Costs and cost-effectiveness of community health worker programmes focussed on non-communicable diseases in low- and middle-income countries (2015–2024): a scoping literature review

Background Non-communicable diseases (NCDs) are the leading cause of death and morbidity worldwide, responsible for 7 out of 10 deaths, 86% occurring in low- and middle-income countries (LMICs). As the NCD burden on health systems increases, community health workers (CHWs) have become increasingly involved in NCD care provision and management. This study updates a 2015 review to synthesise and critically analyse the recent evidence base on the cost-effectiveness and affordability of CHW programmes addressing NCDs in LMICs. 

Methods A scoping review searched 10 databases and the grey literature for original studies published between August 2015 and July 2024. Recognised search terms related to ‘Community Health Workers’ and ‘Economic Evaluation(s)’ in LMICs were used. Covidence software was employed to screen studies based on inclusion and exclusion criteria. Data on study methodology, costs and cost-related outcomes were then extracted, tabulated in a data-extraction form and analysed using Microsoft Excel. 

Results We identified 20 studies with 52 different scenarios covering five areas: cardiovascular disease including hypertension (n=22 scenarios); human papillomavirus and cervical cancer screening (n=13); diabetes (n=12); mental health (n=4); and behavioural risk factors (n=1). Of the 44 scenarios assessing cost-effectiveness, 35 scenarios suggest that CHW programmes are cost-effective. 11 studies compared CHW programmes against an alternative (usual care) to generate an incremental cost-effectiveness ratio, evaluated against the country’s gross domestic product per capita. Methodological heterogeneity across studies and inconsistencies or data gaps in reporting (most importantly the lack of CHW salary information) limits the usefulness of the data. Few studies assessed affordability, despite being equally relevant to decision-making. 

Conclusions More studies including economic evaluations (particularly for NCDs not found in our review), along with more robust and consistent reporting are needed.