The Economics and Value of Lifestyle Medicine in Viet Nam: What Evidence Is Needed Before Claiming Savings?

The Economics and Value of Lifestyle Medicine in Viet Nam: What Evidence Is Needed Before Claiming Savings?

Last reviewed: 24 September 2026

Lifestyle Medicine is often discussed not only as a way to improve health, but also as a way to reduce healthcare costs. The logic sounds straightforward. If better nutrition, physical activity, restorative sleep, tobacco cessation and other evidence-based lifestyle interventions can prevent or improve chronic disease, people may need fewer medicines, fewer hospital admissions and less intensive treatment later. From there, it is easy to conclude that Lifestyle Medicine “saves money.”

That conclusion may sometimes be correct, but it requires evidence. An intervention can improve health without reducing total healthcare spending. It can be cost-effective without being cost-saving. It can reduce hospital use while still costing more overall because the intervention itself requires staff, training, follow-up, technology and infrastructure. It may reduce expenditure for a payer while increasing costs for patients or families. A model projecting savings decades into the future is also very different from observing savings in routine Vietnamese healthcare.

For Lifestyle Medicine to develop credibly in Viet Nam, its economic case should be held to the same standard as its clinical case. The intervention needs to be clearly defined, the comparator needs to reflect a realistic alternative, costs and outcomes need to be measured from an explicit perspective, assumptions need to be transparent, and claims should not go beyond what the evidence actually demonstrates.

Why the economic question matters in Viet Nam

The question is increasingly relevant because Viet Nam is facing a high burden of noncommunicable disease, rapid population aging and continuing pressure on healthcare resources. Noncommunicable diseases account for about 80% of deaths nationally. Prevention and community-based management are also receiving greater policy attention, including through the Law on Disease Prevention No. 114/2025/QH15, which was adopted on 10 December 2025 and took effect on 1 July 2026.

Who ultimately pays for healthcare is equally important. A 2026 international health-system profile drawing on World Health Organization data reports that out-of-pocket payments accounted for 39.2% of current health expenditure in Viet Nam in 2023. This means that economic value cannot be assessed only from the perspective of hospitals or the social health insurance system. Costs borne directly by patients and families remain highly relevant.

There is therefore a strong reason to study the economics of Lifestyle Medicine in Viet Nam. But a high burden of chronic disease does not prove that a particular Lifestyle Medicine program will save money. Disease burden tells us how large the health problem is. Economic evaluation asks a different question: whether a specific intervention provides sufficient health value for the resources required when compared with realistic alternatives.

Cost-saving, cost-effective and affordable are different questions

These terms are often used as though they mean the same thing, but they answer different questions. An intervention can reasonably be described as cost-saving when total relevant costs are lower and health outcomes are at least no worse than with the comparator. A cost-effective intervention may cost more. It is considered good value when the additional health gained is judged to justify the additional resources required. Cost-effectiveness is therefore comparative and context-dependent, rather than an inherent characteristic of an intervention.

Cost-utility analysis often expresses this relationship as an incremental cost per quality-adjusted life-year gained. Budget impact analysis asks a different question: what will happen to the payer's actual budget if an intervention is introduced at scale over the next several years? A program can be cost-effective over a long time horizon while still requiring substantial additional expenditure in the short term.

Return on investment is different again. It generally translates selected benefits, such as healthcare savings, reduced absenteeism or productivity gains, into monetary terms and compares them with the money invested. This can be useful for governments and employers, but the result depends heavily on which benefits are included, how they are valued and over what period they are measured.

The World Health Organization's 2025 global investment case for noncommunicable diseases demonstrates substantial economic value from scaling proven interventions. Importantly, however, the analysis draws on the World Health Organization's package of high-impact “Best Buys,” including policy and clinical interventions. It should not be interpreted as evidence that every clinical program described as Lifestyle Medicine will save money.

What does the international evidence actually show?

The diabetes prevention literature provides one of the clearest examples because lifestyle intervention has been studied clinically and economically over relatively long periods. In the United States Diabetes Prevention Program and its Outcomes Study, intensive lifestyle intervention reduced healthcare costs outside the program and produced more quality-adjusted life-years than placebo. Once the cost of delivering the intervention itself was included, however, total direct medical costs were still higher in the lifestyle group. Over 10 years, the intervention was considered cost-effective from a payer perspective, but it was not cost-saving.

