Table 9 Summary findings on cost-effectiveness

Evidence that CHWs are cost-effective

• CHWs in LMICs are cost effective when compared to standard care for tuberculosis; weaker evidence of cost effectiveness is present for other areas (malaria programs and reproductive, maternal, newborn, and child health) [55].

• Task shifting to CHWs from higher-level staff for HIV care in LMICs is cost effective [50, 52, 53].

• There is a cost savings of 24% when CHWs collect data using personal digital assistants compared to when they use traditional manual methods of data collection and transmission [44].

• Women’s groups (which were almost always facilitated by CHWs) practicing participatory learning and action to improve maternal and newborn health in LMICs were cost-effective as defined by WHO standards [105].

• Pediatric asthma care in HICs by CHWs may be cost-effective [56, 57].

• Diabetes care in HICs by CHWs could save US$2000 annually per Medicaid participant (according to one study) [125]; yield a return on investment of $2.28 per dollar invested (one study) [125], and reduce inappropriate health care utilization [100].

• Community case management of malaria by CHWs using rapic diagnostic tests  is cost-effective in areas with low-to-medium prevalence [21].

• Potential cost savings are present by using CHWs for mental, neurological, and substance-abuse disorders in LMICs [54].

Some cost-effectiveness analyses found no evidence

• The evidence regarding the cost effectiveness of vaccination promotion by CHWs in LMICs is inconclusive [59].

• There are no studies of the cost effectiveness of CHWs for the support of HIC populations with vascular disease [60].

• There are insufficient data to assess the cost-effectiveness of CHWs in the USA underserved groups compared to other types of community health interventions [25].