A method for the inclusion of physical activity-related health benefits in cost-benefit analysis of built environment initiatives.

The built environment has a significant influence on population levels of physical activity (PA) and therefore health. However, PA-related health benefits are seldom considered in transport and urban planning (i.e. built environment interventions) cost-benefit analysis. Cost-benefit analysis implies that the benefits of any initiative are valued in monetary terms to make them commensurable with costs. This leads to the need for monetised values of the health benefits of PA. The aim of this study was to explore a method for the incorporation of monetised PA-related health benefits in cost-benefit analysis of built environment interventions. Firstly, we estimated the change in population level of PA attributable to a change in the built environment due to the intervention. Then, changes in population levels of PA were translated into monetary values. For the first step we used estimates from the literature for the association of built environment features with physical activity outcomes. For the second step we used the multi-cohort proportional multi-state life table model to predict changes in health-adjusted life years and health care costs as a function of changes in PA. Finally, we monetised health-adjusted life years using the value of a statistical life year. Future research could adapt these methods to assess the health and economic impacts of specific urban development scenarios by working in collaboration with urban planners.

Cost-Effectiveness Study of HPV Vaccination as a Primary Prevention Strategy for Anal Cancer in HIV-Positive Men in Chile.

BACKGROUND: Most anal cancers are caused by the human papilloma virus (HPV) infection. The incidence is increasing, especially in high-risk individuals such as HIV-positive men. Evidence shows that the new quadrivalent HPV vaccine reduces the rates of anal intraepithelial neoplasia among men who have sex with men. OBJECTIVE: To determine whether vaccinating against HPV-related anal cancer is cost-effective in HIV-positive men in Chile. METHODS: A cost-effectiveness analysis was conducted by constructing a cohort multistate life-table-based Markov model in MS Excel in which the prevention of HPV infection was expected to influence the incidence of anal cancer in HIV-positive men. The comparator was the current practice of no systematic HPV prevention. Estimates of the efficacy of the vaccine were obtained from a substudy of a larger randomized controlled trial, incidence rates from the Chilean Population Cancer Registries, mortality rates from the National Institute of Statistics, and disease costs from a cost-effectiveness report. A public health care sector perspective was applied. The outcome was measured in averted disability-adjusted life-years. The incremental cost-effectiveness ratio was calculated considering a lifetime horizon for costs and health outcomes. RESULTS: The estimated incremental cost-effectiveness ratio was US $138,269/ disability-adjusted life-year (95% confidence interval $95,936-$221,862). Assuming a threshold of 3 times the gross domestic product per capita, the intervention was not cost-effective. The outcome was sensitive to the vaccine price and vaccine efficacy. CONCLUSIONS: HPV vaccination in HIV-positive men from a Chilean public health care sector perspective is not cost-effective.

Modeling the long term health outcomes and cost-effectiveness of two interventions promoting fruit and vegetable intake among schoolchildren.

This study provides an example on how to assess the cost-effectiveness of a nation wide implementation of two school-based interventions promoting fruit and vegetable intake among primary schoolchildren in the Netherlands compared to 'no intervention' and to each other. Data collection using self-report questionnaires in both studies was conducted between 2003 and 2005. Effects of the intervention in terms of fruit and vegetable intake were assessed and epidemiological modeling (conducted in 2008) was used to estimate the number of disability-adjusted life years gained over the lifetime of all 10 years old in the Netherlands. We assumed 30% of the effect on consumption was permanent. Incremental cost effectiveness ratios (ICER) and net monetary benefits (NMB) were estimated and one-way and probabilistic sensitivity analyses were conducted. The ICER for the Pro Children intervention in comparison with no intervention was estimated at €5728/DALY and the ICER for the Schoolgruiten intervention in comparison with no intervention at €10,674/DALY. Using the Dutch per capita income as a decision threshold (€19,600) the probability that the Pro Children intervention was cost-effective in comparison with no intervention was 80% and that the Schoolgruiten intervention was cost-effective in comparison with no intervention was 68%. The Pro Children had a 70% chance of being dominant over the Schoolgruiten intervention in terms of cost-effectiveness. The current cost-effectiveness model shows that both the Pro Children intervention and the Schoolgruiten intervention were cost-effective in comparison with no intervention. Extensive sensitivity analyses showed that the conclusions were sensitive to the discount rate and the proportion of effects that remains lifelong.