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Cycling interventions and cost-effectiveness Vicki B rown - PHD student

Cycling interventions and cost-effectiveness Vicki B rown - PHD student Supervised by Prof R ob C arter and Prof M arj M oodie. CONTENTS. 1. What we know: Cycling and health Effectiveness and cost-effectiveness 2. What I am planning to do:

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Cycling interventions and cost-effectiveness Vicki B rown - PHD student

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  1. Cycling interventions and cost-effectiveness Vicki Brown - PHD student Supervised by Prof Rob Carter and Prof Marj Moodie

  2. 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.

  3. 1. WHAT WE KNOW

  4. CYCLING AND HEALTH

  5. 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 *Disclaimer

  6. WHAT IS NEEDED….. More research into the effect of interventions, attempting to address methodological challenges.

  7. 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

  8. 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.

  9. 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)

  10. 2. WHAT I PLAN TO DO

  11. OBESITY • Approx. 63% of Australian adults now classified as overweight or obese • 1 in 4 Australian children

  12. CRE in obesity policy

  13. TRANSPORT-RELATED INTERVENTIONS PhD thesis: Economic evaluations of 5 transport-related interventions that may have an impact on physical activity, BMI, obesity.

  14. Significance of the research

  15. 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.

  16. Transport interventions “Nudge” interventions Behavioural change “Push” interventions Structural change Infrastructure Education and awareness Social marketing Travel planning Economic instruments Legislation • SCOPING • Active transport to school; • Education and social marketing; • Congestion pricing; • Public transport pricing, fuel excise; • Provision of infrastructure. Prices Subsidies Taxes

  17. 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

  18. Economic methods Economic methods 1. ACE APPROACH Cost-effectiveness analysis (CEA) • Comparable • High quality • Transparent • Morbidity and mortality 2. COST-BENEFIT (CBA) APPROACH WHO HEAT (mortality only) CRE work: methodological challenges of CBA

  19. 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.

  20. THANK-YOU QUESTIONS?

  21. REFERENCES • 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.

  22. 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.

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