According to World Health Organization, about 1.24 million people die every year as a result of road traffic injuries (RTC), and it is a leading cause of death among young people aged 15–29 years (1). In highly motorized countries, RTC mostly involve car drivers, while in certain countries of Asia, majority of them include motorcycle riders (2).

In Nepal, motorbike constitutes the highest share (77.9%) of motorized vehicles (3). Motorcycles are considered to be the most dangerous form of motorized transportations, and the risk of its accidents is further heightened by poor road condition coupled with crowded roads in Kathmandu Valley. Considering its easy maneuverability and speed, victims of motorcycle crash undergo more movement and impact; thus, they sustain more severe injuries (4).

The annual costs of road traffic crashes in low- and middle-income countries are estimated to be between US$65 and $100 billion, which is more than the total annual amount received for development aid (5). The estimated annual national loss from road accidents is more than £9 million (6), and a hospital-based study from Nepal showed that a single injury case cost US$ 126.2 (7). It is estimated that road traffic crashes annually cost between 1 and 1.5% of gross national product in low-income and middle-income countries, putting significant strain on health-care budgets (8). In 2011/2012, more than 12,000 injuries and 1,863 casualties have been reported in Nepal. Of them, 35% belonged to the economically active population of 16–35 years age group, which is bound to adversely affect the economy of the family and nation (6, 9). It is worth to be noted that only those accidents involving deaths, severe injury, or unsolved disputes are reported to the police, while a fairly large number of accidents are settled at the accident site with mutual understanding of both parties, leading to under-representation of accident cases since only reported cases are reflected in national statistics (8, 10).

Its epidemic is largely influenced by choices at individual and policy levels, which suggests that this problem can be controlled, and this further prompts the need of study of road traffic accidents (RTA) from public health and economics perspective. One effective way of bringing the innovative interventions to increase road safety and hence decrease road accidents is to draw attention of governments and policy makers by providing concrete evidence on costs incurred. All the levels of society ranging from individual to societal level are affected by motor vehicle crashes in many ways. For example, all medical care costs are borne by individuals and their families, and any diversion of resources in treatment and rehabilitation are borne by the society. Significant cost is associated with lost productivity by victim and caregivers, which creates economic hardship for whole family due to loss of income coupled with other additional expenditure. A nation not only loses a productive member of the society but also more resources are used in treatment and rehabilitation of such victims. Many families are driven into poverty due to additional cost of prolonged medical care, the loss of a family breadwinner, or the requirement of extra funds to care for people with disabilities. Road crash survivors, their families, friends, and other caregivers often suffer adverse social, physical, and psychological effects that significantly reduce their quality of lives.

Studies aimed at cost estimation are still scarce in developing countries, and the ones that are done are basically crude estimates based on secondary data available from insurance agencies and from hospital bed occupancy. Primary reason for this gap is the lack of proper registry of accident victims and other necessary data needed for conducting large representative survey. There is troublesome gap in information regarding costs associated with long-term consequences of accidents such as disability, rehabilitation, long-term care, and year of life lost (YLL) due to premature deaths. These studies have further limitations such as lack of cost components and unclear methodology for cost estimation.

Hence, in order to overcome these limitations, a strong need was felt to make comprehensive cost estimation by contacting and including people with different types of injuries. Furthermore, very few studies cover the productivity loss of injured person and/or of care takers resulting in a wide discrepancy between the actual cost incurred and the estimated cost. Attempt was made to show accurate representation of the burden of RTA by calculating disability-adjusted life years (DALYs) lost, which can be taken as a reference for conducting further studies and making comparison. This study will help to guide policy makers for designing cost-effective safety measures and management by showing the most accurate economic burden associated with motorbike accidents. This study aimed to take advantage of comprehensive analysis of cost based on human capital approach that is considered to be the most effective way of cost estimation for developing countries and thereby tackle the limitations of existing literatures having a narrow coverage of the costs incurred (11, 12).

From the table, it is evident that trauma occurred between the age of 18 and 53 years with majority being in the age range of 25–40 years, i.e., young adult. Victims were predominantly males (79%), and three-fourths (75%) of respondents were Brahmins/Chhetri. Nearly half of the respondents were engaged in service (49%) followed by student accounting to 27%. Nearly one quarter of victims were found to be drinking alcohol while driving (21%), and road condition was the most commonly reported reasons for accidents (41%) followed by carelessness (21%) (Table 1).

