Table 1 Full list of citations included in systematic review

Clarke, M., et al. (2006) [39]

South Africa

Training of lay health workers (LHWs) to support treatment and management of TB on farms, instead of clinic nurses or enrolled (non-professional) nurses

Input/process

Cost per minute of health worker time

91% reduction in cost from clinic nurses ($0.12 per minute) to LHWs ($0.01 per minute) and 87.5% reduction from enrolled nurses ($0.08 per minute) to LHWs

Farms with LHWs supporting had 42% better case finding rate and 10% better cure rate

Datiko, D. G. and B. Lindtjorn (2010) [35]

Ethiopia

Comparison of Health Facility-based DOT (HFDOT) program for TB compared with community DOT (CDOT) program using health extension workers

Outcome

Cost per successfully treated patient

63% reduction in costs from HFDOT model ($16.19) to CDOT model ($6.07)

74.8% cure rate for CDOT compared with 68.2% for HFDOT

Dick, J., et al. (2007) [37]

South Africa

Evaluation of a lay health worker project overseen by primary healthcare nurses aimed at treating TB on farms

Outcome

Cost per case detected and cured

74% cost reduction to the District Health Authority on farms with LHW program compared to control farms (absolute cost figures not reported)

Treatment completion rate for smear-positive TB patients 18.7% higher in intervention group compared to controls (p < .05)

Floyd, K., et al. (2003) [41]

Malawi

Community-based outpatient treatment for smear-positive pulmonary patients (instead of inpatient treatment)

Outcome

Cost per patient cured

62% reduction from hospital-based treatment ($786) to community-based treatment ($296)

Cure rate was 68% for community-based strategy and 58% for hospital-based strategy

Islam, M. A., et al. (2002) [36]

Bangladesh

BRAC TB control program using CHWs, compared to government-run program

Input/process; outcome

Total annual cost for TB control program at the subdistrict (thana) level; Cost per patient cured

31% reduction in total annual costs from government program ($10,697) to BRAC program ($7,351); 32% reduction in cost per patient cured

84.1% cure rate in BRAC TB program compared to 82.2% in government program

Khan, M. A., et al. (2002) [40]

Pakistan

Comparison of DOTS by health workers at health centers, DOTS by family members, and “DOTS without direct observation”

Outcome

Cost per case cured

45% reduction from health center DOTS ($310) to CHW DOTS ($172); unsupervised DOTS cost $164

Cure rates were 62% for unsupervised DOTS, 55% for family member DOTS, 67% for CHW DOTS, and 58% for Health Center DOTS

Okello, D., et al. (2003) [38]

Uganda

Comparison of conventional hospital-based care with community-based care for DOTS, including management by a sub-county public health worker

Outcome

Cost per smear-positive patient successfully treated

57% reduction in costs from conventional care ($911) to community-based care ($391)

Treatment success rate for smear-positive cases was 56% for conventional care and 74% within community-based care

Prado, T. N., et al. (2011) [42]

Brazil

Comparison of DOTS overseen by guardians with standard of care treatment by CHWs

Output

Total cost for DOTS course

28% reduction in costs from CHW DOTS ($547) to guardian-supervised DOTS ($389)

98% treatment completion in guardian-supervised DOTS compared to 83% treatment completion with CHW-supervised DOTS (p = .01)

Sinanovic, E., et al. (2003) [43]

South Africa

Comparison of clinic-based care with community-based observation by lay person with community-based care for smear-positive pulmonary and retreatment TB patients

Outcome

Cost per patient successfully treated

62% reduction in costs for new smear-positive patients from clinic-based care ($1302) to community-based care ($392); 62% reduction in costs for retreatment patients from clinic-based care ($2008) to community-based care ($766)

80% treatment success rate for community-based care, compared to 54% treatment success rate for clinic-based care

Babigumira, J. B., et al. (2011) [46]

Uganda

Comparison of a Pharmacy-only Refill Program (PRP) to Standard of Care for treatment for HIV/AIDS patients

Output

Cost per person per year from societal and Ministry of Health perspective

21% reduction in societal costs from Standard of Care ($665) to PRP ($520) and 17% reduction in MoH costs from Standard of Care ($610) to PRP ($496)

No statistically significant difference in favorable immune response among patients in two groups

Bemelmans, M., et al. (2014) [48]

South Africa

Adherence club for ARVs led by lay counselor and offered to all clinically stable patients who had been on ARVs for greater than 12 months; Club met every 2 months for essential medical tasks (e.g., weighing and health assessment) and distribution of ARVs

Output

Cost per patient per year

46% reduction from mainstream model of care ($108) to ARV club model ($58)

<1% mortality at 40 months, and 2.8% loss to follow up at 40 months in ARV club

Fatti, G., et al. (2015) [45]

South Africa

Indirectly Supervised Pharmacist Assistant (ISPA) program compared to nurse-managed models for providing ARTs

