ABSTRACTBackgroundLifestyle Africais an adapted version of the Diabetes Prevention Program designed for delivery by community health workers to socioeconomically disadvantaged populations in low- and middle-income countries (LMICs). Results from theLifestyle Africatrial conducted in an under-resourced community in South Africa indicated that the programme had a significant effect on reducing haemoglobin A1c (HbA1c).ObjectiveTo estimate the cost of implementation and the cost-effectiveness (in cost per point reduction in HbA1c) of theLifestyle Africaprogramme to inform decision-makers of the resources required and the value of this intervention.MethodsInterviews were held with project administrators to identify the activities and resources required to implement the intervention. A direct-measure micro-costing approach was used to determine the number of units and unit cost for each resource. The incremental cost per one point improvement in HbA1c was calculated.ResultsThe intervention equated to 71 United States dollars (USD) in implementation costs per participant and a 0.26 improvement in HbA1c per participant.ConclusionsLifestyle Africareduced HbA1c for relatively little cost and holds promise for addressing chronic disease in LMIC. Decision-makers should consider the comparative clinical effectiveness and cost-effectiveness of this intervention when making resource allocation decisions.Trial RegistrationTrial registration is at ClinicalTrials.gov (NCT03342274).