The cost-effectiveness of New York City's Safe Routes to School Program.

OBJECTIVE We evaluated the cost-effectiveness of a package of roadway modifications in New York City funded under the Safe Routes to School (SRTS) program. METHODS We used a Markov model to estimate long-term impacts of SRTS on injury reduction and the associated savings in medical costs, lifelong disability, and death. Model inputs included societal costs (in 2013 US dollars) and observed spatiotemporal changes in injury rates associated with New York City's implementation of SRTS relative to control intersections. Structural changes to roadways were assumed to last 50 years before further investment is required. Therefore, costs were discounted over 50 consecutive cohorts of modified roadway users under SRTS. RESULTS SRTS was associated with an overall net societal benefit of $230 million and 2055 quality-adjusted life years gained in New York City. CONCLUSIONS SRTS reduces injuries and saves money over the long run.