The Look AHEAD trial provides an equally useful lesson. Among adults with type 2 diabetes and overweight or obesity, intensive lifestyle intervention reduced some healthcare expenditures, including through lower healthcare utilization. But delivering the intervention itself required substantial resources over many years. During the first nine years of the trial, intervention costs averaged US$11,275 per participant compared with US$887 for diabetes support and education, while healthcare expenditures were lower in the lifestyle group. After both were counted, the intensive lifestyle intervention cost approximately US$6,666 more per participant overall. Whether the intervention met conventional definitions of cost-effectiveness also differed according to the health utility measure used.

This distinction is highly relevant to Lifestyle Medicine. Reporting lower medication costs or fewer hospital admissions while excluding the cost of physicians, dietitians, exercise professionals, health coaches, digital systems, group sessions, administration and follow-up can create an appearance of savings that disappears once the full cost of delivering the program is included.

Systematic evidence also shows considerable variation. A review of 16 trial-based economic evaluations of nonpharmacological diabetes prevention programs found that economic results differed considerably according to the intervention, delivery model and study. Lifestyle programs generally showed greater potential for cost-effectiveness than education-only interventions, but there was no single economic result that could be generalized across programs.

A more defensible conclusion is therefore that some lifestyle interventions have demonstrated favorable cost-effectiveness, and some have reduced particular categories of healthcare spending. That is not the same as evidence that Lifestyle Medicine as a whole saves money.

Viet Nam-specific evidence needs careful interpretation

Economic findings cannot simply be imported from the United States, United Kingdom or Australia and converted into Vietnamese đồng. Staff salaries, healthcare tariffs, medicine prices, insurance reimbursement, patterns of service use, food and transportation costs, family support and baseline disease risk are different. The resources needed to deliver the intervention may also differ substantially.

A 2024 modeling study provides a useful Viet Nam example. Researchers used a Markov model to compare no intervention for prediabetes with metformin extended-release, intensive lifestyle change and combinations of the two in Poland, Saudi Arabia and Viet Nam. All intervention strategies reduced the projected number of people developing type 2 diabetes, but in the Viet Nam model the strategies containing intensive lifestyle change remained net costs compared with inaction at all time horizons through 15 years. Metformin alone was the only strategy that became cost-saving, doing so at approximately year 10 in the Viet Nam analysis. The Vietnamese results were especially sensitive to intervention costs and other model parameters.

There are important limits to what this study tells us about Lifestyle Medicine. Its definition of “intensive lifestyle change” was based on monthly health club or gym attendance and a monthly healthy food budget. The modeled monthly intervention cost for Viet Nam was US$160.74. This is clearly not the same thing as a comprehensive, multidisciplinary Lifestyle Medicine service, and it may not reflect how a Vietnamese program would actually be designed or delivered. The analysis was also model-based rather than a Vietnamese clinical trial or real-world economic evaluation, and the study was funded by Merck KGaA, with company-affiliated authors participating in the work. None of these factors automatically invalidates the findings, but all are relevant when considering their transferability.

The appropriate conclusion is therefore that published Vietnamese economic evidence on comprehensive Lifestyle Medicine programs remains limited. That is not an argument against implementation. It is an argument for building economic evaluation into implementation so that clinical outcomes, resource use and costs are measured rather than assumed.

Before claiming savings, count the real cost of the intervention

The cost of a Lifestyle Medicine program is rarely just the price of a consultation. A credible economic evaluation should include the resources required to identify appropriate participants, conduct assessments, train staff, provide individual or group care, deliver nutrition or exercise support, maintain digital systems, coordinate treatment, monitor outcomes and follow people over time.

If a program uses wearable devices, meal replacements, laboratory testing, educational materials or additional clinical visits, those costs should be counted when they form part of the intervention. Staff time deserves particular attention. Lifestyle interventions may be relatively inexpensive when delivered efficiently through primary care teams, group visits or digital support, but they can become resource-intensive when they depend on frequent individual consultations with highly trained professionals. The delivery model may therefore influence economic value almost as much as the clinical content.

