Abstract
IntroductionThe WHO-Europe’s Health Economic Assessment Tool is a tool used to estimatethe costs and benefits of changes in walking and cycling. Due to data limitationsthe tool’s physical activity module assumes a linear dose response relationship be-tween physical activity and mortality.MethodsThis study estimates baseline population physical activity distributions for 44 coun-tries included in the HEAT. It then compares, for three different scenarios, the re-sults generated by the current method, using a linear dose-response relationship,with results generated using a non-linear dose-response relationship.ResultsThe study finds that estimated deaths averted are relatively higher (lower) using thenon-linear effect in countries with less (more) active populations. This difference islargest for interventions which affect the activity levels of the least active the most.Since more active populations, e.g. in Eastern Europe, also tend to have lowerValue of a Statistical Life estimates the net monetary benefit estimated by the sce-narios are much higher in western-Europe than eastern-Europe.ConclusionsUsing a non-linear dose response function results in materially different estimateswhere populations are particularly inactive or particularly active. Estimating base-line distributions is possible with limited additional data requirements, although themethod has yet to be validated. Given the significant role of the physical activitymodule within the HEAT tool it is likely that in the evaluation of many interventionsthe monetary benefit estimates will be sensitive to the choice of the physical activitydose response function.
Highlights
There is a growing recognition of the importance of considering health in all policies[1,2,3]
One example of successful integration of health impact in another policy domain is the World Health Organization’s Health Economic Assessment Tool (HEAT), which has been widely used, primarily by transport planners, to estimate the health benefits associated with increased walking and cycling[4]
Analysis We estimate the number of deaths averted per 100,000 and the net monetary benefit using both the non-linear dose-response method and the linear dose-response currently used by HEAT for 44 European countries in three scenarios: 1. Scenario 1: An extra 10 minutes of daily walking for every person in the population
Summary
There is a growing recognition of the importance of considering health in all policies[1,2,3]. The success of the HEAT is in part due to its simplicity, requiring relatively few user inputs compared to other health economic models[5]. The HEAT methods and user guide states that “a linear relationship was chosen to avoid additional data requirements on baseline activity levels (which would be needed using a non-linear dose–response function)”[4]. There is a recognition that improvements in data availability could allow for a non-linear relationship to be used in the future. The same report states that “An approach based on a non-linear relationship could be adopted as part of future updates of HEAT, when suitable data on the baseline level of physical activity in different populations are available to provide default values for HEAT” (p.9)
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