Deakin University, Geelong, Australia, Deakin Health Economics, Centre for Population Health Research, Locked Bag 20000, Geelong, VIC, 3220, Australia.
Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
Int J Behav Nutr Phys Act. 2019 Mar 8;16(1):26. doi: 10.1186/s12966-019-0786-5.
Physical inactivity is the fourth highest cause of death globally and is a major contributor to increases in healthcare expenditure. Improving public open spaces such as parks in areas of low socio-economic position (SEP) may increase recreational physical activity in disadvantaged populations. We assessed the cost-effectiveness of the installation of a play-space in a large metropolitan park in a low socioeconomic area based on changes in physical activity.
Observational data of visitor counts and activities undertaken in the park before the installation of the new play-scape (T1), at two months (T2) and 14 months post-installation (T3) were obtained for the intervention and a control park (with no refurbishment) located in a high SEP metropolitan area. Observed sitting, standing, and moderate and vigorous-intensity physical activity were converted to yearly MET-h according to age. Costs of the play-scape and ongoing maintenance were obtained from the organisation managing the refurbishment. The incremental cost-effectiveness ratio (ICER) (ratio of incremental cost to incremental effect) was calculated based on the incremental increase in MET-h from T1 to T3 assuming a 20-year lifetime of the play-scape. Observation counts combining moderate and vigorous activity were used in the sensitivity analysis.
When compared with T1, at T3 the new play-scape resulted in an overall incremental net gain of 114,114 MET-h (95% UI: 80,476 - 146,096) compared with the control park and an incremental cost effectiveness ratio (or cost per MET-h gained per park visitor) of AUD $0.58 (95% UI: $0.44-$0.80). The sensitivity analysis combining moderate and vigorous activity into one category showed an increase in estimated incremental MET-h of 118,190 (95% CI: 83,528 - 149,583) and a lower incremental cost per MET-h gained of AUD $0.56 (95% UI: $0.43-$0.77).
Using a benchmark of cost-effectiveness for physical activity interventions of AUD $0.60-$1.30, this study suggests that the installation of a play-scape located in a low SEP area is cost-effective based on its potential to facilitate increases in MET-h. It provides much needed preliminary evidence and requires replication elsewhere.
身体活动不足是全球第四大死亡原因，也是导致医疗保健支出增加的主要因素。改善社会经济地位较低地区的公共开放空间（如公园），可能会增加弱势人群的娱乐性身体活动。我们评估了在一个低社会经济地区的大型城市公园里安装游乐设施，根据身体活动的变化，对其成本效益进行了评估。
在新游乐设施安装前（T1）、安装后两个月（T2）和 14 个月（T3），在干预公园（在一个高社会经济地位地区，没有翻新）和对照公园（进行了翻新）获取游客人数和活动的观测数据。根据年龄，将观察到的久坐、站立以及适度和剧烈强度的身体活动转换为每年的代谢当量（MET）。从负责翻新的组织获取游乐设施的成本和持续维护成本。基于从 T1 到 T3 期间，游乐设施每年新增的 MET-h，计算增量成本效益比（ICER）（增量成本与增量效果的比值）。在敏感性分析中，我们将适度和剧烈活动的观测计数结合在一起使用。
与 T1 相比，在 T3 时，新游乐设施为公园带来了 114114 MET-h 的净增量（95%置信区间：80476 至 146096），与对照公园相比，增量成本效益比（或每位公园游客每获得的 MET-h 的成本）为 0.58 澳元（95%置信区间：0.44 至 0.80）。将适度和剧烈活动合并为一个类别进行敏感性分析显示，估计的增量 MET-h 增加了 118190（95%可信区间：83528 至 149583），而每获得的 MET-h 的增量成本则降低至 0.56 澳元（95%置信区间：0.43 至 0.77）。
以 0.60 至 1.30 澳元的身体活动干预成本效益为基准，本研究表明，在低社会经济地位地区安装游乐设施具有成本效益，因为它有可能促进 MET-h 的增加。它提供了急需的初步证据，需要在其他地方进行复制。