Patient and family costs also matter. These may include transportation, program fees, time away from work, unpaid caregiving and other out-of-pocket expenses. Changes in food expenditure should not automatically be classified as either a cost or a saving. The relevant question is the incremental cost associated with the intervention compared with what the household would otherwise have spent.

This is particularly important in Viet Nam, where out-of-pocket spending still represents a substantial share of health expenditure. A program that saves the social health insurance system VND 1 million while requiring a household to spend an additional VND 3 million creates a very different distribution of value from one that reduces costs for both.

Savings for whom?

No economic claim is complete without specifying the perspective. From a social health insurance perspective, relevant costs may include reimbursed medicines, outpatient services, investigations and hospital admissions. From a hospital perspective, staff time, facilities, operating costs and revenue consequences may matter. From a patient perspective, consultation fees, medicines, travel, food-related costs and time can be important. Employers may care about absenteeism and productivity, while a societal perspective may attempt to capture several of these consequences together.

The same intervention can therefore appear economically attractive from one perspective and less attractive from another. This is why statements such as “the program saved VND X” are incomplete unless the reader knows who saved the money and which costs were included.

There is also an important difference between reducing healthcare utilization and generating cash-releasing savings. Preventing hospital admissions can free capacity and reduce the use of resources, but it does not necessarily mean that a hospital can immediately remove an equivalent amount of cash from its budget. Buildings, equipment, salaried staff and many other costs remain fixed or semi-fixed. Freed capacity may instead allow the organization to care for other patients. In such situations, terms such as cost avoidance, resource release or capacity gained may be more accurate than “savings.”

Time horizon can change the economic conclusion

Prevention often requires investment now for benefits that appear later. Lifestyle programs may require substantial resources during the first year, while reductions in diabetes, cardiovascular events or complications may emerge over a much longer period. A short evaluation can therefore underestimate long-term value, while a lifetime model can do the opposite if short-term effects are assumed to persist for decades without adequate evidence.

A systematic review of 27 economic evaluations of lifestyle and metformin strategies for diabetes prevention found that interventions generally appeared more cost-effective over longer evaluation periods. In the small number of studies examining financial payback, net financial benefits were delayed by approximately 9 to 14 years. The authors also emphasized wide variation in target populations, interventions and modeling assumptions.

Economic evaluations should therefore state clearly how long the analysis runs, how long the intervention effect is expected to persist, whether adherence declines, whether relapse is modeled and how future costs and health outcomes are discounted. Sensitivity analyses should show what happens when the important assumptions change. The point is not that long-term prevention is economically unattractive. It is that the timing of benefits and the assumptions behind them need to be visible.

Health outcomes should come before the savings calculation

The starting question should not be “How much money can this program save?” It should be “Does this intervention improve outcomes that matter?” An intervention does not become valuable simply because it is inexpensive, and reduced medication use is not inherently beneficial if disease control deteriorates or clinically important protection is lost.

Economic evaluation of Lifestyle Medicine therefore depends first on credible evidence of clinical effectiveness. Depending on the intervention, relevant outcomes might include blood pressure, glycated hemoglobin, disease incidence, appropriately defined remission, physical function, health-related quality of life, hospitalization, cardiovascular events or other outcomes meaningful to the population being studied.

Intermediate outcomes such as body weight, physical activity or dietary change can also be useful, but projecting large long-term savings from modest short-term changes requires additional assumptions. Those assumptions need to be justified and tested.

Quality-adjusted life-years provide one way to compare health gains across very different interventions, but economic value is broader than one metric. For older people and those living with multimorbidity, preserving function and independence may be especially important. Equity, affordability and access may also matter to policymakers even when they are not fully reflected in a conventional incremental cost-effectiveness ratio.

Viet Nam is developing a stronger framework for economic evaluation

Viet Nam has begun formalizing economic evaluation within specific health policy and reimbursement processes. On 17 May 2024, the Ministry of Health issued Decision No. 1315/QD-BYT together with technical guidance for pharmacoeconomic evaluation reports. The guidance is intended for evaluations used in the process of proposing, developing and updating medicines within the health insurance benefit context. It covers issues including comparator selection, cost-effectiveness and cost-utility analysis, modeling, budget impact, Vietnamese empirical data and the transferability of international evidence to the Vietnamese setting.

