Risks and Advantages of Detecting Individuals Unfit to Drive: A Markov Decision Analysis

This article reports on a study undertaken to measure the potential effectiveness of a screening program to detect individuals unfit to drive. The authors note that many countries have initiated legislation to detect individuals who are unfit to drive, without any evidence that the positive effects of these screening procedures outweigh their negative effects. The study utilized hypothetical cohorts of 10,000 45-year-old, 65-year-old, 75-year-old and 85-year-old individuals seen in primary care practices. The intervention measures would include a clinical test without on-road confirmatory testing; a clinical test with on-road confirmatory testing, and an imposed driving cessation for patients with a positive test. For each intervention measure, the study compared for two conditions (sleep disorders and dementia) the numbers of crash-related consequences prevented and of adverse events induced (primary objective) and also measured the gain in quality-adjusted life years (secondary objective). The results showed that, for sleep disorders, the on-road confirmatory annual testing was the preferred strategy. Regardless of the medical condition and age when screening starts, the condition of "no screening" was always better than single-test screening without an on-road confirmatory testing. The authors conclude that, because of the anticipated difficulties in the application and cost of road tests and annual screening by clinicians, the most acceptable strategy from public health, clinical, and individual points of view is likely to be no screening.

  • Availability:
  • Authors:
    • Leproust, Sandy
    • Lagarde, Emmanuel
    • Salmi, Louis Rachid
  • Publication Date: 2008-11


  • English

Media Info

  • Media Type: Print
  • Pagination: pp 1525-1497
  • Serial:

Subject/Index Terms

Filing Info

  • Accession Number: 01150381
  • Record Type: Publication
  • Files: TRIS
  • Created Date: Feb 9 2010 11:14AM