THE EFFECTIVENESS AND COST-EFFECTIVENESS OF IMPLEMENTING BICYCLE LANES IN THE PREVENTION OF OBESITY AND PERMANENT SEVERE INJURY

Purpose: To evaluate the effectiveness and cost-effectiveness of building bicycle lanes in downtown Toronto, Canada from the government perspective. Bicycle lanes have been found to increase cyclist safety, reduce perceptions of danger, and encourage physical activity. However, while bicycle lanes may provide safety to current cyclists, they may also increase the risk of severe injury among individuals who otherwise would not have chosen to cycle. 

Method: We developed a Markov microsimulation model based on data from municipal government reports and the peer-reviewed literature. The proposed bicycle lane will be implemented on an existing road in a typical downtown Toronto neighbourhood, which is 2.7 km long and will serve 67,810 residents living within a 4km radius of the road. We evaluated the impact of bicycle lanes on population health outcomes in a cohort of 20 to 84 year olds, representative of potential cyclists residing in the Toronto neighbourhood. Specific health outcomes considered were obesity and severe injury. Primary outcomes were expected quality-adjusted life years (QALYs) and costs discounted at 5%, and incremental costs per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted to assess parameter uncertainty.

Result: Our results showed expected QALYs of 18.17 and 18.12 with and without bicycle lanes, respectively. The expected cost per person was $334.13 with bicycle lanes and $364.73 without bicycle lanes. Accordingly, implementing bicycle lanes in a downtown Toronto neighbourhood is dominant, indicating that bicycle lane implementation is cost-saving and provides health benefits. The preferred decision was shown to be robust in sensitivity analysis. For the population of 67,810, we estimated a total of 3,391 QALYs gained and cost savings of $2.08 million attributable to bicycle lane implementation.

Conclusion: Our study demonstrates that bicycle lane implementation in a typical downtown Toronto neighbourhood provides health gains at lower cost. The cost-effectiveness of bicycle lanes identified in this study is likely a conservative estimate, as our analysis only accounts for a narrow range of health outcomes and costs. While the QALYs associated with implementing bicycle lanes is only marginally elevated on the individual level, the health benefit is quite sizeable on a population level.