Economics of Community Health Workers for Chronic Disease: Findings From Community Guide Systematic Reviews
Context:Cardiovascular disease in the U.S. accounted for healthcare cost and productivity losses of$330 billion in 2013?2014 and diabetes accounted for $327 billion in 2017. The impact is dispro-portionate on minority and low-SES populations. This paper examines the available evidence oncost, economic benefit, and cost effectiveness of interventions that engage community health work-ers to prevent cardiovascular disease, prevent type 2 diabetes, and manage type 2 diabetes.Evidence acquisition:Literature from the inception of databases through July 2016 was searchedfor studies with economic information, yielding nine studies in cardiovascular disease prevention,seven studies in type 2 diabetes prevention, and 13 studies in type 2 diabetes management. Analyseswere done in 2017. Monetary values are reported in 2016 U.S. dollars.Evidence synthesis:The median intervention cost per patient per year was $329 for cardiovasculardisease prevention, $600 for type 2 diabetes prevention, and $571 for type 2 diabetes management.The median change in healthcare cost per patient per year was?$82 for cardiovascular disease pre-vention and?$72 for type 2 diabetes management. For type 2 diabetes prevention, one study saw nochange and another reported?$1,242 for healthcare cost. One study reported a favorable 1.8 returnon investment from engaging community health workers for cardiovascular disease prevention.Median cost per quality-adjusted life year gained was $17,670 for cardiovascular disease prevention,$17,138 (mean) for type 2 diabetes prevention, and $35,837 for type 2 diabetes management.Conclusions:Interventions engaging community health workers are cost effective for cardiovas-cular disease prevention and type 2 diabetes management, based on a conservative $50,000 bench-mark for cost per quality-adjusted life year gained. Two cost per quality-adjusted life year estimatesfor type 2 diabetes prevention were far below the $50,000 benchmark.Am J Prev Med 2019;56(3):e95?e106. Published by Elsevier Inc. on behalf of American Journal of PreventiveMedicine.