{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Department of Reproductive Medicine, KK Women's and Children’s Hospital, Singapore",
        "Academic Clinical Program, Duke-NUS Medical School, Singapore"
      ],
      "name": "Kyaw Zay Ya"
    },
    {
      "affiliations": [
        "Department of Reproductive Medicine, KK Women's and Children’s Hospital, Singapore",
        "Academic Clinical Program, Duke-NUS Medical School, Singapore",
        "SingHealth Duke-NUS Maternal and Child Health Research Institute, KK Women's and Children’s Hospital, Singapore"
      ],
      "name": "Chee Wai Ku"
    },
    {
      "affiliations": [
        "Department of Reproductive Medicine, KK Women's and Children’s Hospital, Singapore",
        "Academic Clinical Program, Duke-NUS Medical School, Singapore",
        "SingHealth Duke-NUS Maternal and Child Health Research Institute, KK Women's and Children’s Hospital, Singapore"
      ],
      "name": "See Ling Loy"
    },
    {
      "affiliations": [
        "Department of Reproductive Medicine, KK Women's and Children’s Hospital, Singapore",
        "SingHealth Duke-NUS Maternal and Child Health Research Institute, KK Women's and Children’s Hospital, Singapore"
      ],
      "name": "Annabel Ngien"
    },
    {
      "affiliations": [
        "Department of Reproductive Medicine, KK Women's and Children’s Hospital, Singapore",
        "Academic Clinical Program, Duke-NUS Medical School, Singapore",
        "SingHealth Duke-NUS Maternal and Child Health Research Institute, KK Women's and Children’s Hospital, Singapore"
      ],
      "name": "Kai Ting Mok"
    },
    {
      "affiliations": [
        "Academic Clinical Program, Duke-NUS Medical School, Singapore",
        "SingHealth Duke-NUS Maternal and Child Health Research Institute, KK Women's and Children’s Hospital, Singapore",
        "Department of Neonatology, KK Women's and Children’s Hospital, Singapore"
      ],
      "name": "Mei Chien Chua"
    },
    {
      "affiliations": [
        "Academic Clinical Program, Duke-NUS Medical School, Singapore",
        "SingHealth Duke-NUS Maternal and Child Health Research Institute, KK Women's and Children’s Hospital, Singapore",
        "Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore",
        "Endocrinology Service, Department of Paediatrics, KK Women's and Children’s Hospital, Singapore"
      ],
      "name": "Fabian Yap"
    },
    {
      "affiliations": [
        "Department of Reproductive Medicine, KK Women's and Children’s Hospital, Singapore",
        "Academic Clinical Program, Duke-NUS Medical School, Singapore",
        "SingHealth Duke-NUS Maternal and Child Health Research Institute, KK Women's and Children’s Hospital, Singapore"
      ],
      "name": "Jerry Kok Yen Chan"
    },
    {
      "affiliations": [
        "Duke-NUS Medical School, National University of Singapore, Singapore",
        "Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia"
      ],
      "name": "Elizabeth Martin"
    }
  ],
  "title": "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",
  "uid": "6415df43-9799-5dc9-8eb7-d4f0c38a08d8"
}