What Is the Best Practice Method for Quantifying the Health and Economic Benefits of Active Transport?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Systematic Review
2.2. Search Strategy and Databases Included
2.3. Inclusion Criteria, Data Extraction and Quality Appraisal
- 1.
- Be published in English between 1 January 2000 and April 2019.
- 2.
- Be in the public domain, either as academic papers in peer reviewed journals or studies from the “grey” literature such as government reports and commissioned documents.
- 3.
- Be a primary study. Reviews and commentaries were excluded.
- 4a.
- Present a model that can be used for economic evaluation of active transport. Applications of already established models were not included unless they represented an extension of the method.
- 4b.
- Reproducible in a different setting.
- 5.
- Study conducted for the Australian context, or that of other high-income countries.
- 6.
- All age groups were considered.
2.4. Quality Assessment/Rating of Method
3. Results
3.1. Literature Review
3.2. Characteristics of Studies Included
3.2.1. Statistical Models
3.2.2. Exposures and Health Outcomes
3.2.3. Outcome Measures
3.2.4. Economic Evaluation
3.2.5. Costing Health Benefits
3.2.6. Discounting
3.2.7. Modelling of Subgroups and Active Transport Modes
3.3. Assessment of Studies
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Category | Characteristics from Stakeholder Consultation | Criteria for Evaluation |
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Types of active transport |
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Statistical model |
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Exposures relevant to active transport |
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Health outcomes |
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Outcome measures |
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Author, Date | Country | Type of Active Transport | Statistical Model | Exposures Considered | Physical Activity Outcome Measures | Injury Outcome Measures | Air pollution Outcome Measures | Summary Outcome Measures | Discounting | Evaluation Method |
---|---|---|---|---|---|---|---|---|---|---|
Brey et al., 2016 | Spain | Cycling | BoD * | Physical activity and injury | All-cause mortality | Bike and car accidents | N/A | Avoided deaths and monetary value of avoided deaths applying value of statistical life year, cost of road transport injury | 5% | CBA * |
Brown et al., 2017 | Australia | Walking and cycling | Multi state lifetable model | Physical activity and injury | Incidence of nine obesity-related diseases modelled via effect on BMI. Ischaemic heart disease, hypertensive heart disease, ischaemic stroke, diabetes, colorectal cancer, kidney cancer, breast cancer, endometrial cancer and osteoarthritis) | Mode-specific fatalities and serious injuries | N/A | YLD (for injury only), HALY and healthcare costs | 3% | CBA * |
Buekers et al., 2015 | Belgium | Walking and cycling | BoD * | Air pollution, road transport injury, physical activity | Incidence: IHD, dementia, type2 diabetes, depression, colon cancer, breast cancer. Mortality: all-cause mortality (mortality risk delayed in time), Morbidity, Morbidity costs (including treatment costs and productivity costs) | Crash risk for cycling and walking, relatively to car driving from local data | All-cause mortality due to air pollution (YLL) | DALY *, external costs, cost per km, cost benefit (YLL * x VSLY *) | No | CBA * |
Cobiac et al., 2009 | Australia | Any physical activity | Multi state lifetable model | Physical activity | Ischaemic heart disease, ischaemic stroke, type 2 diabetes, breast cancer and colon cancer. Morbidity and mortality | N/A | N/A | DALY * & QALY * | 3% | CUA * |
Doorley et al., 2017 | Ireland | Cycling | BoD * | Physical activity, air pollution (PM2.5 *), road transport injury | Cardiovascular disease, breast cancer, colon cancer, dementia, depression and type II diabetes | Morbidity and mortality from road transport injury | Respiratory diseases, cardiovascular diseases and lung cancer. Since cardiovascular disease risk is influenced by both physical activity and pollution exposure, the impacts of the two exposures were modelled multiplicatively | YLL *, YLD *, DALY * | No | HIA * |
