Economic evaluation of the Healthy Early Life Moments in Singapore (HELMS) programme: a study protocol for an integrated lifestyle intervention supported by a mobile health tool for mothers and children in Singapore

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INTRODUCTION: The Healthy Early Life Moments in Singapore (HELMS) programme was developed by a multidisciplinary team to improve metabolic and mental health outcomes in women/mothers and to promote healthy growth and development in their children. Despite increasing interest in preventive life-course care, evidence on the long-term economic impact of these life-course interventions remains limited. This protocol outlines the economic evaluation of the HELMS integrated lifestyle intervention, supported by a mobile health (mHealth) app, across the reproductive continuum from preconception to postpartum. METHODS AND ANALYSIS: The HELMS programme is conducted at KK Women's and Children's Hospital, recruiting overweight or obese women and planning to conceive. The economic evaluation comprises a within-trial costing study and a cost-effectiveness analysis. We will develop a Markov model for mothers and children to simulate maternal-child health outcomes over a 10-year horizon from the healthcare provider's perspective. Primary data will be sourced from the HELMS programme and supplemented by local mother-child cohorts and published literature. The cost analysis will include direct medical, direct non-medical and programme-related costs incurred through the HELMS intervention. We will measure health outcomes in quality-adjusted life-years (QALYs) using the EuroQol-5 Dimension utility scores. We will conduct both deterministic and probabilistic sensitivity analyses to assess model uncertainty. The evaluation will estimate total and incremental costs, QALYs and incremental cost-effectiveness ratios for HELMS versus standard care. We will present cost-effectiveness acceptability curves and perform subgroup analyses to explore heterogeneity by maternal age, ethnicity and body mass index. A willingness-to-pay threshold appropriate for the Singapore context, based on recently published estimates, will be used to determine cost-effectiveness. We will also identify key cost drivers and examine the intervention's scalability. ETHICS AND DISSEMINATION: The study has been approved by the Centralised Institutional Review Board of SingHealth (2021/2247). Written informed consent will be obtained from all participants. The findings will be published in peer-reviewed journals and disseminated to international and national policy makers. TRIAL REGISTRATION NUMBER: NCT05207059.

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