loss due to RTIs in 2004 was 673,000 (95% UI: 546,000-881,000). Mortality contributed 88% of this burden. The use of local data led to a significantly higher estimate of the burden of long-term disability due to RTIs (74,000 DALYs [95% UI: 55,400-88,500] vs. 43,000 [UI: 42,700-43,600]) compared to the standard Global Burden of Disease method. The burden of RTI in 2004 remained at the same level as in 1999. These findings are useful input for economic evaluations of interventions to reduce the burden of RTIs in Thailand. Economic evaluation of measures for preventing and controlling RTIs requires evidence of effectiveness. Published effectiveness studies were conducted almost exclusively in high-income countries, with scant information on the situation in low- and middle-income countries. To help reduce this knowledge gap, in Chapter 5 the effectiveness of interventions and policies concerning alcohol-related RTI in Thailand were reviewed. This showed that sobriety checkpoints are frequently mentioned; however their frequency and coverage were low. Evidence on the effectiveness of these interventions was limited; only two studies were available and they reported different effects. However, the evidence of effectiveness of the study in Khon Kaen provided useful information for economic evaluation of RTI prevention measures in Thailand. Driving under the influence of alcohol is mentioned as one major risk factors of RTI. Information on cost-effectiveness is necessary for decision-makers to make better use of limit resources to reduce alcohol-related RTIs. In Chapter 6 reports on a generalized cost-effectiveness analysis, incorporating information on the proportion of long-term disability and burden of RTIs (Chapter 3), disability-adjusted life years (DALYs) lost due to RTI (Chapter 4), and effectiveness of sobriety checkpoints (Chapter 5). Costs (in 2004 Thai Baht) were calculated based on health sector perspective. The expected effects of random breath testing (RBT), selective breath testing (SBT) and mass media campaigns were compared to a “do nothing” scenario. We measured benefits in terms of DALYs averted. Using a willingness to pay threshold of one time gross domestic product per capita (110,000 Baht), this thesis found that sobriety checkpoints (SBT& RBT), mass media campaigns, and their combinations were very cost-effective. RBT or SBT and mass media campaigns can reduce the burden of alcohol-related RTI by 24%-25%. Given the current emphasis on mass media campaigns, future investment should be used to increase the frequency of roadside alcohol checkpoints. Conclusions: This thesis provides empirical disability weights for RTI, corresponding proportions of victims suffering long-term disabilities, an update of the burden of RTIs, and effectiveness estimates for sobriety checkpoints and mass media campaigns to reduce of alcohol-related RTI, both or which are found to be highly cost-effective. These findings will enable decision-makers to improve road traffic safety and reduce drink driving in Thailand.
