Evidence-based economic evaluation of a new cycling infrastructure to increase physical activity

Abstract Background Active travel-particularly cycling-has gained increasing recognition as a sustainable and effective strategy to promote physical activity and improve public health. As investments in cycling infrastructure grow, it is essential to assess the health and economic benefits to inform evidence-based policy and planning. Methods This study presents a longitudinal economic evaluation of a newly constructed segregated cycleway in Coventry, UK, using the World Health Organization's Health Economic Assessment Tool (HEAT) for cycling. A two-year cross-sectional survey (2023-2024) was conducted with residents to capture changes in cycling behaviour and physical activity levels. Data were analysed using a before-and-after comparison, and also by residential proximity to the cycleway using two spatial buffer zones. Results The before-and-after analysis revealed an increase of 0.7 minutes of cycling per person per day, translating to an estimated 1.4 premature deaths prevented annually. Over a 10-year horizon, this equates to 14 deaths avoided and an economic benefit of US$42 million (adjusted to 2025 values), with a benefit-cost ratio (BCR) of 3.8. The proximity-based analysis showed a 2-minute daily increase in cycling in areas near the cycleway, preventing 67 premature deaths over ten years and leading to BCR of 17, with an economic return of US$188 million. Conclusions These findings demonstrate that even modest increases in cycling, when supported by appropriate infrastructure, can lead to substantial health and economic gains. The evidence underscores the value of integrating active travel into urban planning as a cost-effective intervention to support population health and environmental sustainability. Key messages • Investing in cycling infrastructure, even when it leads to modest increases in cycling behaviour, can generate substantial health and economic benefits. • This makes such interventions highly cost-effective and valuable tools for improving public health and promoting sustainable urban development.