Input/process

Human resource costs and costs per item dispensed

29% reduction in human resource costs from nurse-managed program ($1.89 per patient visit) compared to ISPA model ($1.35 per patient visit); 49% reduction in cost per item dispensed from nurse-managed program ($0.83) to ISPA model ($0.43)

Cumulative attrition lower at ISPA sites (20.7% compared to 31.5%); proportion of patients achieving virological suppression higher at ISPA sites (89.6% compared to 85.9%)

Foster, N. and D. McIntyre (2012) [47]

South Africa

Indirectly Supervised Pharmacist Assistant (ISPA) program and nurse-managed models compared to full-time pharmacist for providing ARTs

Input/process

Cost per patient visit

43% reduction in cost from nurse-driven model ($10.16) to ISPA model ($5.74) and 12% reduction in cost from full-time pharmacist model ($6.55)

Johns, B. and E. Baruwa (2015) [31]

Nigeria

Comparison of hospital-based distribution of ART (by doctors) with clinic-based distribution of ART (by nurses and/or community pharmacists) for stable patients who had been on ART for at least 1 year, in two states aiming to decentralize health services

Output

Total cost per person per year

Total costs increased in one state by 31% and decreased in one state by 32%; In both cases, the largest difference in costs between the hospital and clinic sites was staff cost/patient visit

Few statistically significant differences found in service utilization indicators between patients going to clinic sites versus hospital sites; Patients in the state that achieved cost savings had 3.7× more visits per year than in hospitals (p < .01)

Johns, B., et al. (2014) [30]

Ethiopia

Comparison of minimal, moderate, and maximal task shifting for ARV responsibilities away from physicians with hospital-based ARV distribution . Minimal = nonphysicians clinicians (NPC) monitor ART; Moderate = NPC initiate and monitor ART; Maximal = NPCs initiate, monitor, treat side effects, and switch ARTs

Output

Cost per patient year

No statistically significant changes in cost/patient per year between models of task shifting or between all task shifting models and hospitals

Almost no statistically significant differences in patient retention from different levels of task shifting

Yan, H., et al. (2014) [44]

China

Evaluation of shifting HIV preventive intervention and care for men who have sex with men (MSM) from government facilities to community-based organizations (CBOs)

Outcome

Unit cost per HIV case detected

97% reduction in cost from government health facilities ($14,906) to community-based organizations ($315)

Within 4 years, total % of HIV cases reported increased from ~10 to ~50%, despite “a very low share of HIV tests by CBOs out of the total HIV tests performed each year during the pilot,” which indicates effective targeting of HIV patients for tests by CBOs

Chanda, P., et al. (2011) [49]

Zambia

Comparison of home management (using CHW) with facility-based management of uncomplicated malaria

Output

Cost per case appropriately diagnosed and treated

31% reduction from facility-based management ($6.12) to home management ($4.22)

100% of cases treated appropriately through home management, and 43% of cases treated appropriately in facility

Hamainza, B. M., et al. (2014) [50]

Zambia

Comparison of CHW program to test and treat malaria with facility-based testing and treatment

Output

Total cost per confirmed case treated

60% reduction in cost from facility-based approach ($10.75) to CHW approach ($4.34)

78% of CHW contacts received appropriate testing and treatment, while 53% of facility-based patients received appropriate testing and treatment based on guidelines

Mbonye, A., et al. (2008) [32]

Uganda

Community-based administration of intermittent preventive treatment (IPTp) for malaria by traditional birth attendants, drug-shop vendors, community reproductive health workers, and adolescent peer mobilizers

Output

Cost per patient of providing a full regimen of IPTp

9% increase in costs from health center care (4093 shillings) to community-based care (4491 shillings)

Patouillard, E., et al. (2011) [51]

Ghana

Comparison of IPT administration by village health workers (VHWs), facility-based nurses working in outpatient departments of health centers or EPI outreach clinics

Outcome

Economic cost per child fully covered and fully adherent to treatment

11% reduction from using facility-based strategy ($8.51) to VHW strategy ($7.56)

69.1% of children in VHW strategy completed course, 63.8% of children in facility-based strategy completed course

Ruebush, T. K., 2nd, et al. (1994) [52]

Guatemala

Change to the supervision and distribution model of unpaid Volunteer Collaborators (VC) in the surveillance and treatment of malaria, including treatment for malaria without taking a blood smear, removal of literacy requirement for VC, and reduced supervision from once every 4 weeks to once every 8 weeks

Output

Cost per patient treated

75% reduction in cost per patient treated in modified model of VCs ($0.61) versus control network of VCs ($2.45)

Average time from examination to initiation of treatment was 6.6 days in modified model areas, compared to 14.6 days in control areas

Sikaala, C. H., et al. (2014) [53]

Zambia

Community-based (CB) mosquito surveillance and trapping using light traps (LT) and Ifakara tent traps (ITT) compared to centrally supervised quality assurance (QA) trapping teams, including human-landing catch (HLC) teams, for the prevention of malaria

