BackgroundAir pollution causes around 40 000 early deaths per year in the UK and has a substantial role in many chronic conditions such as cancer, asthma, heart disease, and dementia. Road transport is one of the major sources of air pollution. This study aimed to assess the cost-effectiveness of local interventions to reduce traffic-related air pollution. MethodsAn economic model was developed for comparing costs and benefits to health and other sectors for eight different interventions aimed at reducing traffic-related air pollution against a background of do nothing. Modelled costs include annualised capital and operating costs. Health benefits were modelled with the damage-cost approach, which appraises the damages for each pollutant through different health endpoints (eg, mortality, morbidity). Results were reported as benefit-cost ratios (BCR) and incremental costs per quality adjusted life-year (QALY). Sensitivity analyses explored the uncertainties associated with various model parameters including costs, effectiveness, and risk of harm. FindingsThe benefits were much higher than the costs for some of the interventions: off-road cycle paths in urban areas where they are likely to be widely used by cyclists (£5075 per QALY, BCR 14); street washing and sweeping in densely populated urban areas with relatively low rainfall (£441/QALY); and motorway speed restrictions where the road passes through densely populated areas (£1293/QALY). Owing to quality or availability of key modelling data (eg, size and density of affected population, financial costs) there was less certainty for bypass construction (£6971/QALY), motorway barriers (£25 199/QALY, 3), road closures (cost per QALY, BCR not calculated), low emission zones (£2465/QALY), and vehicle idling (£1572/QALY). Relative size of the population impacts that would be achieved under different interventions could not be modelled because of wide variability in location-specific characteristics between the case-study areas. InterpretationThe analysis suggests that the interventions assessed could be highly cost-effective in some settings. However, the effect and cost of any intervention will be highly dependent on factors specific to the local setting, so cost-effectiveness may vary considerably from the case studies. FundingNational Institute for Health and Care Excellence (NICE).
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