Taking a local government perspective for economic evaluation of a population-level programme to promote exercise

Paolo Candio, David Meads, Andrew J. Hill, Laura Bojke

Research output: Contribution to journalArticlepeer-review

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Background: In order to tackle the issue of physical inactivity, local governments have implemented population-level programmes to promote exercise. While evidence is accumulating on the cost-effectiveness of these interventions, studies have typically adopted a health sector perspective for economic evaluation. This approach has been challenged as it does not allow for key concerns by local governments, which are primary stakeholders, to be addressed.

Objectives: To show how taking a local government perspective for economic evaluation can be implemented in practice and this may affect the economic conclusions.

Methods: Based on data from a case study, the health equity impact of the intervention and its opportunity cost from a service provider viewpoint were assessed. The cost-effectiveness implications of a change in perspective were subsequently estimated by means of scenario analysis.

Findings: The intervention was found to provide adult residents living in the most deprived city areas with greater health benefits compared with the rest of the population. However, a negative net equity impact was found in the short-term. The opportunity cost of the intervention was estimated to be substantially lower than its financial cost (£2.77 per person/year), with significant implications for decision-making.

Conclusions: Taking a local government perspective can affect the conclusions drawn from the economic evaluation of population-level programmes to promote exercise, and therefore influence decision making.
Original languageEnglish
Pages (from-to)651-657
Number of pages7
JournalHealth Policy
Issue number5
Early online date4 Mar 2021
Publication statusPublished - May 2021


  • Health equity
  • Opportunity cost
  • Local government
  • Perspective
  • Cost-effectiveness


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