Cardiovascular Disease Screening By Community Health Workers Can Be Cost-Effective In Low-Resource Countries

Abstract

In low-resource settings, a physician is not always available. We recently demonstrated that community health workers—instead of physicians or nurses—can efficiently screen adults for cardiovascular disease in South Africa, Mexico, and Guatemala. In this analysis we sought to determine the health and economic impacts of shifting this screening to community health workers equipped with either a paper-based or a mobile phone–based screening tool. We found that screening by community health workers was very cost-effective or even cost-saving in all three countries, compared to the usual clinic-based screening. The mobile application emerged as the most cost-effective strategy because it could save more lives than the paper tool at minimal extra cost. Our modeling indicated that screening by community health workers, combined with improved treatment rates, would increase the number of deaths averted from 15,000 to 110,000, compared to standard care. Policy makers should promote greater acceptance of community health workers by both national populations and health professionals and should increase their commitment to treating cardiovascular disease and making medications available.

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

“…78 The most recent data demonstrate that well-trained community health workers can deliver lifestyle modification advice, 79 identify high-risk individuals with similar effectiveness to primary care physicians, 80 be cost-effective in helping patients to adhere to hypertension regimens, 81 and be trained to use mHealth tools effectively. 78,82,83 However, exactly what and how many roles (screening, follow-up, medication prescription) these community health workers should play is unclear. The integration of this workforce into the existing health infrastructure is also a challenge, because their effectiveness depends on the ability to triage the diagnosed cases to appropriate levels of care and to ensure the delivery of medication.…”

Management of Hypertension and Dyslipidemia for Primary Prevention of Cardiovascular Disease

“…CHWs using the same tool in a mobile phone application could save an estimated 15,000-110,000 lives in Guatemala, Mexico, or South Africa at very cost-effective ratios. Using CHWs to screen for CVD using a simple tool is much more cost-effective when the primary health system is prepared and equipped to treat persons identified as high risk (Gaziano, Abrahams-Gessel, Surka, and others 2015). In countries such as South Africa, where at least half of persons identified as high risk get medications, the screening intervention was cost saving.…”

“…Multidrug regimens for secondary prevention of CVD are cost-effective even in LMICs, according to WHO standards (Gaziano and Pagidipati 2013). Application of mHealth (mobile health) strategies and involvement of CHWs in CVD screening are considered to be scalable and cost-effective in LMIC settings (Gaziano, Abrahams-Gessel, Surka, and others 2015).…”

A PROgramme of Lifestyle Intervention in Families for Cardiovascular risk reduction (PROLIFIC Study): design and rationale of a family based randomized controlled trial in individuals with family history of premature coronary heart disease

“…In the era of a rapidly progressing epidemiological transition in India, task shifting/task sharing strategies such as involving FCHWs in non-communicable disease prevention and control are practical, feasible and scalable strategies. Such strategies have been demonstrated to be cost-effective in low and middle income settings [34]. Our study will also provide evidence to support the task shifting/task sharing strategy of involving FCHWs in prevention and control of cardiovascular disease.…”