• Ruben Willems, Konstantina Tsoutsoulopoulou, Ruben Brondeel, Greet Cardon, Konstantinos Makrilakis, Stavros Liatis, Jaana Lindström, Jemina Kivelä, Esther M González-Gil, Natalia Giménez-Legarre, Natalya Usheva, Violeta Iotova, Tsvetalina Tankova, Emese Antal, Imre Rurik, Patrick Timpel, Peter E H Schwarz, Yannis Manios, and Lieven Annemans.
• Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. Electronic address: Ruben.Willems@ugent.be.
• Prev Med. 2021 Dec 1; 153: 106722.

AbstractThe 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.Copyright © 2021 Elsevier Inc. All rights reserved.

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