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J Public Health (Oxf). 2013 Mar;35(1):40-8. doi: 10.1093/pubmed/fds067. Epub 2012 Aug 21.

The cost-effectiveness of mandatory 20 mph zones for the prevention of injuries.

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Peninsula Technology Assessment Group, Peninsula Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, UK.



Traffic calming and speed limits are major public health strategies for further reducing road injuries, especially for vulnerable pedestrians such as children and the elderly. We conducted a cost-benefit analysis (CBA-favoured by transport economists) alongside a cost-utility analysis (CUA-favoured by health economists) of mandatory 20 mph zones, providing a unique opportunity to compare assumptions and results.


A CUA from the public sector perspective and a CBA from a broader societal perspective. One-way, threshold and probabilistic sensitivity analyses were undertaken.


In low casualty areas the intervention was not cost-effective regardless of approach (CUA: cost per QALY = £429 800; CBA: net present value = -£25 500). In high casualty areas, the intervention was cost-effective from the CBA (a saving of £90 600), but not from the CUA [cost per quality-adjusted life year (QALY) = £86 500; assuming National Institute for Health and Clinical Excellence's benchmark for approving health technologies].


Mandatory 20 mph zones may be cost-effective in high casualty areas when a CBA from a societal perspective is considered. Although CBA may appear, in principle, more appropriate, the quality, age or absence of reliable data for many parameters means that there is a great deal of uncertainty and the results should be interpreted with caution.

[Indexed for MEDLINE]

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