Cost-effectiveness of health-related lifestyle advice delivered by peer or lay advisors: synthesis of evidence from a systematic review

Abstract

BackgroundDevelopment 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 synthesises evidence on the cost-effectiveness of HRLA interventions aimed 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.MethodsThe best available evidence on the cost-effectiveness of HRLA interventions was obtained using systematic searches of 20 electronic databases and key journals, as well as searches of the grey literature and the internet. Interventions were classified according to the primary health behaviour targeted and intervention costs were estimated where necessary. Lifetime health gains were estimated (in quality-adjusted life years, where possible), based on evidence of effectiveness of HRLAs in combination with published estimates of the lifetime health gains resulting from lifestyle changes, and assumptions over relapse. Incremental cost-effectiveness ratios are reported.ResultsEvidence of the cost-effectiveness of HRLAs was identified from 24 trials included in the systematic review. The interventions were grouped into eight areas. We found little evidence of effectiveness of HRLAs for promotion of exercise/improved diets. Where HRLAs were effective cost-effectiveness varied considerably: Incremental Cost effectiveness Ratios were estimated at £6,000 for smoking cessation; £14,000 for a telephone based type 2 diabetes management; and £250,000 or greater for promotion of mammography attendance and for HIV prevention amongst drug users. We lacked sufficient evidence to estimate ICERs for breastfeeding promotion and mental health promotion, or to assess the impact of HRLAs on health inequalities.ConclusionsOverall, 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. Further development of HRLA interventions needs to target specific population health needs where potential exists for significant improvement, and include rigorous evaluation to ensure that HRLAs provide sufficient value for money.

Outreach programmes for health improvement of Traveller Communities: a synthesis of evidence

“…146 The benefit from attendance at mammographic screening is small and unlikely to justify a programme to encourage attendance at screening. 107,147 The benefits of boosting vaccination rates are less well defined. Around nine deaths and 5500 inpatient days are attributed to pertussis annually in the UK.…”

Lay Health Trainers Supporting Self-Management amongst Those with Low Heath Literacy and Diabetes: Lessons from a Mixed Methods Pilot, Feasibility Study

“…As a part of the response to the growing number of people living with long-term conditions, a number of which relate to health behaviours, many countries have developed the role of health-related lifestyle advisors (HRLAs) [9]. In the UK the term Lay Health Trainer (LHT) has been adopted.…”

“…However, they were not designed to work with specific health conditions and little work has explored their efficacy in chronic long-term condition management, such as diabetes [11, 12]. Nonetheless, Pennington and colleagues, in their systematic review of the effectiveness, cost-effectiveness, equity, and acceptability of different types of HRLA role, identified some evidence that lay-led self-management interventions can be both effectual and cost-effective [9]. …”

Impact and acceptability of lay health trainer-led lifestyle interventions delivered in primary care: a mixed method study

“…In a cost-effectiveness analysis of the UK Expert Patients Programme, most of the intervention costs were offset by reductions in inpatient days, although these were largely attributable to a few resource-intensive patients (Richardson et al, 2002). Nevertheless, chronic disease management programmes offer the possibility of enabling patient empowerment at modest or zero overall cost (Pennington et al, 2013). In relation to management of type 2 diabetes or impaired glucose tolerance, studies consistently report falls in HbA1c levels attributable to the interventions (Gary et al, 2003, Lujan et al, 2007, Young et al, 2005, Betzlbacher et al, 2013.…”

“…Previous reviews have identified positive effects from LHW programmes, often in terms of increasing access to care for disadvantaged and marginalised populations (Swider, 2002, Andrews et al, 2004. Specific areas where LHW interventions have been found to be effective and cost-effective include: smoking cessation, tuberculosis treatment, HIV prevention, and education to reduce neonatal and maternal mortality (Islam et al, 2002, Sinanovic et al, 2003, Carr et al, 2011, Borghi et al, 2005, Manandhar et al, 2004, Pennington et al, 2013. There is also a separate but linked body of literature on the role of lay or peer support in the management of chronic conditions (Lorig et al, 1993, Reinschmidt et al, 2006, Lorig et al, 1999.…”