Integrated road-vehicle safety and well-being: a cost-utility and behavioral risk analysis of road-vehicle safety technologies

Motor-vehicle theft remains a transport-related safety concern with implications extending beyond financial loss into well-being and daily mobility. This study evaluated the effectiveness and economic value of adopting at least two advanced road-vehicle safety technologies (alarm, immobilizer, secure parking, CCTV, or wheel clamp) among private vehicle users in Israel. A cross-sectional survey of 1,004 respondents assessed perceived safety, theft-related worry, adoption of protection technologies, and incident-related harms. Utility was operationalized via three health-related quality-of-life (HRQoL) domains linked to anxiety/depression, usual activities, and pain/trauma, and mapped to annual quality-adjusted life-year (QALY)-like outcomes. Costs included preventive expenditures and modeled theft-event costs, including vehicle loss, property damage, productivity loss, administrative burden, and insurance deductibles. Propensity-score matching and inverse-probability weighting addressed non-random adoption. Cost-effectiveness outcomes, net monetary benefit (NMB), cost-effectiveness plans, and acceptability curves quantified uncertainty. Results showed no statistically significant improvement in QALY-like outcomes (ΔQALY-like = − 0.007620) and substantially higher incremental costs in the matched analysis (+3,452.107 Israeli new shekels [ILS]), indicating a dominated strategy. Cost-effectiveness probabilities remained below 1% across evaluated willingness-to-pay thresholds. Additional behavioral analyses showed that adoption was more common among respondents with higher theft-related worry, while prior victimization was associated with a numerically higher but not statistically significant adoption rate. These findings support the interpretation that uptake is shaped, at least in part, by perceived risk salience and selection into protection rather than by objective risk alone. Incorporating health-economic evaluation into transport-safety research may improve understanding of behavioral responses to vehicle-related threats and support more evidence-based prevention policies.