Traumatic brain injury (TBI) is the main cause of mortality and severe morbidity in cyclists admitted to Dutch emergency departments (EDs). Although the use of bicycle helmets is an effective way of preventing TBI, this is uncommon in the Netherlands. An option to increase its use is through a legal enforcement. However, little is known about the cost-effectiveness of such mandatory use of helmets in the Dutch context. The current study aimed to assess the cost-effectiveness of a law that enforces helmet use to reduce TBI and TBI-related mortality. The cost-effectiveness was estimated through decision tree modelling. In this study, wearing bicycle helmets enforced by law was compared with the current situation of infrequent voluntary helmet use. The total Dutch cycling population, consisting of 13.5 million people, was included in the model. Model data and parameters were obtained from Statistics Netherlands, the National Road Traffic Database, Dutch Injury Surveillance System, and literature. Effects included were numbers of TBI, death, and disability-adjusted life years (DALY). Costs included were healthcare costs, costs of productivity losses, and helmet costs. Sensitivity analysis was performed to assess which parameter had the largest influence on the incremental cost-effectiveness ratio (ICER). The intervention would lead to an estimated reduction of 2942 cases of TBI and 46 deaths. Overall, the incremental costs per 1) death averted, 2) per TBI averted, and 3) per DALY averted were estimated at 1) € 2,002,766, 2) € 31,028 and 3) € 28,465, respectively. Most favorable were the incremental costs per DALY in the 65+ age group: € 17,775. The overall costs per DALY averted surpassed the Dutch willingness to pay threshold value of € 20,000 for cost-effectiveness of preventive interventions. However, the cost per DALY averted for the elderly was below this threshold, indicating that in this age group largest effects can be reached. If the price of a helmet would reduce by 20%, which is non-hypothetical in a situation of large-scale purchases and use of these helmets, the introduction of this regulation would result in an intervention that is almost cost-effective in all age groups.

中文翻译：

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强制性使用自行车头盔以防止脑外伤和死亡的成本效益。

外伤性脑损伤（TBI）是进入荷兰急诊室（EDs）骑自行车的人的死亡率和严重发病率的主要原因。尽管使用自行车头盔是预防TBI的有效方法，但在荷兰并不常见。一种增加使用量的选择是通过法律执行。但是，对于在荷兰语中强制使用头盔的成本效益知之甚少。当前的研究旨在评估强制使用头盔以降低TBI和TBI相关死亡率的法律的成本效益。通过决策树建模来估算成本效益。在这项研究中，将依法强制佩戴的自行车头盔与不经常使用自愿头盔的现状进行了比较。该模型包括荷兰自行车总人口，包括1,350万人。模型数据和参数来自荷兰统计局，国家道路交通数据库，荷兰伤害监测系统和文献。包括的影响包括TBI的数量，死亡和残疾调整生命年（DALY）。其中包括医疗保健成本，生产力损失成本和头盔成本。进行敏感性分析以评估哪个参数对增量成本效益比（ICER）的影响最大。干预措施将导致估计减少2942例TBI病例和46例死亡。总体而言，每1）个避免的死亡，2）每个避免的TBI和3）每个避免的DALY的增量成本分别为1）2,002,766欧元，2）31,028欧元和3）28,465欧元。最有利的是65岁以上年龄段每个DALY的增量费用：17,775欧元。每个DALY避免的总成本超过了荷兰愿意为预防性干预措施的成本效益支付20,000欧元的门槛值的意愿。但是，老年人避免的平均DALY成本低于此阈值，这表明在该年龄组中可以达到最大的效果。如果头盔的价格降低20％（在大规模购买和使用这些头盔的情况下这不是假设的），则该法规的引入将导致在所有年龄段几乎都具有成本效益的干预措施组。