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  • Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study

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    Author(s)
    Veerman, J Lennert
    Zapata-Diomedi, Belen
    Gunn, Lucy
    McCormack, Gavin R
    Cobiac, Linda J
    Herrera, Ana Maria Mantilla
    Giles-Corti, Billie
    Shiell, Alan
    Griffith University Author(s)
    Veerman, Lennert L.
    Zapata Diomedi, Belen
    Cobiac, Linda
    Year published
    2016
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    Abstract
    Background: Studies consistently find that supportive neighbourhood built environments increase physical activity by encouraging walking and cycling. However, evidence on the cost-effectiveness of investing in built environment interventions as a means of promoting physical activity is lacking. In this study, we assess the cost-effectiveness of increasing sidewalk availability as one means of encouraging walking. Methods: Using data from the RESIDE study in Perth, Australia, we modelled the cost impact and change in health-adjusted life years (HALYs) of installing additional sidewalks in established neighbourhoods. Estimates ...
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    Background: Studies consistently find that supportive neighbourhood built environments increase physical activity by encouraging walking and cycling. However, evidence on the cost-effectiveness of investing in built environment interventions as a means of promoting physical activity is lacking. In this study, we assess the cost-effectiveness of increasing sidewalk availability as one means of encouraging walking. Methods: Using data from the RESIDE study in Perth, Australia, we modelled the cost impact and change in health-adjusted life years (HALYs) of installing additional sidewalks in established neighbourhoods. Estimates of the relationship between sidewalk availability and walking were taken from a previous study. Multistate life table models were used to estimate HALYs associated with changes in walking frequency and duration. Sensitivity analyses were used to explore the impact of variations in population density, discount rates, sidewalk costs and the inclusion of unrelated healthcare costs in added life years. Results: Installing and maintaining an additional 10 km of sidewalk in an average neighbourhood with 19 000 adult residents was estimated to cost A$4.2 million over 30 years and gain 24 HALYs over the lifetime of an average neighbourhood adult resident population. The incremental cost-effectiveness ratio was A$176 000/HALY. However, sensitivity results indicated that increasing population densities improves cost-effectiveness. Conclusions: In low-density cities such as in Australia, installing sidewalks in established neighbourhoods as a single intervention is unlikely to cost-effectively improve health. Sidewalks must be considered alongside other complementary elements of walkability, such as density, land use mix and street connectivity. Population density is particularly important because at higher densities, more residents are exposed and this improves the cost-effectiveness. Health gain is one of many benefits of enhancing neighbourhood walkability and future studies might consider a more comprehensive assessment of its social value (eg, social cohesion, safety and air quality).
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    Journal Title
    BMJ Open
    Volume
    6
    Issue
    9
    DOI
    https://doi.org/10.1136/bmjopen-2016-011617
    Copyright Statement
    © The Author(s) 2017.This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
    Subject
    Clinical sciences
    Health services and systems
    Public health
    Other health sciences
    Health economics
    Biomedical and clinical sciences
    Health sciences
    Psychology
    Publication URI
    http://hdl.handle.net/10072/373704
    Collection
    • Journal articles

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