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Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study

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posted on 2023-03-10, 02:23 authored by JL Veerman, B Zapata-Diomedi, L Gunn, GR McCormack, LJ Cobiac, AMM Herrera, B Giles-Corti, Alan ShiellAlan Shiell

Background: Studies consistently find that supportive neighbourhood built environments increase physical activity by encouraging walking and cycling. However, evidence on the cost-effectiveness of investing in built environment interventions as a means of promoting physical activity is lacking. In this study, we assess the cost-effectiveness of increasing sidewalk availability as one means of encouraging walking. Methods: Using data from the RESIDE study in Perth, Australia, we modelled the cost impact and change in health-adjusted life years (HALYs) of installing additional sidewalks in established neighbourhoods. Estimates of the relationship between sidewalk availability and walking were taken from a previous study. Multistate life table models were used to estimate HALYs associated with changes in walking frequency and duration. Sensitivity analyses were used to explore the impact of variations in population density, discount rates, sidewalk costs and the inclusion of unrelated healthcare costs in added life years. Results: Installing and maintaining an additional 10 km of sidewalk in an average neighbourhood with 19 000 adult residents was estimated to cost A$4.2 million over 30 years and gain 24 HALYs over the lifetime of an average neighbourhood adult resident population. The incremental cost-effectiveness ratio was A$176 000/HALY. However, sensitivity results indicated that increasing population densities improves cost-effectiveness. Conclusions: In low-density cities such as in Australia, installing sidewalks in established neighbourhoods as a single intervention is unlikely to cost-effectively improve health. Sidewalks must be considered alongside other complementary elements of walkability, such as density, land use mix and street connectivity. Population density is particularly important because at higher densities, more residents are exposed and this improves the cost-effectiveness. Health gain is one of many benefits of enhancing neighbourhood walkability and future studies might consider a more comprehensive assessment of its social value (eg, social cohesion, safety and air quality).


JLV, BZ-D, LG, BG-C and AS are part of the NHMRC CRE in Healthy, Liveable Communities (APP1061404). JLV and AMMH are supported by funding from the NHMRC Centre for Research Excellence (CRE) in Obesity Policy and Food Systems (APP1041020). BZ-D is supported by an Australian Postgraduate Award. AS acknowledges the financial support provided to him to carry out this work by the Alberta Heritage Foundation for Medical Research, the Canadian Institutes of Health Research and the Public Health Agency of Canada. GRM is supported by a Canadian Institutes of Health Research New Investigator Award.


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© The Authors 2016 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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