The Impact of Urban Green Space Improvements on Cardiovascular Health Through Physical Activity Facilitation: A Health Economic Modelling Study

Sammanfattning

Background: Cardiovascular disease (CVD) burden remains a major public health problem worldwide. One recommended strategy to prevent CVDs is daily physical activity (PA), and urban green spaces (UGSs) have been shown to promote PA. However, the extent to which UGSs encourage movement depends on their quality. Consequently, making changes in existing green spaces can result in varying levels of health benefits. There is a need to inform decision-making in this area to enable choosing the most cost-effective green space solutions. Yet, most studies that have evaluated the health economic consequences of improving UGSs have been conducted outside Europe, with limited consideration of multidimensional interventions. Aim: The aim of this study was to estimate the health impact and the potential cost-effectiveness of improvements in UGSs in the Scania region to facilitate PA and prevent CVD. Method: A Markov cohort model was built to estimate and extrapolate societal costs and quality-adjusted life years (QALYs) over a lifetime time horizon based on UGS improvements in terms of the number of perceived sensory dimensions (PSDs). Data from the existing literature and statistical databases were used as model inputs. Results: Improving green spaces was found to be potentially cost-effective if the maximum intervention costs for the one-point PSD changes remain within the range from approximately 2,000,000 to 20,600,000 SEK, depending on the level of improvements. Conclusion: Improving urban green spaces to facilitate physical activity and prevent CVD is a potentially cost-effective solution to implement in the Scania region. Further research is needed to extend the model and evaluate other health conditions, as well as to estimate cost-effectiveness across different subpopulations.