Quality of life and cost-effectiveness of a 3-year trial of lifestyle intervention in primary health care. Cost-effectiveness analysis of a European primary-care physician training in smoking cessation counseling Cost-Effectiveness of Peer Counselling for the Promotion of Exclusive Breastfeeding in Uganda Physical activity counseling in primary care and patient well-being: Do patients benefit? The impact of two workplace-based health risk appraisal interventions on employee lifestyle parameters, mental health and work ability: results of a randomized controlled trial. Economic evaluation of participatory learning and action with women’s groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India Economic evaluation of a weight control program with e-mail and telephone counseling among overweight employees: a randomized controlled trial Impact of a Telephone-Based Intervention on the Reduction of Health Risks Impact of health education on health-related quality of life among elderly persons: results from a community-based intervention study in rural Bangladesh. Economic Evaluation of a Web-Based Tailored Lifestyle Intervention for Adults: Findings Regarding Cost-Effectiveness and Cost-Utility From a Randomized Controlled Trial Cost-effectiveness of a Population-based Lifestyle Intervention to Promote Healthy Weight and Physical Activity in Non-attenders of Cardiac Rehabilitation. Implementation and effectiveness of a community-based health promotion program for older adults. Using email reminders to engage physicians in an Internet-based CME intervention Cost-effectiveness of involving nurse specialists for adult patients with urinary incontinence in primary care compared to care-as-usual: an economic evaluation alongside a pragmatic randomized controlled trial. Cost-effectiveness of a randomised trial of physical activity in Alzheimer’s disease: a secondary analysis exploring patient and proxy-reported health-related quality of life measures in Denmark Examination of costs for a lay health educator-delivered translation of the Diabetes Prevention Program in senior centers. Cost effectiveness of peer support for type 2 diabetes.
BACKGROUND Lifestyle interventions reduce cardiovascular risk and risk of diabetes mellitus , but reports on long-term effects on quality of life ( QOL ) and health care utilization are rare . We investigated the impact of a primary health care-based lifestyle intervention program on QOL and cost-effectiveness over 3 years . METHODS A total of 151 men and women , aged 18 to 65 years , at moderate to high risk for cardiovascular disease , were r and omly assigned to either lifestyle intervention with st and ard care or st and ard care alone . Intervention consisted of supervised exercise sessions and diet counseling for 3 months , followed by regular group meetings over a 3-year period . Change in QOL was measured with EuroQol ( 5-dimensional EuroQol-5D [ EQ-5D ] and EuroQol-VAS [ EQ-VAS ] ) , the 36-Item Short-Form Health Survey ( SF-36 ) , and the 6-dimensional Short-Form 6D ( SF-6D ) . The health economic evaluation was performed from a societal view and a treatment perspective . In a cost-utility analysis , the costs , gained quality -adjusted life-years ( QALYs ) , and savings in health care were considered . Cost-effectiveness was also described using the net monetary benefit method . RESULTS Significant differences between the groups over the 3-year period were shown in the EQ-VAS ( P = .002 ) , SF-6D ( P = .01 ) , and SF-36 ( P = .04 ) physical component summary but not in the EQ-5D ( P = .24 ) or SF-36 ( P = .37 ) mental component summary . The net savings were $ 47 per participant . Costs per gained QALY , savings not counted , were $ 1668 to $ 4813 . Probabilities of cost-effectiveness were 89 % to 100 % when the amount of $ 50,000 was used as stakeholder 's threshold of willingness to pay for a gained QALY . CONCLUSION Lifestyle intervention in primary care improves QOL and is highly cost-effective in relation to st and ard care . Trial Registration clinical trials.gov Identifier : NCT00486941 Background  Physician training in smoking cessation counseling  has been shown to be effective as a means to increase quit success . We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme . Its effectiveness was previously demonstrated in a cluster r and omized , control trial performed in two Swiss university out patients clinics , in which residents were r and omized to receive training in smoking interventions or a control educational intervention .  