Cost-effectiveness of Lifestyle Africa: an adaptation of the diabetes prevention programme for delivery by community health workers in urban South Africa

ABSTRACT

Background

Lifestyle Africa is an adapted version of the Diabetes Prevention Program designed for delivery by community health workers to socioeconomically disadvantaged populations in low- and middle-income countries (LMICs). Results from the Lifestyle Africa trial conducted in an under-resourced community in South Africa indicated that the programme had a significant effect on reducing haemoglobin A1c (HbA1c).

Objective

To estimate the cost of implementation and the cost-effectiveness (in cost per point reduction in HbA1c) of the Lifestyle Africa programme to inform decision-makers of the resources required and the value of this intervention.

Methods

Interviews were held with project administrators to identify the activities and resources required to implement the intervention. A direct-measure micro-costing approach was used to determine the number of units and unit cost for each resource. The incremental cost per one point improvement in HbA1c was calculated.

Results

The intervention equated to 71 United States dollars (USD) in implementation costs per participant and a 0.26 improvement in HbA1c per participant.

Conclusions

Lifestyle Africa reduced HbA1c for relatively little cost and holds promise for addressing chronic disease in LMIC. Decision-makers should consider the comparative clinical effectiveness and cost-effectiveness of this intervention when making resource allocation decisions.

Trial Registration

Trial registration is at ClinicalTrials.gov (NCT03342274).

KEYWORDS:

• Economic analysis
• HbA1c
• lifestyle interventions
• low- and middle-income countries
• probabilistic sensitivity analysis

Responsible Editor Stig Wall

Responsible Editor Stig Wall

Acknowledgments

The study was supported by the National Heart Lung and Blood Institute of the United States’ National Institutes of Health under award number R01HL126099. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors thank our community advisory board, our partner NGOs, the community health workers and participants who made this study possible.

Author contributions

All authors except MDW and ATF made substantial contributions to the conception and/or design of the trial. MDW led the cost analysis itself with KKF, DC and ATF contributing to the analysis and/or interpretation of the data. MDW and DC drafted the work and all others contributed to revising it and approved it for submission. All authors agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval and consent to participate

The study from which the present data were obtained was approved by the ethics committees at the University of Cape Town (primary) and Children’s Mercy Kansas City. Consent was obtained from all participants prior to data collection.

Paper context

Little is known about cost-effectiveness for delivering community-based lifestyle interventions in low- and middle-income countries. The Lifestyle Africa intervention equated to 71 United States dollars (USD) in implementation costs per participant and a 0.26 improvement in haemoglobin A1c (HbA1c) per participant. Decision makers should consider the comparative clinical effectiveness and cost-effectiveness of Lifestyle Africa when making resource allocation decisions.

Data availability statement

The data supporting the conclusions of this article have been made publicly available within Table 1 of this manuscript.

Additional information

Funding

This work was supported by the National Heart Lung and Blood Institute of the National Institutes of Health (US) under Grant [R01HL126099].