A comparison of the World Health Organisation's HEAT model results using a non-linear physical activity dose response function with results from the existing tool

Abstract

Introduction: The WHO-Europe’s Health Economic Assessment Tool is a tool used to estimate the costs and benefits of changes in walking and cycling. Due to data limitations the tool’s physical activity module assumes a linear dose response relationship be-tween physical activity and mortality. Methods: This study estimates baseline population physical activity distributions for 44 countries included in the HEAT. It then compares, for three different scenarios, the results generated by the current method, using a linear dose-response relationship, with results generated using a non-linear dose-response relationship. Results: The study finds that estimated deaths averted are relatively higher (lower) using the non-linear effect in countries with less (more) active populations. This difference is largest 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 lower Value of a Statistical Life estimates the net monetary benefit estimated by the scenarios are much higher in western-Europe than eastern-Europe. Conclusions: Using a non-linear dose response function results in materially different estimates where populations are particularly inactive or particularly active. Estimating base-line distributions is possible with limited additional data requirements, although the method has yet to be validated. Given the significant role of the physical activity module within the HEAT tool it is likely that in the evaluation of many interventions the monetary benefit estimates will be sensitive to the choice of the physical activity dose response function.