Design and methods We used a Markov simulation model for effectiveness analysis . This model incorporates the intervention efficacy , the natural quit rate , and the lifetime probability of relapse after 1-year abstinence . We used previously published results in addition to hospital service and outpatient clinic cost data . The time horizon was 1 year , and we opted for a third-party payer perspective . Results The incremental cost of the intervention amounted to US$ 2.58 per consultation by a smoker , translating into a cost per life-year saved of US$ 25.4 for men and 35.2 for women . One-way sensitivity analyses yielded a range of US$ 4.0 - 107.1 in men and US$ 9.7 - 148.6 in women . Variations in the quit rate of the control intervention , the length of training effectiveness , and the discount rate yielded moderately large effects on the outcome . Variations in the natural cessation rate , the lifetime probability of relapse , the cost of physician training , the counseling time , the cost per hour of physician time , and the cost of the booklets had little effect on the cost-effectiveness ratio . Conclusions Training residents in smoking cessation counseling  is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions Background Community based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence . However , there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa . This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children . Methods Data were obtained from a community r and omized trial conducted in Ug and a between 2006–2008 , and supplemented with evidence from several studies in sub-Saharan Africa . In the trial , peer counselling was offered to women in intervention clusters . In the control and intervention clusters , women could access st and ard health facility breastfeeding promotion services ( HFP ) . Thus , two methods of breastfeeding promotion were compared : community based peer counselling ( in addition to HFP ) and st and ard HFP alone . A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies . The model estimated changes in breastfeeding prevalence and disability adjusted life years . Costs were estimated from a provider perspective . Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis . Findings Peer counselling more than doubled the breastfeeding prevalence as reported by mothers , but there was no observable impact on diarrhoea prevalence . Estimated incremental cost-effectiveness ratios were US$ 68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year ( DALY ) averted . The findings were robust to parameter variations in the sensitivity analyses Conclusions Our strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Ug and a , because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Ug and a ’s GDP per capita ( US$ 1653 ) . However , since the intervention significantly increases prevalence of exclusive or predominant breastfeeding , it could be adopted in Ug and a if benefits other than reducing the occurrence of diarrhoea are believed to be important Background : Promoting physical activity is an important public health strategy for long-term reductions in incidence or severity of clinical disease . Benefits to health-related quality of life ( HRQL ) and subjective well-being may be as important and take less time to accrue . Purpose : We examined the HRQL benefits of a social-cognitive-theory-based intervention of the Activity Counseling Trial ( ACT ) , both directly in terms of changes in physical fitness and indirectly from increased self-efficacy associated with the intervention . Methods : In ACT , 395 female and 479 male inactive patients ages 35 to 75 years were r and omized to one of : physician advice , advice plus behavioral counseling during primary care visits , or advice plus behavioral counseling that also included telephone contact and behavioral classes .  Participants were assessed at baseline , 6 months , and 24 months . HRQL was assessed as perceived quality of life , perceived stress , depression , and general health . Satisfaction with function and appearance , self-efficacy , and social support were also assessed . Results : At 24 months women who received counseling or assistance had significant reductions in daily stress and improvements in satisfaction with body function compared to those receiving advice only . Men had reductions in daily stress across all treatment arms . These results mirrored V02max changes observed per group . Change in barriers self-efficacy was significantly associated with reductions in daily stress at 24 months . Conclusions : Patient benefit from ACT intervention was mediated by enhanced cardiorespiratory fitness and by barriers self-efficacy Health risk appraisal s ( HRA ) are a common type of workplace health promotion programme offered by American employers . In the United Kingdom , evidence of their effectiveness for promoting health behaviour change remains inconclusive . This r and omized controlled trial examined the effects of two HRA interventions on lifestyle parameters , mental health and work ability in a UK context . A total of 180 employees were r and omized into one of three groups : Group A ( HRA augmented with health promotion and education activities ) , Group B ( HRA only ) and Group C ( control , no intervention ) . After 12 months , changes in mean scoring in 10 lifestyle , mental health and work ability indices were compared , Groups A and B demonstrated non-significant improvements in 70 % and 80 % , respectively , compared with controls ( 40 % ) . Odds