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Health economic assessment of a scenario to promote bicycling as active transport in Stockholm, Sweden
  1. Hedi Katre Kriit1,
  2. Jennifer Stewart Williams2,
  3. Lars Lindholm2,
  4. Bertil Forsberg1,
  5. Johan Nilsson Sommar1
  1. 1 Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  2. 2 Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
  1. Correspondence to Hedi Katre Kriit; hedi.kriit{at}


Objectives To conduct a health economic evaluation of a proposed investment in urban bicycle infrastructure in Stockholm County, Sweden.

Design A cost-effectiveness analysis is undertaken from a healthcare perspective. Investment costs over a 50-year life cycle are offset by averted healthcare costs and compared with estimated long-term impacts on morbidity, quantified in disability-adjusted life years (DALYs). The results are re-calculated under different assumptions to model the effects of uncertainty.

Setting The Municipality of Stockholm (population 2.27 million) committed funds for bicycle path infrastructure with the aim of achieving a 15% increase in the number of bicycle commuters by 2030. This work is based on a previously constructed scenario, in which individual registry data on home and work address and a transport model allocation to different modes of transport identified 111 487 individuals with the physical capacity to bicycle to work within 30 min but that currently drive a car to work.

Results Morbidity impacts and healthcare costs attributed to increased physical activity, change in air pollution exposure and accident risk are quantified under the scenario. The largest reduction in healthcare costs is attributed to increased physical activity and the second largest to reduced air pollution exposure among the population of Greater Stockholm. The expected net benefit from the investment is 8.7% of the 2017 Stockholm County healthcare budget, and 3.7% after discounting. The economic evaluation estimates that the intervention is cost-effective and each DALY averted gives a surplus of €9933. The results remained robust under varied assumptions pertaining to reduced numbers of additional bicycle commuters.

Conclusion Investing in urban infrastructure to increase bicycling as active transport is cost-effective from a healthcare sector perspective.

  • health economic evaluation
  • commuting
  • transport mode shift
  • health impacts
  • DALY

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  • Contributors HKK planned the health economic study and undertook the data collection and economic analysis with input from LL. HKK wrote the first draft. JSW reviewed the overall content, provided input, and revised and re-drafted the paper in conjunction with HKK. BF advised on the planning and conduct of the study and was responsible for the overall transport scenario project of which this work was part. JS provided health impact estimates and critical input into the planning and conduct of the study, assisted with the statistical analyses and helped to revise the drafts. All the authors read and approved the final version of the manuscript.

  • Funding This work was funded by the Swedish Research Council for Health, Working Life and Welfare (grant number 2012-1296). BF received a grant (2012-1296) from FORTE (Forskningsrådet för hälsa, arbetsliv och välfärd) for the transport scenario study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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