Genter et al., 2009 | New Zealand | Walking and cycling | BoD * | Physical activity | All-cause mortality, colon, lung, breast and all cancer, CVD, type 2 diabetes (mortality), depression (incidence) | N/A | N/A | Cost benefit per km of active transport (VSL x mortality) | No | CBA * |
Gu et al., 2016 | New York, USA | Cycling | Markov model | Physical activity, air pollution (PM2.5 *), road transport injury | LE * gain from physical activity considered in total cost output | QALYs * from injury considered in output | LE * gain/decrease from air pollution considered in total model | QALY *, cost per QALY * | 3% | CEA * |
Holm 2012 | Copenhagen, Denmark | Cycling | BoD * | Physical activity, air pollution, road transport injury | YLL * and YLD * ischaemic heart disease, ischaemic stroke, type II diabetes, breast cancer, colon cancer | YLL * and YLD * injuries | YLL * and YLD * cardiopulmonary diseases, lung cancer | DALY * | No | HIA * |
Johansson et al., 2017 | Stockholm, Sweden | Cycling | BoD * | Air pollution | N/A | N/A. | LE * gained due to decreased mortality | Years of life gained | No | HIA * |
Kahlmeier et al., 2017 | Non-specific | Walking and cycling | BoD * | Physical activity, air pollution (PM2.5 *), road transport injury | All-cause mortality | All-cause mortality | All-cause mortality | Mortality and cost calculated per VSLY | 5% | CBA * |
Li et al., 2014 | USA | Cycling | BoD * | Physical activity | All-cause mortality and health care costs | N/A | N/A | Reduced healthcare costs, reduced mortality cost (calculated by assigning VSLY * to reduced mortality), reduced accident cost | 5% | CBA * |
Macmillan et al., 2014 | New Zealand | Cycling | System dynamics model | Physical activity, air pollution, road transport injury | All-cause mortality | Serious injury and deaths caused by a collision with a light vehicle. | Deaths, cardiovascular and respiratory, carbon monoxide, COPD * hospitalizations and restricted activity days due to PM10 *, cancer incidence due to benzene | Deaths, hospitalisations, restricted activity days, monetary values (net benefit, cost benefit) | No | CEA * |
Mueller et al., 2017 | Spain | Physical activity | BoD * | Physical activity, air pollution, road transport injury | Physical activity all-cause mortality for YLL * and YLD *—cardiovascular disease (CVD *), stroke, type 2 diabetes, colon cancer, breast cancer and dementia. | Road transport Traffic incidents with injuries (fatal or non-fatal) | Air pollution, all-cause mortality, cardiovascular disease (CVD *), stroke, type 2 diabetes, respiratory hospital admissions, preterm birth, low birth weight. | YLL *, YLD *, DALY * | No | HIA * |
Rojas-Rueda et al., 2013 | Spain | Cycling | BoD * | Physical activity, air pollution, road transport injury | Physical activity: cardiovascular disease, type 2 diabetes, breast cancer, colon cancer, dementia | Road traffic incidents: minor and major injuries | Air pollution: CVD *, cerebrovascular disease, lower respiratory tract infection, low birth weight and preterm birth | Morbidity and DALY * | No | HIA * |
Saelensminde 2004 | Norway | Walking and cycling | Other-cost savings per new active traveller | Physical activity | The four types of diseases are cancer (five different types), high blood pressure, type 2 diabetes and musculoskeletal ailments. | N/A | N/A | Cost | 3% and 8% | CBA * |
Stokes et al., 2007 | US | Walking | Other cost saving by applying cost of obesity from other study | Physical activity | Obesity and obesity related costs | N/A | N/A | Cost | No | CBA * |
Taddei et al., 2014 | Italy | Cycling | BoD * | Physical activity, road transport injury | All-cause mortality, incidence type 2 diabetes, AMI *, heart failure, stroke | Road traffic accidents and fatalities by mode of transport | N/A | Incidence, mortality, treatment cost and cost | 5% | CEA * |
Woodcock, et al., 2013 | UK | Physical activity | BoD * | Physical activity, air pollution, road transport injury | CVD *, colon cancer, breast cancer, diabetes, dementia, depression, all-cause mortality | Road transport injury | Cardio-respiratory diseases, lung cancer, acute respiratory infections | DALY * | No | HIA * |
