Cost-Effectiveness and Implementation Strategies for Hypertension Management Using Non-Physician Healthcare Workers in Low- and Middle-Income Countries: A Systematic Review

TL;DR

This review finds that non-physician healthcare workers can manage hypertension in low- and middle-income countries at a low cost, but more research is needed.

Contribution

The study systematically evaluates the cost-effectiveness and implementation strategies of using non-physician workers for hypertension care in LMICs.

Findings

Non-physician healthcare workers achieved cost per mmHg reduction of $2.25 systolic and $2.03 diastolic.

Cost per controlled patient was $1.48, and ICERs ranged from $0.41 to $14,373.97.

Training and community engagement were key implementation strategies.

Abstract

This review assessed the cost-effectiveness and implementation strategies of hypertension management by non-physician healthcare workers (NPHCWs) in low- and middle-income countries (LMICs).

A systematic search (inception–May 2024) included adults ≥18 years managed by NPHCWs LMICs, following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Economic evaluations were assessed using Drummond’s checklist and ROBINS-I.

Seven studies (2002–2022) conducted across eight countries enrolled 96–10,000 participants and included randomized, modeling, observational, and quasi-experimental designs. NPHCWs included pharmacists, community and village health workers, and nurses. Patients’ mean age ranged 58–71 years, with 57–82% female. Outcomes assessed included cost per mmHg reduction ($INT 2.25 systolic, $INT 2.03 diastolic), per controlled patient ($INT 1.48), annual cost ($INT 0.22–232.31), cost per disability-adjusted life year (DALY) averted ($INT 411.39–4709.96), and per quality-adjusted life year (QALY) gained ($INT 1.04–13.30). Incremental cost-effectiveness ratio (ICERs) varied ($INT 0.41–14,373.97). Strategies included NPHCWs training and community engagement/counseling.

Hypertension management by NPHCWs appears cost-effective in LMICs, though more studies are needed for generalizability.

Figures