TY - JOUR T1 - Cost-effectiveness analysis of a school- and community-based intervention to promote a healthy lifestyle and prevent type 2 diabetes in vulnerable families across Europe: the Feel4Diabetes-study. JF - Prev Med Y1 - 2021 A1 - Ruben Willems A1 - Konstantina Tsoutsoulopoulou A1 - Ruben Brondeel A1 - Greet Cardon A1 - Konstantinos Makrilakis A1 - Stavros Liatis A1 - Jaana Lindström A1 - Jemina Kivelä A1 - Esther M González-Gil A1 - Natalia Giménez-Legarre A1 - Natalya Usheva A1 - Violeta Iotova A1 - Tsvetalina Tankova A1 - Emese Antal A1 - Imre Rurik A1 - Patrick Timpel A1 - Peter E H Schwarz A1 - Yannis Manios A1 - Annemans, Lieven AB -

The Feel4Diabetes-study implemented a school- and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes mellitus (T2DM) in six European countries. The intervention included a special focus on families at increased T2DM risk. The current study evaluates the intervention's cost-effectiveness. A Markov-type health economic model was developed to predict the incidence of T2DM and its complications. Incremental cost-effectiveness ratios (lifetime horizon, societal perspective) were calculated based on the overall intervention effect on health behaviour, and stratified for low- and high-risk families. Sensitivity analyses captured input parameters uncertainty. A budget impact analysis was performed. The increase in children's water consumption and physical activity led to a modest gain in quality adjusted life years (QALYs) at a low intervention cost and budget impact. Medical cost savings due to avoided illness could only be achieved on the very long-term (>30 years). The intervention in its entirety was cost-effective (more QALYs at a reasonable investment) in Belgium, Finland, Bulgaria, and Hungary, while being dominant (net savings and more QALYs) in Greece and Spain. Results were cost-effective for the low-risk families, who only received the school- and community-based intervention component. Results for the high-risk families were only cost-effective (with considerable uncertainty) in Greece and Spain, but not when the intervention would need to be repeated. The Feel4Diabetes-intervention is potentially cost-effective, especially in countries with a high overweight and obesity prevalence, at a limited budget impact. The incremental financial investments to reach and support high-risk families did not result in the hoped-for health benefits.

VL - 153 M3 - 10.1016/j.ypmed.2021.106722 ER -