CRICOS Provider Code: 0113B
Cycling interventions and cost-effectiveness
Vicki Brown - PHD student
Supervised by Prof Rob Carter and Prof Marj Moodie
CRICOS Provider Code: 0113B
CONTENTS1. What we know:– Cycling and health– Effectiveness and cost-effectiveness
2. What I am planning to do:–Incorporating health effects related to change in physical activity into transport appraisal.
CRICOS Provider Code: 0113B
Limited RIGOROUS evidence EXISTS on THE effect of cycling interventions
Methodological challenges include:– Controlled studies difficult, not feasible– Time periods to observe changes can be long, study time frames often short– Data issues– Other factors influence modal choice
CRICOS Provider Code: 0113B
WHAT IS NEEDED…..
More research into the effect of interventions, attempting to address methodological
challenges.
CRICOS Provider Code: 0113B
METHODS FOR ESTABLISHING COST-EFFECTIVENESS
Transport appraisal
Cost Benefit Analysis (CBA)
Costs and benefits in monetary terms
Health – commonly limited to accidents/injuries and
environmental effects (pollution, emissions)
Health evaluation
Cost Effectiveness Analysis (CEA)
Benefits using measures that incorporate both the quality and quantity of life
CRICOS Provider Code: 0113B
CAVILL ET AL REVIEW
Systematic review: economic evaluations of transport infrastructure
and policies incorporating health effects related to physical activity.
Interventions mostly cost-effective - some cost-saving.
CRICOS Provider Code: 0113B
WHO HEALTH ECONOMIC ASSESSMENT TOOL (HEAT)- CYCLING
HEAT estimates the economic benefit of reduced deaths
Adult populations aged 20-64 yearsRisk of death (mortality)
CRICOS Provider Code: 0113B
OBESITY• Approx. 63% of Australian adults
now classified as overweight or obese
• 1 in 4 Australian children
CRICOS Provider Code: 0113B
TRANSPORT-RELATED INTERVENTIONS
PhD thesis: Economic evaluations of 5 transport-related interventions that may have an impact on physical activity, BMI, obesity.
CRICOS Provider Code: 0113B
UPDATE OF CAVILL REVIEWSystematic review of economic
evaluations of transport interventions that include health effects related to
change in physical activity.
27 new studies.
CRICOS Provider Code: 0113B
“Nudge” interventionsBehavioural change
“Push” interventionsStructural change
Education and
awareness
Social marketin
g
Travel plannin
g
Economic instrument
s Legislation
Infrastructure
Prices
Taxes
Subsidies
Transport interventions
SCOPING•Active transport to school;•Education and social marketing;•Congestion pricing;•Public transport pricing, fuel excise;•Provision of infrastructure.
CRICOS Provider Code: 0113B
Cre Methodology for assessing interventionsACE approach, as utilised in ACE-Obesity and ACE-Prevention projects.
Key characteristics:
•Standardised evaluation protocol.
•Scoping papers to assess potential interventions for modelling
•Technical Advisory Panels (TAPs) and expert guidance to provide advice and recommendations
•Other factors
CRICOS Provider Code: 0113B
Economic methodsEconomic methods• Comparable• High quality • Transparent
Morbidity and mortality
1. ACE APPROACH
Cost-effectiveness analysis (CEA)
2. COST-BENEFIT (CBA) APPROACH
WHO HEAT (mortality only)
CRE work: methodological challenges of CBA
CRICOS Provider Code: 0113B
CONCLUSION• In-depth analysis of the potential
role and impact of transport-related interventions on obesity prevention.
• Contribution to the body of evidence on the physical activity related health effects of transport.
• Another step towards routine inclusion of physical activity related health benefits into transport appraisal.
CRICOS Provider Code: 0113B
REFERENCES1. Australian Government Department of Infrastructure and Transport.
Walking, Riding and Access to Public Transport: Supporting active travel in Australian communities. Canberra: Aust Government . Department of Infrastructure and Transport, 2013.
2. AustRoads, Australian Bicycle Council. National Cycling Strategy, 2011-16. Sydney: AustRoads, 2010.
3. Andersen LB, Schnohr P, Schroll M, Hein HO. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Archives of internal medicine. 2000;160(11):1621-8.
4. Ogilvie D, Egan M, Hamilton V, Petticrew M. Promoting walking and cycling as an alternative to using cars: systematic review. Brit Med J. 2004;329(7469):763-6B.
5. Pucher J, Dill J, Handy S. Infrastructure, programs, and policies to increase bicycling: An international review. Preventive medicine. 2010;50:S106-S25.
6. Yang L, Sahlqvist S, McMinn A, Griffin SJ, Ogilvie D. Interventions to promote cycling: systematic review. Brit Med J. 2010;341.
7. Cavill N, Kahlmeier S, Rutter H, Racioppi F, Oja P. Economic analyses of transport infrastructure and policies including health effects related to cycling and walking: a systematic review. Transport Policy. 2008;15(5):291-304
8. World Health Organisation. Development of the health economic assessment tools (HEAT) for walking and cycling, Meeting report of the consensus workshop in Bonn, Germany, 1-2 October 2013. Copenhagen, Denmark: WHO Regional Office for Europe, 2014.
CRICOS Provider Code: 0113B
ceaCompares costs and outcomes like CBA, but difficulties with monetising health effects so uses utility based measures:•QALY – measure of disease burden including both quantity and quality of life; Perfect health=1, death=0.•DALY – measure of disease burden, no. years lost to disability, death.