ratios revealed that , compared with the control group , Group A was 29.2 ( 95 % CI : 9.22 - 92.27 ) times more likely to report a perceived change in lifestyle behaviour ; Group B 4.4 times ( 95 % CI : 1.65 - 11.44 ) . In conclusion , participation in the HRA was associated with a higher likelihood of perceived lifestyle behaviour change which was further increased in the augmented HRA group , thereby providing preliminary evidence that HRA and augmented HRA in particular may help UK employees make positive healthy lifestyle changes Background Neonatal mortality remains unacceptably high in many low and middle-income countries , including India . A community mobilisation intervention using participatory learning and action with women ’s groups facilitated by Accredited Social Health Activists ( ASHAs ) was conducted to improve maternal and newborn health . The intervention was evaluated through a cluster-r and omised controlled trial conducted in Jharkh and and Odisha , eastern India . This aims to assess the cost-effectiveness this intervention . Methods Costs were estimated from the provider ’s perspective and calculated separately for the women ’s group intervention and for activities to strengthen Village Health Sanitation and Nutrition Committees ( VHNSC ) conducted in all trial areas . Costs were estimated at 2017 prices and converted to US dollar ( USD ) . The incremental cost-effectiveness ratio ( ICER ) was calculated with respect to a do-nothing alternative and compared with the WHO thresholds for cost-effective interventions . ICERs were calculated for cases of neonatal mortality and disability-adjusted life years ( DALYs ) averted . Results The incremental cost of the intervention was USD 83 per averted DALY ( USD 99 inclusive of VHSNC strengthening costs ) , and the incremental cost per newborn death averted was USD 2545 ( USD 3046 inclusive of VHSNC strengthening costs ) . The intervention was highly cost-effective according to WHO threshold , as the cost per life year saved or DALY averted was less than India ’s Gross Domestic Product ( GDP ) per capita . The robustness of the findings to assumptions was tested using a series of one-way sensitivity analyses . The sensitivity analysis does not change the conclusion that the intervention is highly cost-effective . Conclusion Participatory learning and action with women ’s groups facilitated by ASHAs was highly cost-effective to reduce  neonatal mortality in rural setting s with low literacy levels and high neonatal mortality rates . This approach could effectively complement facility-based care in India and can be scaled up in comparable high mortality setting Background Distance lifestyle counseling for weight control is a promising public health intervention in the work setting . Information about the cost-effectiveness of such interventions is lacking , but necessary to make informed implementation decisions . The purpose of this study was to perform an economic evaluation of a six-month program with lifestyle counseling aim ed at weight reduction in an overweight working population with a two-year time horizon from a societal perspective . Methods A r and omized controlled trial comparing a program with two modes of intervention delivery against self-help . 1386 Employees from seven companies participated ( 67 % male , mean age 43 ( SD 8.6 ) years , mean BMI 29.6 ( SD 3.5 ) kg/m2 ) . All groups received self-directed lifestyle brochures . The two intervention groups additionally received a workbook-based program with phone counseling ( phone ; n=462 ) or a web-based program with e-mail counseling ( internet ; n=464 ) . Body weight was measured at baseline and 24 months after baseline . Quality of life ( EuroQol-5D ) was assessed at baseline , 6 , 12 , 18 and 24 months after baseline . Re source use was measured with six-monthly diaries and valued with Dutch st and ard costs . Missing data were multiply imputed . Uncertainty around differences in costs and incremental cost-effectiveness ratios was estimated by applying non-parametric bootstrapping techniques and graphically plotting the results in cost-effectiveness planes and cost-effectiveness acceptability curves . Results At two years the incremental cost-effectiveness ratio was € 1009/kg weight loss in the phone group and € 16/kg weight loss in the internet group . The cost-utility analysis result ed in € 245,243/ quality adjusted life year ( QALY ) and € 1337/QALY , respectively . The results from a complete-case analysis were slightly more favorable . However , there was considerable uncertainty around all outcomes . Conclusions Neither intervention mode was proven to be cost-effective compared to self-help . Trial registration IS RCT Purpose . Evaluate the long-term impact of telephone-based interventions that target high risk , ready-to-change individuals . Design . Quasi-experimental design with pre/post comparisons of lifestyle-related health risks between participants and non participants . Setting . Six organizations from the private and public sectors . Subjects . Subjects were 607 intervention participants who were compared with a control group of 1134 eligible non participants . Measures . Health risk assessment at baseline and at an average of 2 years later measured risk in 13 lifestyle areas . Intervention . Programs were offered in seven areas : back care , cholesterol control , eating habits , exercise and activities , stress management , tobacco use , and weight control . Each program was conducted by a trained health educator who provided information and counseling to facilitate change in the area selected by the participant . All counseling was done by telephone and included three to five contacts over a 1-year period . Results . Binary logistic regression models controlling for gender and age revealed both specific and general effects . Participants were 1.8 to 3.5 times as likely as non participants to reduce the targeted risk in six of seven risk areas . In addition , participants were 1.7 to 3.5 times as likely as non participants to reduce their risks in nine of 13 areas not targeted by the intervention ( i.e. , general effect ) . Overall , participants significantly reduced their number of risks , whereas non participants significantly increased their risk ( difference of .85 risks ) . Conclusions . Results show that at-risk participants make long-term improvements in health risks directly related to the intervention in which they participate . Results also suggest that this intervention may help individuals develop behavior-change skills they can apply to other lifestyle issues UNLABELLED This study examines the change in health-related quality of life ( HRQoL ) among ( > or = 60 years ) elderly persons as a result of health education intervention . A community-based intervention study was performed in eight r and omly selected villages ( INTERVENTION n = 4 ; CONTROL n = 4 ) in rural Bangladesh . A total of 1135 elderly persons was selected for this study . The analyses include 839 participants ( INTERVENTION n = 425 ; CONTROL n = 414 ) who participated in both baseline and post-intervention surveys . Participants in the intervention area were further stratified into compliant ( n = 315 ) and non-compliant ( n = 110 ) groups based on the reported compliance to the intervention activities . The intervention includes , for example , physical activity , advice on healthy food intake and other aspects of management . To create an enabling environment , social awareness was provided by means of information about the contribution of and challenges faced by elderly persons at home and the community , including information about elderly persons ' health and health care . The intervention activities were provided to the elderly persons , caregivers , household members and community people for 15 months . The HRQoL was assessed using a multi-dimensional generic instrument design ed for elderly persons . Multivariate analyses revealed that in the non-compliant group the probabilities of increased scores were less likely in overall HRQoL ( OR 0.52 , 95 % CI 0.32 - 0.82 ) . Among the CONTROL group , increased scores were less likely in the physical ( OR 73 , 95 % CI 0.54 - 0.99 ) , social ( OR 0.37 , 95 % CI 0.27 - 0.50 ) , spiritual ( OR 0.60 , 95 % CI 0.34 - 0.94 ) , environment ( OR 0.36 , 95 % CI 0.26 - 0.49 ) dimensions and overall HRQoL ( OR 0.44 , 95 % CI 0.32 - 0.59 ) ( adjusted for age , sex , literacy , marital status and economic status ) . This study concludes that provision of community-based health education intervention might be a potential public health initiative to enhance the HRQoL in old age Background Different studies have reported the effectiveness of Web-based computer-tailored lifestyle interventions , but economic evaluations of these interventions are scarce . Objective The objective was to assess the cost-effectiveness and cost-utility of a sequential and a simultaneous Web-based computer-tailored lifestyle intervention for adults compared to a control group . Methods The economic evaluation , conducted from a societal perspective , was part of a 2-year r and omized controlled trial including 3 study groups . All groups received personalized health risk appraisal s based on the guidelines for physical activity , fruit intake , vegetable intake , alcohol consumption , and smoking . Additionally , respondents in the sequential condition received personal advice about one lifestyle behavior in the first year and a second behavior in the second year ; respondents in the simultaneous condition received personal advice about all unhealthy behaviors in both years . During a period of 24 months , health care use , medication use , absenteeism from work , and quality of life ( EQ-5D-3L ) were assessed every 3 months using Web-based question naires . Demographics were assessed at baseline , and lifestyle behaviors were assessed at both baseline and after 24 months . Cost-effectiveness and cost-utility analyses were performed based on the outcome measures lifestyle factor ( the number of guidelines respondents