Cost-Effectiveness of Improvements to the Built Environment Intended to Increase Physical Activity

Background: Improving sidewalks may encourage physical activity by providing safe, defined, and connected walking spaces. However, it is unknown if reduced health care expenditures assumed by increased physical activity offset the investment for sidewalk improvements. Methods: This cost-effectiveness analysis of sidewalk improvements in Houston, TX, was among adults enrolled in the Houston Travel-Related Activity in Neighborhoods Study, 2013–2017 . The 1-year change in physical activity was measured using self-report (n = 430) and accelerometry (n = 228) and expressed in metabolic equivalent (MET) hours per year (MET·h·y−1). Cost-effectiveness ratios were calculated by comparing annualized sidewalk improvement costs (per person) with 1-year changes in physical activity. Results: The estimated cost-effectiveness ratio were $0.01 and −$0.46 per MET·h·y−1 for self-reported and accelerometer-derived physical activity, respectively. The cost-effectiveness benchmark was $0.18 (95% confidence interval, $0.06–$0....