Background Road traffic injuries account for the major proportion of injury and economic burden globally. However, motorcyclists are the most vulnerable group to sustain fatal and non-fatal injuries. The use of helmet is one of most acknowledged protective measure. However cost-saving ability of helmet use is inconsistent in the literature.

Aim To estimate the difference in the healthcare cost of motorcycle crash in those who were wearing helmet and those who were not wearing helmet in Karachi, Pakistan.

Methodology We conducted a cross-sectional study by using micro-costing method and out-of-pocket expenditure data collection for healthcare cost estimation in a public tertiary hospital of Karachi, Pakistan. We included 18 year and above victims of motorcycle crash both riders and pillions through consecutive sampling from the emergency department and grouped them in to helmeted and non-helmeted. Cost differences were compared using t-test.

Result We recruited 323 participants, 127 (39%) were wearing helmet, while, 93 (60%) were not wearing helmet at the time of crash. The helmeted group had 18% head injuries as compared to 46% in the non-helmeted. Helmeted group incurred a total healthcare cost of PKR.15855, whereas, non-helmeted victims had a median healthcare cost of PKR.91229. Furthermore, the out-of-pocket (OOP) is lower in in the helmeted group (PKR.1250) compared to the counterpart (PKR.16800).

Conclusion We conclude that there are substantial cost implications of not wearing helmet and the traffic and road safety authorities should make sure that all motorcycle users including riders and pillions wear helmet not for their safety but also as a cost-saving approach to reduce burden on healthcare system.