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 ClinicalTrials.gov (NCT03342274).
Glob Health Action
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
Whittington MD, Goggin K, Tsolekile L, et al. Cost-effectiveness of Lifestyle Africa: an adaptation of the diabetes prevention programme for delivery by community health workers in urban South Africa. Glob Health Action. 2023;16(1):2212952. doi:10.1080/16549716.2023.2212952