Socio-economic evaluation of the cost of road unsafety in France : Estimating the human and medical costs of road traffic injuries and fatalities : New reference values

En France, en 2020, le coût de la mortalité routière officiel, présenté par l’Observatoire national interministériel de la sécurité routière (ONISR), est estimé par la Valeur de la Vie Statistique (VVS) valant 3 331 000 euros. Cette VVS est une valeur consentie ex ante par une population donnée pour éviter le décès. Le coût de la morbidité routière est quant à lui approximé en prenant 0,5% et 12,5% de cette VVS pour estimer respectivement le coût du blessé léger et du blessé grave. La VVS et les pourcentages attribués aux blessés sont issus de transferts de valeur sur des études européennes et des consensus et nécessitent par conséquent d’être révisés. L’objectif de la thèse est d’acquérir une meilleure évaluation des coûts de l’insécurité routière en France en apportant une compréhension approfondie des coûts humains et des coûts médicaux et en fournissant de nouvelles valeurs de références basées sur l’exploitation de données françaises. L’atteinte des objectifs de valorisation de l’insécurité routière présente un enjeu double de production de connaissances et d’aide à la décision pour les politiques publiques, tant pour comprendre l’impact de l’insécurité routière sur le bien-être de notre société que pour prendre des décisions de financement efficientes. Pour atteindre ces objectifs, la valeur du QALY (quality-adjusted life year) gagnée a été estimée à 203 478 euros. De plus, une étude de consentement à payer sur les préférences déclarées a été développée pour la France et a permis d’estimer la valeur du blessé grave à 830 000 euros et la Valeur de la Vie Statistique à 5 300 000 euros. Ensuite, la quantification des coûts humains des blessés hospitalisés avec l’approche DALY (disability-adjusted life year) a conduit à estimer le coût humain du blessé léger à 63 866 euros. Au total, les coûts médicaux et les coûts humains estimés atteignent 53 milliards d’euros annuels ce qui représente 1,4 fois le bilan national du coût de l’insécurité routière affiché par l’ONISR en 2020 alors que trois composantes de coût n’ont pas été pris en compte dans le calculIn France, in 2020, the official cost of road mortality, presented by the National Interministerial Observatory of Road Safety (ONISR), is estimated by the Value of Statistical Life (VSL) worth 3,331,000 euros. This VSL is a value given ex ante by a given population to avoid death. The cost of road morbidity is approximated by taking 0.5% and 12.5% of this VSL to estimate the cost of a slightly injured person and a seriously injured person respectively. The VSL and the percentages attributed to injuries are derived from value transfers from European studies and consensus and therefore need to be revised. The objective of the thesis is to acquire a better evaluation of the costs of road insecurity in France by providing an in-depth understanding of the human and medical costs and by providing new reference values based on the exploitation of French data. Achieving the objectives of valuing road insecurity presents a dual challenge of knowledge production and decision support for public policies, both to understand the impact of road insecurity on the well-being of our society and to make efficient financing decisions. To achieve these objectives, the value of the QALY (quality-adjusted life year) gained was estimated at 203,478 euros. In addition, a willingness-to-pay study on stated preferences was developed for France and allowed to estimate the value of the serious injury at 830,000 euros and the Value of Statistical Life at 5,300,000 euros. Next, the quantification of the human costs of hospitalized casualties using the DALY (disability-adjusted life year) approach led to an estimate of the human cost of a slight injury at 63,866 euros. In total, the estimated medical and human costs reach 53 billion euros per year, which represents 1.4 times the national balance sheet of the cost of road safety posted by the ONISR in 2020, even though three cost components have not been taken into account in the calculatio

Valorisation socio-économique du coût des accidents de la route en France : estimation des coûts humains et des coûts médicaux des blessés et des tués de la route : nouvelles valeurs de référence

In France, in 2020, the official cost of road mortality, presented by the National Interministerial Observatory of Road Safety (ONISR), is estimated by the Value of Statistical Life (VSL) worth 3,331,000 euros. This VSL is a value given ex ante by a given population to avoid death. The cost of road morbidity is approximated by taking 0.5% and 12.5% of this VSL to estimate the cost of a slightly injured person and a seriously injured person respectively. The VSL and the percentages attributed to injuries are derived from value transfers from European studies and consensus and therefore need to be revised. The objective of the thesis is to acquire a better evaluation of the costs of road insecurity in France by providing an in-depth understanding of the human and medical costs and by providing new reference values based on the exploitation of French data. Achieving the objectives of valuing road insecurity presents a dual challenge of knowledge production and decision support for public policies, both to understand the impact of road insecurity on the well-being of our society and to make efficient financing decisions. To achieve these objectives, the value of the QALY (quality-adjusted life year) gained was estimated at 203,478 euros. In addition, a willingness-to-pay study on stated preferences was developed for France and allowed to estimate the value of the serious injury at 830,000 euros and the Value of Statistical Life at 5,300,000 euros. Next, the quantification of the human costs of hospitalized casualties using the DALY (disability-adjusted life year) approach led to an estimate of the human cost of a slight injury at 63,866 euros. In total, the estimated medical and human costs reach 53 billion euros per year, which represents 1.4 times the national balance sheet of the cost of road safety posted by the ONISR in 2020, even though three cost components have not been taken into account in the calculationEn France, en 2020, le coût de la mortalité routière officiel, présenté par l’Observatoire national interministériel de la sécurité routière (ONISR), est estimé par la Valeur de la Vie Statistique (VVS) valant 3 331 000 euros. Cette VVS est une valeur consentie ex ante par une population donnée pour éviter le décès. Le coût de la morbidité routière est quant à lui approximé en prenant 0,5% et 12,5% de cette VVS pour estimer respectivement le coût du blessé léger et du blessé grave. La VVS et les pourcentages attribués aux blessés sont issus de transferts de valeur sur des études européennes et des consensus et nécessitent par conséquent d’être révisés. L’objectif de la thèse est d’acquérir une meilleure évaluation des coûts de l’insécurité routière en France en apportant une compréhension approfondie des coûts humains et des coûts médicaux et en fournissant de nouvelles valeurs de références basées sur l’exploitation de données françaises. L’atteinte des objectifs de valorisation de l’insécurité routière présente un enjeu double de production de connaissances et d’aide à la décision pour les politiques publiques, tant pour comprendre l’impact de l’insécurité routière sur le bien-être de notre société que pour prendre des décisions de financement efficientes. Pour atteindre ces objectifs, la valeur du QALY (quality-adjusted life year) gagnée a été estimée à 203 478 euros. De plus, une étude de consentement à payer sur les préférences déclarées a été développée pour la France et a permis d’estimer la valeur du blessé grave à 830 000 euros et la Valeur de la Vie Statistique à 5 300 000 euros. Ensuite, la quantification des coûts humains des blessés hospitalisés avec l’approche DALY (disability-adjusted life year) a conduit à estimer le coût humain du blessé léger à 63 866 euros. Au total, les coûts médicaux et les coûts humains estimés atteignent 53 milliards d’euros annuels ce qui représente 1,4 fois le bilan national du coût de l’insécurité routière affiché par l’ONISR en 2020 alors que trois composantes de coût n’ont pas été pris en compte dans le calcu

Economic valuation of preventing fatal and serious road injuries. Results of a Willingness-To-Pay study in four European countries

