No abstract available
BACKGROUND: In Switzerland, as in various other countries throughout the world, elderly drivers have to pass a medical screening assessment every two years to keep their driver’s licence. The scientific literature shows no clear evidence that these policies improve road safety. This study evaluated the effects of the Swiss screening policy by comparing the accident and injury rates of elderly road users in Switzerland with those in Austria and Germany, two neighbouring countries without systematic age-based screening policies. The aims of this study were to examine if the screening policy is associated with a reduced risk of elderly car drivers causing serious accidents (research question 1) or with an increased risk of elderly pedestrians or (e-)cyclists being seriously or fatally injured (research question 2).
METHODS: In all three countries, data on accidents were taken from official statistics based on police reports and mileage data from national mobility surveys. An accident was defined as serious if at least one person is seriously or fatally injured in it. Accident and injury rates were calculated using distances driven and population size as measurement of exposure. Multiple Poisson regression models were used to examine the association between the Swiss policy and the accident or injury risk of elderly persons.
RESULTS: We found no association between the screening policy for elderly drivers in Switzerland and their risk of causing a serious accident (incidence rate ratio [IRR] 1.24, 95% confidence interval [CI] 0.79–1.94). Contrary to other studies, however, the Swiss policy was not associated with an increased risk of elderly pedestrians (IRR 1.16, 95% CI 0.80–1.68) and (e-)cyclists (IRR 0.79, 95% CI 0.56–1.12) being seriously or fatally injured.
CONCLUSIONS: The intended positive effect of the Swiss screening policy on accident rates of elderly drivers could not be demonstrated in this study. These findings serve as a basis for discussion on how to proceed with the policy in the future.
BACKGROUND: Lung volume reduction, either by surgery or bronchoscopically by endobronchial valve treatment have been shown to be a cost-effective alternative compared with conservative therapy. However, there is no comparative analysis of lung volume reduction by surgery and bronchoscopic lung volume reduction using endobronchial valves.
OBJECTIVES: The aim of this retrospective study was to provide a cost-effectiveness analysis of lung volume reduction by surgery compared with bronchoscopic lung volume reduction using endobronchial valves.
METHODS: The effectiveness of lung volume reduction was assessed using forced expiratory volume in the first second (FEV1), residual volume (RV) and 6-minute walking distance (6MWD), measured at baseline and at 4 to 12 weeks. Cost unit accounting derived from SwissDRG was used as a surrogate of the costs from the payer’s perspective.
RESULTS: In total, 67 patients (37 men and 30 women) with a mean age of 68.3 ± 7.4 years were included. Both clinical effectiveness and costs were comparable between surgical and bronchoscopic lung reduction. The incremental cost-effectiveness ratios (ICERs) for bronchoscopic compared with lung volume reduction by surgery for FEV1, RV and 6MWD were –101, 4 and 58, respectively. For RV and 6MWD, it could be shown that endobronchial valve treatment is justified as a probably cost-effective alternative to lung volume reduction by surgery. Endobronchial valve treatment resulted in an improvement of 0.25 quality-adjusted life years (QALYs) and an ICER of € 7657 per QALY gained.
CONCLUSION: A robust statement on the superiority of one of the two procedures in terms of cost-effectiveness cannot be made from the present study. Therefore, the study is not suitable for resource allocation. Two upcoming trials comparing lung volume reduction surgery and endobronchial valve treatment may be able to answer this question.</p>