Output

Cost per specimen of Anopheles funestus captured

96% reduction in costs from using QA-LT ($141) to CB-LT ($5.3); 83% reduction in costs from using QA-ITT ($168) to CB-ITT ($28); QA-HLC method cost $10.5

Aung, T., et al. (2013) [62]

Myanmar

Comparison of costs to treat diarrhea by CHW, government facility, and private provider

Input/process

Total patient cost for consultation and correct ORS

7% reduction from private providers ($5.40) to CHWs ($5) and 67% reduction from government facilities ($15) to CHWs

CHWs provided appropriate ORS and amount of drinking water in 57.6% of cases, private providers in 47.1% of cases, and government facilities in 71.4% of cases

Buttorff, C., et al. (2012) [57]

India

Comparison of “collaborative care” model using full-time physician, lay health worker (LHW), and mental health specialist with “enhanced usual care” by full-time physician only for treatment of depression and anxiety disorders

Output

Average annual cost per subject

23% reduction in costs from collaborative care model ($177) compared to physician-only care model ($229)

Patients in collaborative care improved 3.84 points more on the Revised Clinical Interview Schedule (to measure psychiatric symptoms) compared to physician-only care model

Chuit, R., et al. (1992) [60]

Argentina

Surveillance to reduce transmission of Chagas disease using Primary Health Care (PHC) agents compared to a vertically oriented program run by trained entomological professionals

Output

Cost of surveillance per house

80% reduction in cost from vertical surveillance ($17) to PHC surveillance ($3.40)

Surveillance rates and levels of infestation detection were comparable across intervention and control arms

Cline, B. L. and B. S. Hewlett (1996) [61]

Cameroon

Diagnosis and treatment for schistosomiasis by CHWs identified by the community

Output

Average cost of diagnosis and treatment of a child

90% reduction in cost from treatment at nearest pharmacy (approx. $15) to CHW model ($1.50)

7% prevalence in school children after participating in program, compared to 71% in children who did not participate in program

Fiedler, J. L., et al. (2008) [63]

Honduras

Community-based integrated child care (AIN-C) program that uses volunteers to help mothers monitor and maintain adequate growth of young children

Input/process

Cost for one child growth and development consultation

86% reduction from facility-based consultation (105.1 lempiras) to community-based program (14.67 lempiras)

Hounton et al., (2009) [33]

Burkina Faso

Training of obstetricians, general practitioners, and clinical officers to lead surgical teams for caesarian sections

Outcome

Incremental cost of one newborn life saved

Compared to clinical officers, one newborn life saved cost $200 for general practitioners, and $3,235 for obstetricians

Higher newborn and maternal case fatality rates among clinical officers than other types of practitioners

Jafar, T. H., et al. (2011) [54]

Pakistan

Home-health education (HHE) by CHWs, home-health education plus general practitioner (GP) supervision (combined group), or general practitioner-supervision only to control blood pressure

Output

Total cost per patient over 2 years for each group

7% reduction in costs from GP-only group ($537) to combined group ($500); 27% reduction in costs from GP-only group to HHE-only group ($393)

Decline in systolic BP was highest in the combined group (p = .001)

Kruk, M. E., et al. (2007) [58]

Mozambique

Comparison of surgically trained assistant medical officers and specialist physicians

Input/process

Cost per major obstetric surgical procedure

72% reduction in costs using assistant medical officers ($39) compared to specialist physicians ($144)

Laveissiere, C., et al. (1998) [56]

Cote d'Ivoire

Detection of sleeping sickness using conventional mobile teams compared to integration of activity into CHW duties

Output

Cost of surveillance per person

81% reduction in costs using CHWs ($0.10) instead of using mobile teams ($0.55)

Puett, C., et al. (2013) [55]

Bangladesh

Community-based management of severe acute malnutrition by CHWs compared to inpatient treatment

Outcome

Cost per DALY averted

98% reduction in costs/DALY averted from observed inpatient treatment costs ($1344) to community treatment ($26) and in costs/death averted from observed inpatient treatment costs ($45,688) to community treatment ($869)

91.9% of children in community treatment area recovered, compared to only 1.4% in inpatient treatment

Sadruddin, S., et al. (2012) [59]

Pakistan

Comparison of home treatment of severe pneumonia by lady health workers with referred cases treated by other practitioners

Output

Cost per treatment of severe pneumonia

81% reduction in costs using lady health workers ($1.46) compared to referred cases ($7.60)

93.4% of cases successfully treated by lady health workers with a 5-day course of amoxicillin, and remaining cases referred for further treatment

Munyaneza, F., et al. (2014) [34]

Rwanda

Use of CHWs and nurses to collect geographic coordinates using GIS systems instead of trained and dedicated GIS teams

Input/process

Total cost of mapping activities

51% reduction in costs from using dedicated GIS teams ($60,112) to CHWs ($29,692)