This study showed that the P.A.R.T.Y. injury education program involving real-life trauma scenarios was cost-effective intervention in reducing subsequent risk of committing violence or traffic-related offences, injuries, and death for juvenile justice offenders. This result is significant and requires careful consideration.
First, a recent Access Economic report on economics of road trauma showed that the average cost of a person hospitalized due to motor vehicle accident was much higher than the figure we used in this cost-effectiveness analysis ($22,217 vs. $4706) if we included all private and public costs such as rehabilitation, occupational therapy, and home services . Furthemore, the cost of loss in productivity due to injuries and costs related to damage to vehicles and infrastructure, police time, potential legal implications have also not been considered in this economic analysis. As such, if we change our economic analysis from a health service perspective to a societal perspective, the P.A.R.T.Y. education program would be even more cost-effective. Second, the cost-effectiveness of this program compared favorably with some widely accepted preventive programs such as screening for breast cancer - evaluated at $24,000 per life year gained  - and also life-saving medical interventions for patients with major trauma [18, 19].
Third, this small pilot program is not operating at its capacity and many more juvenile justice offenders can be potentially be accommodated. Currently only two hospitals in Australia, Royal Perth Hospital in Western Australia and Alfred Hospital in Victoria, are offering this education program to juvenile justice offenders. It is thus possible to improve the overall health and health-cost benefit of this program if the program is implemented in other states of Australia and other parts of the world. Fourth, a prospective study on the effectiveness of this education program on a large cohort of high-school students is underway in this study centre. Whether this education program is equally cost-effective for young people without prior offences in Australia remains uncertian. If the program is also proved to be useful in reducing serious injuries among the high school student participants, for example achieving a relative risk reduction of 30%, a reduction in up to 4 and 2 motor vehicle accident deaths per 100,000 population for males and females respectively, 600 hospitalizations, and $510 million health care cost each year in Western Australia alone is possible [2, 6, 20]. In addition, this education program may potentially change the lives of many young Australians and their families who would otherwise be seriously affected by traffic-related serious injuries.
The final consideration is the limitations of this study. First, although selection bias was not apparent when we analyzed the effectiveness of this education program , due to the design of the study, hidden or unmeasured selection biases might have, at least in part, contributed to the substantial beneficial effect of this education program and hence the cost-effectiveness of the program. Second, the follow-up period of this study was relatively short (median 33 months). It is possible that by empowering our participants to protecting themselves through the risky period for life-threatening injuries will alter their attitudes towards risk-taking behaviour for the rest of their lives. Whether the benefits of this education program will last for the life-time of the participants remains, however, uncertain and this will affect the results of the cost per life year gained analysis. Third, costs were likely to be overestimated in relation to outcomes because costs were estimated for the entire period, which did not allow for follow-up in outcomes for attendees who attended the program at a later period of the study. As such, a follow-up study on the same cohort of study subjects in a few years time would be warranted to confirm the long-term health and economic benefits of the program. Finally, there are many approaches to promote injury awareness in reducing risk of injuries but the cost-effectiveness of these programs remains uncertain [9, 10]. Whether this P.A.R.T.Y. injury awareness program is more cost-effective than other programs or whether they may have synergistic effect on risk of injuries remains uncertain, but this merits further investigation.
In summary, the P.A.R.T.Y. injury education program involving real-life trauma scenarios was cost-effective in reducing subsequent risk of committing violence or traffic-related offences, injuries, and death for juvenile justice offenders in Western Australia. Our results may be useful for policy decision-makers to decide whether this education program should be widely implemented as part of the rehabiliation program for junvenile justice offenders.