adhered to ) and quality of life , respectively . We accounted for uncertainty by using bootstrapping techniques and sensitivity analyses . Results A total of 1733 respondents were included in the analyses . From a willingness to pay of € 4594 per additional guideline met , the sequential intervention ( n=552 ) was likely to be the most cost-effective , whereas from a willingness to pay of € 10,850 , the simultaneous intervention ( n=517 ) was likely to be most cost-effective . The control condition ( n=664 ) appeared to be preferred with regard to quality of life . Conclusions Both the sequential and the simultaneous lifestyle interventions were likely to be cost-effective when it concerned the lifestyle factor , whereas the control condition was when it concerned quality of life . However , there is no accepted cutoff point for the willingness to pay per gain in lifestyle behaviors , making it impossible to draw firm conclusions . Further economic evaluations of lifestyle interventions are needed . Trial Registration Dutch Trial Register NTR2168 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2168 ( Archived by WebCite at http://www.webcitation.org/6MbUqttYB ) BACKGROUND To evaluate the long-term cost-effectiveness of two home-based cardiac rehabilitation ( CR ) interventions ( Healthy Weight ( HW ) and Physical Activity ( PA ) ) for patients with cardiovascular disease ( CVD ) , who had been referred to cardiac rehabilitation ( CR ) but had not attended . The interventions consisted of pedometer-based telephone coaching sessions on weight , nutrition and physical activity ( HW group ) or physical activity only ( PA group ) and were compared to a control group who received information brochures about physical activity . METHODS A cost-effectiveness analysis was conducted using data from two r and omised controlled trials . One trial compared HW to PA ( PANACHE study ) , and the second compared PA to usual care . A Markov model was developed which used one risk factor , body mass index ( BMI ) to determine the CVD risk level and mortality . Patient-level data from the trials were used to determine the transitions to CVD states and healthcare related costs . The model was run for separate cohorts of males and females . Univariate and probabilistic sensitivity analysis were conducted to test the robustness of the results . RESULTS Given a willingness-to-pay threshold of $ 50,000/QALY , in the long run , both the HW and PA interventions are cost-effective compared with usual care . While the HW intervention is more effective , it also costs more than both the PA intervention and the control group due to higher intervention costs . However , the HW intervention is still cost-effective relative to the PA intervention for both men and women . Sensitivity analysis suggests that the results are robust . CONCLUSION The results of this paper provide evidence of the long-term cost-effectiveness of home-based CR interventions for patients who are referred to CR but do not attend . Both the HW and PA interventions can be recommended as cost-effective home-based CR programs , especially for people lacking access to hospital services or who are unable to participate in traditional CR programs BACKGROUND Because preventing functional decline in older adults is a national priority and senior centers have been identified as potentially important venues for health-promotion activities , a trial of a multicomponent disability prevention program was conducted at a senior center . METHODS One hundred older adults were recruited for a 6-month r and omized clinical trial . All members of the experimental group received an exercise intervention , nutrition counseling , and a home safety assessment . Smoking and alcohol interventions were delivered to at-risk subjects . Outcome variables included the Medical Outcomes Study Short Form ( SF-36 ) health survey , the CES-Depression scale , bed days , and restricted-activity days . RESULTS A single study announcement result ed in a response sufficient to recruit 100 subjects . The exercise program was well received : 85 % of intervention subjects completed the 6-month program and adherence was excellent , with over 90 % attendance at exercise classes . After 6 months the intervention group had significantly better scores on 7 of 8 SF-36 subscales and fewer depressive symptoms than controls . CONCLUSIONS Senior centers may be excellent sites for community-based health promotion interventions : participation and adherence rates may be acceptable , interventions can be design ed that are feasible in this setting , and these interventions appear to affect health status positively . The study program improved physical and psychosocial functioning and is a promising model for preventing functional decline through activities based at senior centers Background Engaging practicing physicians in educational strategies that reinforce guideline adoption and improve the quality of healthcare may be difficult . Push technologies such as email offer new opportunities to