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Health economic assessment of a scenario to promote bicycling as active transport in Stockholm, Sweden
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.ORCID-id: 0000-0002-1633-2179
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.ORCID-id: 0000-0002-0159-6657
Visa övriga samt affilieringar
2019 (Engelska)Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 9, nr 9, artikel-id e030466Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVES: To conduct a health economic evaluation of a proposed investment in urban bicycle infrastructure in Stockholm County, Sweden.

DESIGN: A cost-effectiveness analysis is undertaken from a healthcare perspective. Investment costs over a 50-year life cycle are offset by averted healthcare costs and compared with estimated long-term impacts on morbidity, quantified in disability-adjusted life years (DALYs). The results are re-calculated under different assumptions to model the effects of uncertainty.

SETTING: The Municipality of Stockholm (population 2.27 million) committed funds for bicycle path infrastructure with the aim of achieving a 15% increase in the number of bicycle commuters by 2030. This work is based on a previously constructed scenario, in which individual registry data on home and work address and a transport model allocation to different modes of transport identified 111 487 individuals with the physical capacity to bicycle to work within 30 min but that currently drive a car to work.

RESULTS: Morbidity impacts and healthcare costs attributed to increased physical activity, change in air pollution exposure and accident risk are quantified under the scenario. The largest reduction in healthcare costs is attributed to increased physical activity and the second largest to reduced air pollution exposure among the population of Greater Stockholm. The expected net benefit from the investment is 8.7% of the 2017 Stockholm County healthcare budget, and 3.7% after discounting. The economic evaluation estimates that the intervention is cost-effective and each DALY averted gives a surplus of €9933. The results remained robust under varied assumptions pertaining to reduced numbers of additional bicycle commuters.

CONCLUSION: Investing in urban infrastructure to increase bicycling as active transport is cost-effective from a healthcare sector perspective.

Ort, förlag, år, upplaga, sidor
BMJ Publishing Group Ltd, 2019. Vol. 9, nr 9, artikel-id e030466
Nyckelord [en]
DALY, commuting, health economic evaluation, health impacts, transport mode shift
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
URN: urn:nbn:se:umu:diva-163491DOI: 10.1136/bmjopen-2019-030466ISI: 000497787600283PubMedID: 31530609Scopus ID: 2-s2.0-85072268060OAI: oai:DiVA.org:umu-163491DiVA, id: diva2:1353412
Tillgänglig från: 2019-09-23 Skapad: 2019-09-23 Senast uppdaterad: 2023-09-05Bibliografiskt granskad
Ingår i avhandling
1. Improved health economic assessments of sustainable transport solutions in urban environments
Öppna denna publikation i ny flik eller fönster >>Improved health economic assessments of sustainable transport solutions in urban environments
2022 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Introduction: Part of the European Strategy to achieve climate neutrality in the transport sector is to increase the proportion of electric vehicles (EVs) and active commuting. Health co-benefits from reduced air pollution and increased active commuting are assumed to follow; however, all dimensions of expected health effects are not quantified nor valued monetarily. Current state-of-the art health impact assessments (HIAs) of air pollution assume immediate change in health with exposure; however, the time-window of importance for health outcomes is unknown. Moreover, the currently applied risk estimate of sick leaves in relation to air pollution is poorly generalizable due to outdated exposure assessment and subjective data on outcome. The overall aim of this thesis is to assess the health economic effects of sustainable urban transport solutions and improve the epidemiological knowledge base of air pollution effects. 

Methods: The health effects of increased active commuting and the resulting change in air pollution exposure were valued monetarily from a health care perspective, and a cost-effectiveness analysis of investment in bicycle infrastructure was conducted. A health economic assessment from a societal perspective was also conducted for an increased proportion of EVs in the vehicle fleet, considering a change in both exhaust and non-exhaust particles. The exposure-lag response between air pollution and risk for ischemic heart disease (IHD) and stroke was assessed in a multi-cohort study using distributed lag-nonlinear models (DLNMs). A case cross-over study design was applied to estimate the odds of sick leaves in relation to short-term PM2.5 exposure, and production losses were valued using the human capital method. 

Results: Investing in bicycle infrastructure to enable increased active commuting was estimated to be cost-effective from a health care perspective. An increased proportion of EVs was estimated to decrease population-weighted PM2.5 concentrations without the use of studded winter tires, but was estimated to increase with the current use of studded winter tires in Stockholm Sweden. For a 0-50% use of studded winter tires the health economic costs ranged between €20 and €122 million (M). An independent effect of PM2.5 on sick leaves was estimated to correspond to €2M per year in productivity loss for the population of Stockholm municipality. Exposure time windows closer in time and local sources of air pollution were suggested to be of greater importance for incident IHD and stroke.

Conclusions: This thesis has demonstrated the health economic potential in policies seeking to transform the transport sector towards sustainability. Investment in the transport sector could lead to decreased morbidity and decreased monetary burden in the health care sector. Non-exhaust particles should be considered in order to fully assess the health economic effects of EVs. Moreover, the risk estimate of sick leaves in relation to air pollution exposure could be included in international HIAs.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå Univeristet, 2022. s. 100
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2199
Nyckelord
active commuting, electric vehicles, air pollution, particle matter, physical activity, morbidity, mortality, health economic evaluation
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Forskningsämne
epidemiologi; folkhälsa; hållbar utveckling
Identifikatorer
urn:nbn:se:umu:diva-198995 (URN)978-91-7855-869-8 (ISBN)978-91-7855-870-4 (ISBN)
Disputation
2022-09-23, Triple Helix, Universitetsledningshuset,, Umeå, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2022-09-02 Skapad: 2022-08-31 Senast uppdaterad: 2022-09-01Bibliografiskt granskad

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Kriit, Hedi KatreStewart Williams, JenniferLindholm, LarsForsberg, BertilSommar, Johan

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