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

1. WHAT WE KNOW

CRICOS Provider Code: 0113B

CYCLING AND HEALTH

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

2. WHAT I PLAN TO DO

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

CRE in obesity policy

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

Significance of the research

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

THANK-YOU

QUESTIONS?

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.