engage physicians in online educational reinforcing strategies . The objectives are to investigate 1 ) the effectiveness of email announcements in engaging recruited community-based primary care physicians in an online guideline reinforcement strategy design ed to promote Chlamydia screening , 2 ) the characteristics of physicians who respond to email announcements , as well as 3 ) how quickly and when they respond to email announcements . Methods Over a 45-week period , 445 recruited physicians received up to 33 email contacts announcing and reminding them of an online women 's health guideline reinforcing CME activity . Participation was defined as physician log-on at least once to the website . Data were analyzed to determine participation , to compare characteristics of participants with recruited physicians who did not participate , and to determine at what point and when participants logged on . Results Of 445 recruited physicians with accurate email addresses , 47.2 % logged on and completed at least one module . There were no significant differences by age , race , or specialty between participants and non- participants . Female physicians , US medical graduates and MDs had higher participation rates than male physicians , international medical graduates and DOs . Physicians with higher baseline screening rates were significantly more likely to log on to the course . The first 10 emails were the most effective in engaging community-based physicians to complete the intervention . Physicians were more likely to log on in the afternoon and evening and on Monday or Thursday . Conclusions Email course reminders may enhance recruitment of physicians to interventions design ed to reinforce guideline adoption ; physicians ' response to email reminders may vary by gender , degree , and country of medical training . Repetition of email communications contributes to physician online participation AIMS To determine the 12-month , societal cost-effectiveness of involving urinary incontinence ( UI ) nurse specialists in primary care compared to care-as-usual by general practitioners ( GPs ) . METHODS From 2005 until 2008 an economic evaluation was performed alongside a pragmatic multicenter r and omized controlled trial comparing UI patients receiving care by nurse specialists with patients receiving care-as-usual by GPs in the Netherl and s. One hundred eighty-six adult patients with stress , urgency , or mixed UI were r and omly allocated to the intervention and 198 to care-as-usual ; they were followed for 1 year . Main outcome measures were Quality Adjusted Life Year ( QALY(societal ) ) based on societal preferences for health outcomes ( EuroQol-5D ) , QALY(patient ) based on patient preferences for health outcomes ( EuroQol VAS ) , and Incontinence Severity weighted Life Year ( ISLY ) based on patient-reported severity and impact of UI ( ICIQ-UI SF ) . Health care re source use , patient and family costs , and productivity costs were assessed . Data were collected by three monthly question naires . Incremental cost-effectiveness ratios were calculated . Uncertainty was assessed using bootstrap simulation , and the expected value of perfect information was calculated ( EVPI ) . RESULTS Compared to care-as-usual , nurse specialist involvement costs € 16,742/QALY(societal ) gained . Both QALY(patient ) and ISLY yield slightly more favorable cost-effectiveness results . At a threshold of € 40,000/QALY(societal , ) the probability that the intervention is cost-effective is 58 % . The EVPI amounts to € 78 million . CONCLUSIONS Based on these results , we recommend adopting the nurse specialist intervention in primary care , while conducting more research through careful monitoring of the effectiveness and costs of the intervention in routine practice Objectives To explore the cost-effectiveness of a supervised moderate-to-high intensity aerobic exercise programme in people diagnosed with Alzheimer ’s disease ( AD ) and estimate incremental cost-effectiveness ratios ( ICER ) using participant-reported and proxy-reported measures of health-related quality of life ( HRQoL ) Design A cost-effectiveness analysis of economic and HRQoL data from a r and omised trial delivered over 16 weeks . Setting Memory clinics in Denmark . Participants 200 individuals with mild AD aged 50–90 years gave informed consent to participate in the study . Participants were r and omised to control or intervention group . Interventions Control group received treatment as usual . The intervention group performed 1 hour of supervised moderate-to-high intensity aerobic exercise three times weekly for 16 weeks . Primary and secondary outcomes measures Different physical , functional and health measures were obtained at inclusion ( baseline ) and 4 and 16 weeks after . HRQoL ( EuroQol-5 Dimensions-5 Levels/EQ-Visual Analogue Scale ) was reported by the participants and the primary caregivers as proxy respondents . Differences in HRQOL as reported by the participant and caregiver were explored as were different values of