title: Increasing heart-health lifestyles in deprived communities: economic evaluation of lay health trainers.
abstract: OBJECTIVE
  Cardiovascular disease (CVD) often arises from modifiable lifestyle factors. Health care professionals may lack the skills and resources to sustain behaviour change, lay 'health trainers' (LHT) offer a potential alternative. We sought to assess the cost-effectiveness of using a LHT to improve heart-health lifestyles in deprived communities.
  
  
  METHODS
  Participants in this randomized trial were aged ≥18 years with at least one risk factor for CVD (hypertension, raised cholesterol, diabetes, BMI>30 or current smoker). Both groups received health promotion literature. LHT were also able to provide intervention participants with information, advice and support aimed at changing beliefs and behaviour. Costs and quality-adjusted life year (QALY) changes were estimated over 6 months. The cost-utility [incremental cost-effectiveness ratio (ICER)] of LHT was calculated and assessed in relation to the cost-effectiveness threshold of £20 000-30 000 per QALY. The probability of LHT being cost-effective was also calculated.
  
  
  RESULTS
  Seventy-two participants were randomized to a LHT, with 38 controls. The mean cost of the LHT intervention was £151. On average, other health and social service costs fell by £21 for controls and £75 for intervention participants giving a LHT mean overall incremental cost of £98. The mean QALY gains were 0.022 and 0.028, respectively. The ICER for LHT was £14 480, yet there was a 61% chance of making the wrong decision at a £20 000/QALY threshold.
  
  
  CONCLUSIONS
  LHT provision was estimated to be cost-effective for people at risk of CVD. However, a large level of uncertainty was associated with that decision.
authors.affiliation: Health Economics Group (HEG), Norwich Medical School, Faculty of Medicine and Health Sciences, Chancellor's Drive, University of East Anglia, Norwich, UK. g.barton@uea.ac.uk
authors.forename: Garry R
authors.initials: GR
authors.lastname: Barton
authors.forename: Mark
authors.initials: M
authors.lastname: Goodall
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.forename: Sue
authors.initials: S
authors.lastname: Woolf
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
authors.forename: Mark B
authors.initials: MB
authors.lastname: Gabbay
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D058006:General Practice; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D011204:Poverty Areas; D040242:Risk Reduction Behavior; D013222:State Medicine; D006113:United Kingdom