17/02 – QALY

How You Can Help

Chairman Degnan, Director Foye, Commissioners.

Thank you for the opportunity to speak in favor of adding widened paths on the George Washington Bridge to the 10 Year Capital Plan. My name is Dustin Fry, I am a student at the Columbia School of Public Health.

In November 2016, Neile Weissman presented you with the results from applying a World Health Organization model to cycling across a widened GWB.  It showed that twenty deaths per year would be prevented by the increase in physical activity.[1]

But improving public health is about more than just preventing deaths, it’s also about preventing disease. One way to measure disease prevention is through the quality-adjusted life year, or QALY. One QALY refers to one person living one year in perfect health. So the term conceptualizes both longevity and wellness.[2]

Given limited resources, it is important to identify and fund interventions that add the most life-years to society for the lowest cost. For example, drivers’ side airbags cost $30,000[3] per life-year gained. Vaccinating children against the flu would be $12,000.[4]

Recently, Doctors Gu, Babak, and Muennig of the Columbia School of Public Health conducted a study to assess the health and economic impacts of the 2015 expansion of New York City’s bike grid. They found that expenditures on bicycle infrastructure to be an incredibly cost-effective public health intervention, costing just $1,300 per QALY gained. [5]

Screen Shot 2017-02-28 at 6.58.54 AM.pngImage Atlanta Bicycle Coalition.

Applying the same methodology to the cyclists described in Mr. Weissman’s study, the authors found that these cyclists’ health and longevity improved by 8%, adding 1,100 QALYs each year. [6]

But the GWB paths are no longer adequate for the high traffic they carry. And continuing to support the growing volume of cyclists means spending an estimated $90 million. But over the entire 90-year projected longevity of the GWB, that’s 100,000 quality-adjusted life years at a cost of just $883 per QALY. [7]

The George Washington Bridge is an important part of the New York metropolitan area’s cycling infrastructure. It also saves lives and prevents disease with tremendous cost-effectiveness. Widening the paths is the right choice for public health.

Thank you.

[1] Applying the World Health Organization/HEAT model to 14,000 cyclists per weekend cycling 50 miles, 35 times per year, it was determined that the increased physical activity supported by wider paths save 21 lives per year year for an annual health cost savings of $195 million., WHO-HEAT, Complete George, http://tinyurl.com/z2u4d9r

[2] Quality-adjusted life year (QALY), Wikipedia, http://tinyurl.com/ml87f4p

[3] Peter Neumann, Natalia Olchanski, A Web-based Registry of Cost-Utility Analysis, International Society for Pharmacoeconomics and Outcomes Research, http://tinyurl.com/hnpq7cp

Screen Shot 2016-12-21 at 8.29.12 PM.pngA Web-based Registry of Cost Utility Analyses.

[4] Lisa A. Prosser, Carolyn Buxton Bridges, Timothy M. Uyeki et al. Health Benefits, Risks, and Cost-Effectiveness of Influenza Vaccination of Children. Emerging Infectious Disease. http://tinyurl.com/j8hpp7z

[5] “In NYC, the one-year investment in bike lanes comes in at an exceptionally good value, costing just $1297/QALY.”, Jing Gu, Babak Mohit, Peter Alexander Muennig, The cost-effectiveness of bike lanes in New York City, Injury Prevention, http://tinyurl.com/jttqqrb

[6] 14,163 individual life-years times 0.08 improvement in quality of life = 1133.04 QALY per year

[7] 1133.04 QALYs times 90 years (estimated lifespan of GWB) = 101970 QALYs. $90 million cost to widen the GWB paths divided by 101970 QALYs = $882.61 per QALY