CYCLING INTERVENTIONS AND COSTEFFECTIVENESS
VICKI BROWN - PHD STUDENT
SUPERVISED BY PROF ROB CARTER AND PROF MARJ MOODIE
CRICOS Provider Code: 0113B
CONTENTS
1. 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
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CYCLING AND HEALTH
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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
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WHAT IS NEEDED…..
More research into the effect of interventions,
attempting to address methodological challenges.
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METHODS FOR ESTABLISHING COSTEFFECTIVENESS
Transport appraisal
Health evaluation
Cost Benefit Analysis
(CBA)
Cost Effectiveness
Analysis (CEA)
Costs and benefits in monetary
terms
Benefits using measures that
incorporate both the quality and
quantity of life
Health – commonly limited to
accidents/injuries and
environmental effects (pollution,
emissions)
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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.
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WHO HEALTH ECONOMIC ASSESSMENT TOOL (HEAT)CYCLING
HEAT estimates the economic benefit of reduced deaths
Adult populations aged 20-64 years
Risk of death (mortality)
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2. WHAT I PLAN TO DO
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OBESITY
• Approx. 63% of Australian adults now classified as
overweight or obese
• 1 in 4 Australian children
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CRE IN OBESITY POLICY
Priority Setting
& Policy
Implementation
Policy
Impact
Monitoring
of Actions
& Outcomes
Stream 1
Stream 2
Stream 3
Stream 4
What are the
economic
credentials of (nonhealth sector) policy
options?
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How can evidenceinformed policy
development &
implementation be
enhanced and
sustained?
What are the
impacts of policies
on environments &
systems?
What progress is
being made by
public & private
sectors in Australia
& internationally?
CRE research program
Economic
Policy process Policy impacts & Monitoring for
credentials
analysis
systems changes accountability
of policy options
Policy process
Scoping & Analysis
of
Potential
Solutions
TRANSPORT-RELATED INTERVENTIONS
PhD thesis:
Economic evaluations of 5 transport-related interventions
that may have an impact on physical activity, BMI, obesity.
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SIGNIFICANCE OF THE RESEARCH
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UPDATE OF CAVILL REVIEW
Systematic review of economic evaluations of transport interventions
that include health effects related to change in physical activity.
27 new studies.
CRICOS Provider Code: 0113B
Transport interventions
“Nudge” interventions
Behavioural change
Education
and
awareness
Social
marketing
SCOPING
• Active transport to school;
• Education and social
marketing;
• Congestion pricing;
• Public transport pricing, fuel
excise;
• Provision of infrastructure.
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“Push” interventions
Structural change
Travel
planning
Infrastructure
Economic
instruments
Legislation
Prices
Subsidies
Taxes
CRE METHODOLOGY FOR ASSESSING
INTERVENTIONS
ACE 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
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ECONOMIC METHODS
1. ACE APPROACH
Cost-effectiveness analysis
(CEA)
2. COST-BENEFIT (CBA)
APPROACH
WHO HEAT (mortality only)
CRE work: methodological
challenges of CBA
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• Comparable
• High quality
• Transparent
Morbidity and
mortality
CONCLUSION
•
In-depth analysis of the potential
role and impact of transportrelated 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?
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REFERENCES
1.
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8.
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.
AustRoads, Australian Bicycle Council. National Cycling Strategy, 2011-16. Sydney: AustRoads, 2010.
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.
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.
Pucher J, Dill J, Handy S. Infrastructure, programs, and policies to increase bicycling: An international review. Preventive
medicine. 2010;50:S106-S25.
Yang L, Sahlqvist S, McMinn A, Griffin SJ, Ogilvie D. Interventions to promote cycling: systematic review. Brit Med J.
2010;341.
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
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.
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CEA
Compares 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.
CRICOS Provider Code: 0113B