This study examined different types of costs incurred by person and their families involved in motorbike accidents. In consistent to other studies, in this study too, majority of people of productive age group were involved in road traffic crashes. This predominance is evident in studies conducted in other countries of the world as well (8). Males outnumbered females with the proportion of male casualties reaching as high as 80%, and it reflects the reality that if current trend continues, more adult young men in economically productive group will continue to die or get injured as a result of accident, thus reducing productivity. It can have enormous negative economic consequences to the families and nation as a whole. This finding is in accordance with global findings as well as findings from several countries (4, 8, 18). Furthermore, it can be hypothesized that males are more involved in risk-taking behavior such as alcohol consumption, mobile in nature, and engage in outdoor activities more than their female counterparts resulting in heightened risk of accidents. These findings are similar to other studies (9, 19, 20), which showed involvement of alcohol in 20–25% of cases. As a study by Michael Kudebong, a large chunk of accident victims were students suggesting that preventive interventions need to be targeted in young adult males (4). Several causes of accidents identified in this study go in agreement with findings given in paper by Thapa (6, 10), where negligence of the driver stood as the primary cause, followed by high speed and overtaking. It stresses the persistence of negligence and violation of traffic rules by drivers and pedestrians and dire need of strict investigation, law enforcement, awareness program, and punishment in case of any violation.

Mortality from RTA constitute about 25–40% of total deaths in developed countries and 10–30% in developing countries (8, 21). Though fatalities in motorbike accidents are high in this study, the results cannot be directly compared with other findings as it includes fatalities due to all types of accidents.

Similar to our findings, hospital-based studies from Nepal showed fracture as the most common injuries sustained during accidents followed by muscle injuries (7, 22). This study showed large variation in costs as reported in the previous national and international studies. However, it confirms the significant financial burden to victims, family, and community. The conservative cost of road traffic crashes was high, and in case of survival of the victim, direct costs occupy the biggest chunk of TCs accounting to almost 86% which was in agreement with the study done in Barcelona (23). However, ICs in terms of productivity loss outweigh direct costs in the case of disabilities and treatment, highlighting its huge long-term impact on economic welfare of nation. Furthermore, as this study was based on recall, people might have forgotten the costs they have paid in hospitals resulting lower estimation. Another probable explanation for these variations in costs may be difference in health-care delivery systems, insurance pattern, service costs, driving culture, and many other factors across countries.

Economic cost calculated for motorbike accidents are just the tip of iceberg of total individual killed, crashed or disabled by motorbike accidents, and there is higher cost associated with the expenses of prolonged medical care, loss of family breadwinner, or the added burden of caring for the disabled. Consistent to our study, a study done by Miller et al. showed that total medical costs account for 6% of TCs of motorcycle injuries, of which 29% is due to work loss (24).

This study is limited to small sample size due to communication and financial constraints and lack of proper recording mechanism. Despite its small sample size, it is the first study of its kind in our setting and provides useful information regarding economic burden, which can be used as a reference for conducting further researches and program designing. Even though productivity loss accounts for huge burden to victims, families, and society, it is unrecognizable yet. This study attempts to show the economic burden by including these indirect losses also and hence highlight the appropriate recognition and awareness of a whole society to traffic safety aspect. The cost estimation in this study is of minimum value as some of the cost elements have not been included due to the lack of information, and it does not include intangible cost such as pain grief, suffering, household work loss, and travel time loss due to accidents. Use of non-random sampling might have introduced selection bias, and attempt was made to select respondents as randomly as possible.

It is recommended to conduct national costing of road accidents immediately to address emerging problem of accidents, its associated consequences, and worsening situation of road safety. There is a strong need of adopting effective policy interventions for reducing the number of motorbike accidents for the improvement of overall community’s health status through reduction of life years lost and years living with disabilities. Strict enforcement of policy-related motorcycle-safety measures such as regular helmet use and driving license will contribute a lot to reduce motorbike accidents. Furthermore, it will reduce imposed costs on the health system and country’s economies as study showed that accident impose a high financial burden, directly and/or indirectly. Findings suggest that burden of RTC can be catastrophic for families because of high direct costs, significant absent days from work or schools for patients as well as caregivers, and impact on health-related quality of life. The importance of the problem warrants further interventions to reduce motorbike crashes.

This study concluded the persistence of RTC as significant public health problem from economic lens. Costs of motorbike crashes are very high both in terms of epidemiological and economic aspects. All components of cost were significantly high with direct costs constituting largest proportion in case of serious injuries and IC in case of fatal injuries. The increasing burden of motorbike accidents and large amount of economic cost associated with it calls for considering appropriate research and effective interventions. Relatively high loss of healthy life from accidents needs to be addressed by public health systems in Kathmandu. There should be strict enforcement of law regarding regular helmet use, issuing driver’s license, and regular mass education on high economic burden of motorbike crashes. Record mechanism in traffic police and hospital sections need to be strengthened with inclusion of all the details of accident.

DS and SA were involved in conception and design of the study. DS was involved in tool preparation. DS, BB, and SA edited and finalized the tools. DS and BB were involved in data acquisition and in analysis and interpretation. All the authors participated in report writing and providing intellectual input. DS and SA prepared the draft that was critically reviewed and approved by all the authors. The manuscript has been read and approved by all the authors, and the requirement for authorship was fulfilled by all authors.

The authors declare non-existence of financial relationships with any entities that could influence the submitted work. There is no competing interest.