York Health Economics Consortium, University of York, UK.
Eur J Public Health. 2012 Dec;22(6):869-73. doi: 10.1093/eurpub/ckr151. Epub 2012 Feb 24.
The Department of Health in England asked the National Institute for Health and Clinical Excellence (NICE) to develop guidance on environmental interventions that promote physical activity. The economic appraisals summarized in this study informed the development of that guidance. In view of the difficulties inherent in applying conventional health economic evaluation techniques to public health interventions, the economic appraisal employed a multi-faceted approach.
The analyses comprised of three components. Two cost-utility analyses; the first used a life-time disease progression model which sought to take into account the long-term benefits of physical activity on health outcomes, whereas the second used data from a regression analysis which captured some of the short-term, process benefits of physical activity which might manifest themselves in terms of improved mental health and wellbeing. The third approach was a cost-benefit analysis that took into account benefits beyond healthcare.
The cost-utility approaches generated cost-effectiveness estimates ranging between £100 and £10 000 per QALY depending on the level of effectiveness of the intervention and the proportion of the intervention cost that was deemed to be attributable to health. The standardized cost-benefit ratio was 11:1.
The findings present a consistent case to support environmental interventions that promote increased physical activity in the sedentary adult population. However, some degree of caution should be taken in interpreting the findings due to the limitations of the evidence upon which they are based. Further consideration should also be given to the relative merits of alternative approaches to assessing the value of changes to the built environment that might also benefit health as a positive externality.
英格兰卫生部要求国家卫生与临床优化研究所（NICE）制定促进身体活动的环境干预措施指南。本研究总结的经济评估为该指南的制定提供了信息。鉴于将传统健康经济评估技术应用于公共卫生干预措施所固有的困难，经济评估采用了多方面的方法。
分析包括三个部分。两项成本效益分析；第一项使用了终生疾病进展模型，旨在考虑身体活动对健康结果的长期益处，而第二项使用了回归分析数据，该分析捕捉到了身体活动的一些短期、过程益处，这些益处可能表现为心理健康和幸福感的提高。第三种方法是成本效益分析，考虑了医疗保健以外的收益。
成本效益分析得出的成本效益估计值在每 QALY 100 英镑至 10000 英镑之间，具体取决于干预的有效性水平和被认为归因于健康的干预成本比例。标准化成本效益比为 11:1。
这些发现为支持促进久坐成年人增加身体活动的环境干预提供了一致的理由。然而，由于它们所依据的证据存在局限性，因此在解释这些发现时应谨慎行事。还应进一步考虑评估可能对健康产生积极外部性的建筑环境变化的价值的替代方法的相对优点。
