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Background: The costs of unhealthy lifestyles and strained budgets of healthcare systems have increased the interest in targeting lifestyle change and disease prevention. International organizations and Swedish government agencies have highlighted the costs and risks associated with unhealthy lifestyles as well as publishing guidelines on how to combat unhealthy living habits. Building on this, Hälsocoach online is a new lifestyle change intervention in Region Västra Götaland (VGR) launched in 2017. The intervention incorporates health coaching and technology to provide clients the support and knowledge to change unhealthy living habits related to tobacco, alcohol, diet, and physical inactivity.

Aim: To establish the cost-effectiveness of Hälsocoach online versus current practice in VGR and provide decision-makers with recommendations for improvement of the intervention based on literature and empirical data.

Design: Cost-effectiveness / Cost-utility analysis.

Data Sources: Empirical data from Hälsocoach online provided by project managers and sourced relevant literature

Target Population: Men and women aged 16 years or older within the catchment area of SÄS and Närhälsan i Sjuhärad. N = 31 ranging from ages 30-66 years old.

Time Horizon: 1 year.

Perspective: Healthcare provider.

Intervention: Hälsocoach online aims to provide support to clients in changing lifestyle habits related to physical inactivity, tobacco usage, alcohol abuse, and poor dietary habits. The program utilizes a digital platform, cross-disciplinary cooperation with other healthcare services, and physical meetings with health coaches to improve overall health while increasing autonomy of clients. Coaching last for 1-3 months on 5-6 occasions where health coaches work with the client toward goals and milestones set by the client themselves.

Outcome Measures: Incremental cost-effectiveness ratios (ICER) comparing Hälsocoach online to current practices (2018 Swedish Kronor (SEK)).

Results of Base-Case Analysis: Results indicate that Hälsocoach online is cost-effective compared to current practices using Swedish thresholds for cost-effectiveness. The cost per unit increase in Hälsocoach online’s perceived health scale was 25 563 SEK. The cost per quality adjusted life-year gained for Hälsocoach Online was 267 728 SEK.

Results of Sensitivity Analysis: Deterministic sensitivity analyses revealed Hälsocoach online consistently fell under established cost-effectiveness thresholds with ICERs ranging between 664 - 334 660 SEK per QALY.

Limitations: The limitations in the study were the lack of a control arm, indirect calculation of QALYs, and the short duration & small size of the dataset used.

Conclusion: Based on the empirical data and in line with the literature, Hälsocoach online is cost-effective and should be continued. The study should be re-evaluated once more clients have completed the program. In addition, more standardized and generalizable instruments for estimating health gains should be implemented.