Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
PLoS One. 2021 Feb 8;16(2):e0246419. doi: 10.1371/journal.pone.0246419. eCollection 2021.
Decision-makers are increasingly requesting economic analyses on transportation-related interventions, but health is often excluded as a determinant of value. We assess the health-related economic impact of bicycle infrastructure investments in three Canadian cities (Victoria, Kelowna and Halifax), comparing a baseline reference year (2016) with the future infrastructure build-out (2020).
The World Health Organization's Health Economic Assessment Tool (HEAT; version 4.2) was used to quantify the economic value of health benefits associated with increased bicycling, using a 10-year time horizon. Outputs comprise premature deaths prevented, carbon emissions avoided, and a benefit:cost ratio. For 2016-2020, we derived cost estimates for bicycle infrastructure investments (including verification from city partners) and modelled three scenarios for changes in bicycling mode share: 'no change', 'moderate change' (a 2% increase), and 'major change' (a 5% increase). Further sensitivity analyses (32 per city) examined how robust the moderate scenario findings were to variation in parameter inputs.
Planned bicycle infrastructure investments between 2016 and 2020 ranged from $28-69 million (CAD; in 2016 prices). The moderate scenario benefit:cost ratios were between 1.7:1 (Victoria) and 2.1:1 (Halifax), with the benefit estimate incorporating 9-18 premature deaths prevented and a reduction of 87-142 thousand tonnes of carbon over the 10-year time horizon. The major scenario benefit:cost ratios were between 3.9:1 (Victoria) and 4.9:1 (Halifax), with 19-43 premature deaths prevented and 209-349 thousand tonnes of carbon averted. Sensitivity analyses showed the ratio estimates to be sensitive to the time horizon, investment cost and value of a statistical life inputs.
Within the assessment framework permitted by HEAT, the dollar value of health-related benefits exceeded the cost of planned infrastructure investments in bicycling in the three study cities. Depending on the decision problem, complementary analyses may be required to address broader questions relevant to decision makers in the public sector.
决策者越来越多地要求对与交通相关的干预措施进行经济分析，但健康通常不作为价值的决定因素。我们评估了加拿大三个城市（维多利亚，基洛纳和哈利法克斯）自行车基础设施投资的健康相关经济影响，将基准参考年（2016 年）与未来基础设施建设（2020 年）进行了比较。
使用世界卫生组织的健康经济评估工具（HEAT；版本 4.2）来量化与骑自行车增加相关的健康益处的经济价值，使用 10 年的时间范围。产出包括预防的过早死亡，避免的碳排放以及收益：成本比。对于 2016-2020 年，我们从自行车基础设施投资中得出了成本估算（包括与城市合作伙伴的验证），并对三种骑行模式份额变化情景进行了建模：“不变”，“适度变化”（增加 2%）和“重大变化”（增加 5%）。进一步的敏感性分析（每个城市 32 个）检查了中度情景的发现对参数输入变化的稳健性。
2016 年至 2020 年之间计划的自行车基础设施投资范围为 28-6900 万美元（加元；按 2016 年价格计算）。中度情景的收益：成本比在 1.7：1（维多利亚）和 2.1：1（哈利法克斯）之间，收益估计包括预防 9-18 例过早死亡和在 10 年时间内减少 87-142 万吨碳排放。重大情景的收益：成本比在 3.9：1（维多利亚）和 4.9：1（哈利法克斯）之间，预防 19-43 例过早死亡和避免 209-349 万吨碳排放。敏感性分析表明，比率估计对时间范围，投资成本和生命统计价值输入敏感。
在 HEAT 允许的评估框架内，与三个研究城市骑自行车相关基础设施投资成本相比，健康相关效益的美元价值更高。根据决策问题的不同，可能需要进行补充分析，以解决公共部门决策者相关的更广泛问题。
