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Publication Date



DOI: 10.1080/16549716.2023.2212952; PMCID: PMC10208125


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 (NCT03342274).

Journal Title

Glob Health Action





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MeSH Keywords

Humans; South Africa; Community Health Workers; Cost-Benefit Analysis; Glycated Hemoglobin; Life Style; Diabetes Mellitus, Type 2


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


Grant support

This work was supported by the National Heart Lung and Blood Institute of the National Institutes of Health (US) under Grant [R01HL126099]. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. Publisher's Link: