Cycling Promotion and Non-Communicable Disease Prevention: Health Impact Assessment and Economic Evaluation of Cycling to Work or School in Florence

Objective
To estimate the effects of cycling promotion on major non-communicable diseases (NCDs) and costs from the public healthcare payer’s perspective.
Design
Health impact assessment and economic evaluation using a dynamic model over a ten-year period and according to two cycling promotion scenarios.
Setting
Cycling to work or school in Florence, Italy.
Population
All individuals aged 15 and older commuting to work or school in Florence.
Main outcome measures
The primary outcome measures were changes in NCD incidence and healthcare direct costs for the Tuscany Regional Health Service (SST) due to increased cycling. The secondary outcome was change in road traffic accidents.
Results
Increasing cycling modal share in Florence from 7.5% to about 17% (Scenario 1) or 27% (Scenario 2) could decrease the incidence of type 2 diabetes by 1.2% or 2.5%, and the incidence of acute myocardial infarction (AMI) and stroke by 0.6% or 1.2%. Within 10 years, the number of cases that can be prevented is 280 or 549 for type 2 diabetes, 51 or 100 for AMI, and 51 or 99 for stroke in Scenario 1 or Scenario 2, respectively. Average annual discounted savings for the SST are estimated to amount to €400,804 or €771,201 in Scenario 1 or Scenario 2, respectively. In Florence, due to the high use of vulnerable motorized vehicles (such as scooters, mopeds, and motorcycles), road traffic accidents are expected to decline in both our scenarios. Sensitivity analyses showed that health benefits and savings for the SST are substantial, the most sensitive parameters being the relative risk estimates of NCDs and active commuting.
Conclusions
Effective policies and programs to promote a modal shift towards cycling among students and workers in Florence will contribute to reducing the NCD burden and helping long-term economic sustainability of the SST.