Within this pharmacoeconomic guidance, the base-case costing perspective is that of the social health insurance payer. For model-based evaluations, costs and health outcomes extending beyond one year are discounted at 3% in the base case, with 0% to 6% considered in sensitivity analysis. The guidance also specifies a base-case cost-effectiveness threshold of one to three times Viet Nam's gross domestic product per capita, while allowing other Viet Nam-specific thresholds when appropriately supported.

These provisions need to be interpreted within their proper scope. Decision No. 1315/QD-BYT is guidance for pharmacoeconomic evaluation, particularly in the context of medicines and health insurance reimbursement. It is not a universal legal standard requiring every Lifestyle Medicine program to use the same perspective, threshold or analytical structure. Its relevance here is methodological: it shows that Vietnamese health decision-making is increasingly incorporating structured economic evaluation, local data and explicit consideration of uncertainty in selected reimbursement and priority-setting contexts.

International reporting guidance can also be useful. The Consolidated Health Economic Evaluation Reporting Standards 2022 provide a 28-item checklist for transparent reporting of health economic evaluations, including complex interventions. They are reporting standards, not a scoring tool for methodological quality, and budget impact analyses fall outside their scope.

What evidence would justify saying a Vietnamese program saves money?

For a specific Lifestyle Medicine program in Viet Nam, a credible claim of savings should ideally come from prospective evidence comparing the program with a clearly defined alternative, usually usual care or another realistic model of care. The population, intervention, comparator, setting, time horizon and analytic perspective should all be explicit.

The full cost of delivering the program should be measured. Medicine use, hospital admissions, outpatient visits, investigations and other healthcare utilization should come from reliable Vietnamese data wherever possible. Patient and family costs should be included when relevant to the selected perspective. Outcomes should be followed long enough to detect meaningful differences, and uncertainty should be reported rather than concealed behind a single point estimate.

If longer-term savings are projected through modeling, observed data and assumptions should be clearly separated. Assumptions about adherence, persistence of behavior change, disease progression, intervention durability, inflation, resource use and discounting should be subjected to appropriate sensitivity analyses.

Most importantly, the wording of the claim should match the result. If hospitalization costs fell, say hospitalization costs fell. If healthcare utilization decreased, say healthcare utilization decreased. If an intervention produced additional health at an acceptable additional cost, say that it was cost-effective under the stated assumptions. If total relevant costs, including the resources required to deliver the intervention, were lower and health outcomes were at least as good as the comparator, then describing the program as cost-saving may be justified.

That may sound cautious, but this is exactly the distinction between economic evidence and promotional language.

A practical research agenda for Lifestyle Medicine in Viet Nam

Viet Nam does not need to begin by estimating billions of đồng in national savings. A stronger approach would be to build evidence incrementally through well-designed real-world programs in primary care, hospitals, ambulatory clinics, workplaces or defined community populations.

Baseline clinical status, medication use, healthcare utilization, patient-reported outcomes and costs could be collected prospectively and followed over time. Where feasible, comparison groups should be used instead of relying only on before-and-after measurements. Early studies could focus on areas where clinical outcomes and healthcare utilization can be measured relatively clearly, such as prediabetes, type 2 diabetes, hypertension, cardiometabolic risk associated with obesity or selected populations with multimorbidity.

Different delivery models also deserve evaluation. Individual versus group care, in-person versus hybrid programs, different staffing models and different frequencies of follow-up may produce similar clinical outcomes at very different costs. Implementation outcomes should be measured alongside economics because a program that works in a highly selected research setting may perform very differently at scale. Uptake, adherence, workforce requirements, cultural acceptability, affordability and equity all affect real-world value.

The objective should not be to prove in advance that Lifestyle Medicine saves money. It should be to determine which evidence-based lifestyle interventions work, for whom, in which Vietnamese settings, at what cost, and with what consequences for patients, families and the health system. That evidence would be far more useful than importing a return-on-investment figure from another country.

Value is broader than reducing healthcare expenditure

Focusing too heavily on savings can also set an unnecessarily high standard for prevention. We do not expect every effective medicine, surgical procedure or diagnostic technology to pay for itself. Many accepted healthcare interventions increase expenditure because they enable people to live longer, function better or experience less illness. Lifestyle Medicine should not be judged by a fundamentally different economic standard.

