Chapter One. Introduction

Project Objectives

Globally, motor vehicle crashes are the eighth-leading cause of death for all ages and the leading cause of death for people ages 15 to 29 (World Health Organization [WHO], 2013). In recognition of this fact, the United Nations General Assembly mandated a Decade of Action for Road Safety 2011–2020, which aims to reduce road injuries and deaths across the world. The problem is just as acute in the United States, where, in 2013, more than 32,700 people were killed and approximately 2.3 million were injured in motor vehicle crashes (National Highway Traffic Safety Administration [NHTSA], 2015). In 2010, the economic costs associated with motor vehicle crashes were substantial, estimated to be $242 billion (Blincoe, Miller, et al., 2015). Fortunately, a wide range of evidence-based interventions, including both policies and programs, can help prevent motor vehicle–related injuries. As such, prevention of motor vehicle–related injuries has been designated as one of ten “Winnable Battles” by the Centers for Disease Control and Prevention (CDC).3

In the United States, many of the available evidence-based interventions to prevent motor vehicle–related injuries can be implemented at the state level. Given limited resources for implementing interventions, states must prioritize interventions and choose those that will give them the greatest reduction in injuries and deaths for their implementation dollars. To do this prioritization, states require state-specific information on the costs and effects of the interventions. Although considerable evaluation work has identified evidence-based interventions to prevent motor vehicle–related injuries and estimated the costs of motor vehicle–related injuries and deaths in the United States, little has been done to identify the levels of economic resources needed to implement these interventions. Consequently, decision makers—a term we use broadly throughout this report to include state health, transportation, and safety officials, as well as other officials who might use the tool—are not able to fully assess the costs and effects of different interventions and select the most cost-effective ones.

The purpose of this project was to support states and local communities across the United States in making evidence-based resource allocation decisions relating to the implementation of effective interventions to prevent motor vehicle–related injuries. This is achieved by building an interactive online tool ( that states can use to assess state-specific costs and effects of different interventions designed to prevent motor vehicle–related injuries and deaths and to select interventions that are most effective for a given implementation budget. The tool should help states understand the trade-offs and prioritize the most cost-effective interventions to reduce motor vehicle–related injuries and deaths. This report also contains detailed implementation cost information, which can be useful to state planners in determining the types and amounts of costs involved in implementing selected interventions.

We conducted this project in five steps:

  1. We selected a set of evidence-based interventions based on systematic reviews and evaluated against a set of predetermined criteria.
  2. We examined existing literature to estimate the interventions’ effectiveness in reducing injuries and deaths and followed the National Cooperative Highway Research Program (NCHRP) Report 622 (Preusser, Williams, et al., 2008) methodology in estimating the effect for each individual state.
  3. We extended a methodology used to estimate the costs of motor vehicle–related injuries at the national level to account for state-level variation in these costs and calculated these costs for each state to account for state-level variation.
  4. We developed a methodology to estimate the cost components and subcomponents for implementing each intervention through a review of the literature to identify existing implementation cost estimates and scaled the costs to the state level.
  5. We built an online tool that state decision makers can use to generate a variety of state-specific cost-effectiveness analyses, whose outcomes include estimates for costs and effectiveness, automatic prioritization according to effectiveness–cost ratio, and selection of the most beneficial package of interventions to implement for a given budget according to portfolio analysis.

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Organization of This Report

This report serves as the documentation of this effort. Following this introduction, Chapter Two describes our process for selecting the 14 interventions that are included in the tool and provides a brief description of each. Chapter Three explains the cost-estimating structure, as well as the data and supporting assumptions used to develop the costs for implementing each intervention. Chapter Four describes the parallel process for identifying the effectiveness of each intervention. Chapter Five describes how these data and assumptions were used to build the tool. Finally, Chapter Six serves as a user manual, providing a detailed example of how to use the tool, including a series of screenshots. Appendix A details the process of selecting interventions, and Appendix B provides fact sheets about each intervention.

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  1. CDC’s Winnable Battles are defined as public health priorities with large-scale impact on health and with known, effective strategies to address them. For more information on CDC’s Winnable Battles, please see CDC, 2014a.