This paper presents the results of a stated choice study for estimating the Willingness-To-Pay of respondents in four European countries (Belgium, France, Germany and the Netherlands) to reduce the risk of fatal and serious injuries in road crashes. Respondents were confronted with hypothetical route choices that differ in respect of travel costs, travel time and crash risk. The survey was completed by 8,002 respondents, equally spread over the four participating countries and representative for each country with regards to gender, age and region. Possible biases caused by problematic choice behaviour such as inconsistent, irrational or lexicographic answers were addressed. The resulting values were estimated by means of a mixed logit model allowing to account for the panel nature of the data. The Value of a Statistical Life (VSL) was estimated at 6.2 Mill EUR, the Value of a Statistical Serious Injury (VSSI) at 950,000 EUR, and the Value of Time (VoT) at 16.1 EUR/h. Consequently, the relative value of avoiding a fatal injury is estimated to be around 7 times higher than the value of an avoided serious injury. The study revealed differences between countries with France showing values that are significantly lower than the average and Germany showing values that are significantly higher. The estimated VSL values are considerably higher than the values currently used in the four countries, but they are within the range of values found in similar stated choice studies. The results can be used as an input in a broad range of socioeconomic studies including cost-benefit analysis and assessments of socioeconomic costs of road crashes

Effect of an ICU Diary on Posttraumatic Stress Disorder Symptoms Among Patients Receiving Mechanical Ventilation

International audienc

Additional file 2: of The ICU-Diary study: prospective, multicenter comparative study of the impact of an ICU diary on the wellbeing of patients and families in French ICUs

World Health Organization Trial Registration Data Set*. (XLSX 10 kb

Additional file 3: of The ICU-Diary study: prospective, multicenter comparative study of the impact of an ICU diary on the wellbeing of patients and families in French ICUs

Participants’ centers. (DOCX 13 kb

Additional file 1: of The ICU-Diary study: prospective, multicenter comparative study of the impact of an ICU diary on the wellbeing of patients and families in French ICUs

SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related documents*. (DOC 121 kb

Enteral versus parenteral early nutrition in ventilated adults with shock : a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2)

International audienceBackgroundWhether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition.MethodsIn this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20–25 kcal/kg per day), within 24 h after intubation. Randomisation was stratified by centre using permutation blocks of variable sizes. Given that route of nutrition cannot be masked, blinding of the physicians and nurses was not feasible. Patients receiving parenteral nutrition could be switched to enteral nutrition after at least 72 h in the event of shock resolution (no vasopressor support for 24 consecutive hours and arterial lactate <2 mmol/L). The primary endpoint was mortality on day 28 after randomisation in the intention-to-treat-population. This study is registered with ClinicalTrials.gov, number NCT01802099.FindingsAfter the second interim analysis, the independent Data Safety and Monitoring Board deemed that completing patient enrolment was unlikely to significantly change the results of the trial and recommended stopping patient recruitment. Between March 22, 2013, and June 30, 2015, 2410 patients were enrolled and randomly assigned; 1202 to the enteral group and 1208 to the parenteral group. By day 28, 443 (37%) of 1202 patients in the enteral group and 422 (35%) of 1208 patients in the parenteral group had died (absolute difference estimate 2·0%; [95% CI −1·9 to 5·8]; p=0·33). Cumulative incidence of patients with ICU-acquired infections did not differ between the enteral group (173 [14%]) and the parenteral group (194 [16%]; hazard ratio [HR] 0·89 [95% CI 0·72–1·09]; p=0·25). Compared with the parenteral group, the enteral group had higher cumulative incidences of patients with vomiting (406 [34%] vs 246 [20%]; HR 1·89 [1·62–2·20]; p<0·0001), diarrhoea (432 [36%] vs 393 [33%]; 1·20 [1·05–1·37]; p=0·009), bowel ischaemia (19 [2%] vs five [<1%]; 3·84 [1·43–10·3]; p=0·007), and acute colonic pseudo-obstruction (11 [1%] vs three [<1%]; 3·7 [1·03–13·2; p=0·04).InterpretationIn critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition.FundingLa Roche-sur-Yon Departmental Hospital and French Ministry of Health.Copyright © 2017 Elsevier Ltd. All rights reserved