An intervention that costs additional money but produces meaningful and sustained health improvement can still represent excellent value. Conversely, an inexpensive intervention that produces little benefit is not necessarily a good use of resources.

Health economics has long recognized that disease prevention does not automatically eliminate future healthcare expenditure. Longer and healthier lives may also mean that people use healthcare for other conditions later. The appropriate question is therefore often not whether prevention completely pays for itself, but whether the health gained justifies the resources used.

For Viet Nam, value may also include reduced household financial burden, improved access to prevention, more years lived in good health, preserved function and independence, stronger primary care, and more efficient use of specialist and hospital capacity. These potential benefits should be measured where possible rather than assumed.

From an attractive claim to a testable question

There are good reasons to believe that well-designed lifestyle interventions can generate substantial health value. Some have demonstrated favorable cost-effectiveness internationally, and some have reduced particular categories of healthcare expenditure. The World Health Organization's broader evidence also shows that investing in proven noncommunicable disease interventions can generate major health and economic benefits.

But none of this establishes that every Lifestyle Medicine service will save money in Viet Nam. A credible evidence-based field should be comfortable making that distinction.

The stronger question is not simply “Does Lifestyle Medicine save money?” It is “Which evidence-based lifestyle interventions improve meaningful health outcomes in Viet Nam, what resources are required to deliver them, who bears those costs, and do the resulting health and economic benefits justify the investment?”

When those questions are answered with robust Vietnamese data, claims about value, cost-effectiveness or savings can become conclusions rather than assumptions.

Selected references

1. World Health Organization. Saving lives, spending less: the global investment case for noncommunicable diseases. Geneva: World Health Organization; 2025.

2. World Health Organization. Viet Nam unites to tackle top causes of disease and death. 15 December 2025.

3. The Commonwealth Fund. International Health Care System Profiles: Viet Nam. May 2026. Out-of-pocket expenditure data sourced from the World Health Organization Global Health Observatory.

4. Diabetes Prevention Program Research Group. The 10-Year Cost-Effectiveness of Lifestyle Intervention or Metformin for Diabetes Prevention: An Intent-to-Treat Analysis of the Diabetes Prevention Program and Outcomes Study. Diabetes Care. 2012;35(4):723-730. doi:10.2337/dc11-1468.

5. Zhang P, Atkinson KM, Bray GA, et al. Within-Trial Cost-Effectiveness of a Structured Lifestyle Intervention in Adults With Overweight/Obesity and Type 2 Diabetes: Results From the Action for Health in Diabetes Study. Diabetes Care. 2021;44(1):67-74. doi:10.2337/dc20-0358.

6. Xiong Y, Huo Z, Wong SYS, Yip BHK. Cost effectiveness of nonpharmacological prevention programs for diabetes: A systematic review of trial-based studies. Chronic Diseases and Translational Medicine. 2024;10(1):12-21. doi:10.1002/cdt3.89.

7. Al-Omar HA, Czech M, Tran QN, et al. Cost saving analysis of prediabetes intervention modalities in comparison with inaction using Markov state transition model: a multiregional case study. Journal of Diabetes. 2024;16(5):e13553. doi:10.1111/1753-0407.13553.

8. Roberts S, Barry E, Craig D, et al. Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes. BMJ Open. 2017;7:e017184. doi:10.1136/bmjopen-2017-017184.

9. Husereau D, Drummond M, Augustovski F, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 statement: updated reporting guidance for health economic evaluations. BMJ. 2022;376:e067975. doi:10.1136/bmj-2021-067975.

10. Ministry of Health of Viet Nam. Decision No. 1315/QD-BYT dated 17 May 2024, issuing technical guidance for pharmacoeconomic evaluation reports.

11. National Assembly of Viet Nam. Law on Disease Prevention No. 114/2025/QH15. Adopted 10 December 2025; effective 1 July 2026.

This article is intended for professional education and general information. Economic estimates should not be interpreted as predictions of savings for a specific program, healthcare organization, insurer or patient population without an appropriate economic evaluation in the relevant Vietnamese context.

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