caregiver time with respite from care tasks . Results The intervention cost was estimated at € 608 and € 496 per participant , with and without transport cost , respectively . Participants and caregivers in the intervention group reported a small , positive non-significant improvement in EQ-5D-5L and EQ-VAS after 16 weeks . The ICER was estimated at € 72 000/ quality -adjusted life year using participant-reported outcomes and € 87000 using caregiver-reported outcomes . Conclusions The findings suggest that the exercise intervention is unlikely to be cost-effective within the commonly applied threshold values . The cost of the intervention might be offset by potential savings from reduction in use of health and social care . Trial registration number https:// clinical trials.gov/ct2/show/NCT01681602 OBJECTIVE Older adults in the U.S. have high rates of obesity . Despite the demonstrated efficacy of lifestyle interventions among older adults , lifestyle interventions are not widely implemented in community setting s. Program delivery by lay health educators ( LHEs ) might support greater dissemination because of lower delivery cost and greater accessibility . We examined the costs of a LHE-delivered translation of the Diabetes Prevention Program ( DPP ) evidence -based lifestyle intervention for older adults in Arkansas senior centers . METHODS This examination of costs used data from a cluster r and omized control trial ( conducted 2008 - 2010 ) in which 7 senior centers ( 116 participants ) were r and omized to implement a LHE-delivered 12-session translation of the DPP lifestyle intervention . We compiled direct lifestyle intervention  implementation costs , including training , recruitment , material s , and ongoing intervention implementation support . Weight loss data ( at 4-month follow-up ) were collected from participants . RESULTS Participant weight loss averaged 3.7 kg at 4-months . The total estimated cost to implement the lifestyle intervention is $ 2731 per senior center , or $ 165 per participant . The implementation cost per kilogram lost is $ 45 . CONCLUSIONS A LHE-delivered DPP translation in senior centers is effective in achieving weight loss at low cost and offers promise for the dissemination of this evidence -based intervention OBJECTIVES The aim of this study is to examine the cost-effectiveness of a group-based peer support intervention in general practice for patients with type 2 diabetes . METHODS Incremental cost utility analysis combining within trial and beyond trial components to compare the lifetime costs and benefits of alternative strategies : CONTROL st and ardized diabetes care ; INTERVENTION group-based peer support in addition to st and ardized diabetes care . Within trial analysis was based on a cluster r and omized controlled trial of 395 patients with type 2 diabetes in the east of Irel and . Beyond trial analysis was conducted using the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) Outcomes Model . Uncertainty was explored using a range of sensitivity analyses and cost-effectiveness acceptability curves were generated . RESULTS Compared with the control strategy , the intervention was associated with an increase of 0.09 ( 95 percent confidence interval [ CI ] , -0.05 to 0.25 ) in mean quality -adjusted life-years per patient and savings of € 637.43 ( 95 percent CI , -2455.19 to 1125.45 ) in mean healthcare cost per patient and € 623.39 ( 95 percent CI , -2507.98 to 1298.49 ) in mean total cost per patient respectively . The likelihood of the intervention being cost-effective was appreciably higher than 80 percent for a range of potential willingness-to-pay cost-effectiveness thresholds . CONCLUSIONS Our results suggest that while a group-based peer support intervention shows a trend toward improved risk factor management , we found no significant differences in final cost or effectiveness endpoints between intervention and control . The probabilistic results suggest that the intervention was more cost-effective , with probability values of higher than 80 percent across a range of potential cost-effectiveness threshold values
We found little evidence of effectiveness of HRLAs for promotion of exercise/improved diets .
Conclusions Overall , there is limited evidence suggesting that HRLAs are cost-effective in terms of changing health-related knowledge , behaviours or health outcomes .
The evidence that does exist indicates that HRLAs are only cost-effective when they target behaviours likely to have a large impact on overall health-related quality of life .
Background Development of new peer or lay health-related lifestyle advisor ( HRLA ) roles is one response to the need to enhance public engagement in , and improve cost-effectiveness of , health improvement interventions .
This article synthesis es evidence on the cost-effectiveness of HRLA interventions aim ed at adults in developed countries , derived from the first systematic review of the effectiveness , cost-effectiveness , equity and acceptability of different types of HRLA role .