Zapata-Diomedi et al., 2017 | Australia | Walking and cycling | Multi state lifetable model | Physical activity, air pollution, road transport injury | Breast cancer, colon cancer, ischemic Stroke, ischemic heart disease, type 2 diabetes | Road transport injury | Ischemic stroke, ischemic heart disease, tracheal, bronchus and lung cancer, COPD * | Health care costs, life years, HALYs *, prevalent cases, deaths, YLD * | No | CBA * |
Zheng et al., 2010 | Australia | Walking | BoD * | Physical activity | CHD * | N/A | N/A | Health care cost saving | No | CBA * |
Criteria | Brey et al., 2016 | Brown et al., 2017 | Buekers et al., 2015 | Cobiac et al., 2009 | Doorley et al., 2017 | Genter et al., 2009 | Gu et al., 2016 | Holm 2012 | Kahlmeier et al., 2017 | Macmillan et al., 2014 | Mueller et al., 2017 | Rojas-Rueda et al., 2013 | Taddei et al., 2014 | Woodcock et al., 2013 | Zapata-Diomedi et al., 2017 | Zheng et al., 2010 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Active Transport Modes | ||||||||||||||||
Different forms of active transport (minimum cycling and walking) | No | Yes | Yes | Yes | Yes | Yes | No | No | Yes | No | Yes | Yes | No | Yes | Yes | No |
Duration and intensity of active transport | No | Yes | No | Yes | Yes | No | Yes | No | Yes | Yes | Yes | Yes | No | Yes | Yes | No |
Exposures Relevant to Active Transport | ||||||||||||||||
Physical activity | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Air pollution | No | No | Yes | No | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | No |
Injury | Yes | Yes | Yes | No | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No |
Statistical Model | ||||||||||||||||
States input parameter and assumptions | No | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Analysis by population subgroups | Yes * | Yes * | Yes * | Yes * | Yes * | No | Yes * | Yes * | Yes * | Yes * | Yes * | Yes * | Yes * | Yes * | Yes * | No |
Dynamic model | No | Yes | No | Yes | No | No | Yes | No | No | Yes | No | No | No | No | Yes | No |
Models at fine grained level | No | Yes | No | Yes | Yes | No | Yes | Yes | No | Yes | Yes | No | No | Yes | Yes | No |
Heath Outcomes (Minimum Included) # | ||||||||||||||||
Physical activity | No | Obesity related outcomes | Yes | Yes | Yes | Yes | No | Yes | No | No | Yes | Yes | Yes | Yes | Yes | No |
Air pollution | No | No | No | No | Yes | No | No) | No | No | Yes | Yes | Yes | No | Yes | Yes | No |
Injury | Yes | Yes | Yes | No | Yes | No | No | Yes | No | Yes | Yes | Yes | Yes | Yes | Yes | No |
Outcome Measures | ||||||||||||||||
Morbidity | No | No | No | No | No | No | No | No | No | Yes | No | Yes | Yes | No | Yes | Yes |
Mortality | Yes | Yes | No | No | No | No | Yes | No | Yes | Yes | No | No | Yes | No | Yes | No |
YLD | No | Yes | Yes | Yes | Yes | No | No | Yes | No | No | Yes | Yes | No | Yes | Yes | No |
YLL | No | No | Yes | Yes | Yes | No | No | Yes | No | No | Yes | Yes | No | Yes | Yes | No |
Summary measure of population health | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | No | Yes | Yes | No | Yes | Yes | No |
Health care costs | Yes | Yes | No | No | No | Yes | No | No | No | No | No | No | No | No | Yes | Yes |
Productivity | No | No | No | No | No | No | No | No | No | No | No | No | Yes | No | Yes (Later Model) | |
Monetisation | Yes | Yes | Yes | No | No | Yes | Yes | No | Yes | Yes | No | No | No | No | Yes | Yes |
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Share and Cite
Möller, H.; Haigh, F.; Hayek, R.; Veerman, L. What Is the Best Practice Method for Quantifying the Health and Economic Benefits of Active Transport? Int. J. Environ. Res. Public Health 2020, 17, 6186. https://doi.org/10.3390/ijerph17176186
Möller H, Haigh F, Hayek R, Veerman L. What Is the Best Practice Method for Quantifying the Health and Economic Benefits of Active Transport? International Journal of Environmental Research and Public Health. 2020; 17(17):6186. https://doi.org/10.3390/ijerph17176186
Chicago/Turabian StyleMöller, Holger, Fiona Haigh, Rema Hayek, and Lennert Veerman. 2020. "What Is the Best Practice Method for Quantifying the Health and Economic Benefits of Active Transport?" International Journal of Environmental Research and Public Health 17, no. 17: 6186. https://doi.org/10.3390/ijerph17176186