Cardiovascular Disease Screening By Community Health Workers Can Be Cost-Effective In Low-Resource Countries.
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.
Thomas Gaziano (tgaziano@partners.org) is an assistant professor in the Cardiovascular Division of Brigham and Women's Hospital, in Boston, Massachusetts.
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Shafika Abrahams-Gessel is a research manager at the Center for Health Decision Science in the Harvard T. H. Chan School of Public Health, in Boston.
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Sam Surka is a researcher in the Chronic Diseases Initiative for Africa at Old Groote Schuur Hospital, in Cape Town, South Africa.
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Stephen Sy is a programmer at the Center for Health Decision Science in the Harvard T. H. Chan School of Public Health.
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Ankur Pandya is an assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health.
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Catalina A. Denman is a professor in the Centro de Estudios en Salud y Sociedad at El Colegio de Sonora, in Hermosillo, Mexico.
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Carlos Mendoza is a coinvestigator at the Instituto de Nutricion de Centro America y Panama, in Guatemala City, Guatemala.
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Thandi Puoane is a professor in the School of Public Health at the University of the Western Cape, in Bellville, South Africa.
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Naomi S. Levitt is director of the Division of Diabetes and the Chronic Diseases Initiative for Africa, both at Old Groote Schuur Hospital.
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D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003150:Community Health Workers / Q000191:economics* / Q000706:statistics & numerical data*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D005260:Female; D006166:Guatemala; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008800:Mexico; D008875:Middle Aged; D013019:South Africa
cardiovascular disease; community health workers; cost-effectiveness; mobile health; screening