Clinical effectiveness and cost-effectiveness of primary community health care nurses: A meta-analysis

Global shortages in the health-care workforce hinder the achievement of universal health coverage and equitable access to high-quality, affordable health care. Primary community health care nurses have emerged as a strategy to improve access and care quality, but comprehensive evidence on their impact and economic value remains limited.

To synthesize evidence on the cost-effectiveness of the use of primary community health care nurses compared with medical practitioners on patient health and economic outcomes.

A meta-analysis of economic evaluations alongside randomized controlled trials (RCTs).

CINAHL, CENTRAL, Embase, Medline-OVID, PubMed, EconLit, and the National Health Service Economic Evaluation Database were searched until October 2025. The outcomes included patient health outcomes (depression, anxiety, fatigue, activities of daily living, pain, patient satisfaction, total cholesterol, blood pressure, body mass index, mortality) and economic outcomes comprising health resource utilization (outpatient visits, hospitalization, length of stay, generalist medical practitioner consultations, emergency unit visits, specialist medical practitioner visits, and absenteeism) and cost-effectiveness (incremental net monetary benefit from payer and societal perspectives). Data were pooled using a random-effects model, and moderator and meta-regression analyses were conducted to test for heterogeneity.

Twenty-one studies involving 14,523 participants were included. Primary community health care nurses significantly improved patient health outcomes (depression: g -0.31; 95% confidence interval -0.47 to -0.15, anxiety: g -0.23; 95% confidence interval -0.35 to -0.11, fatigue: g -0.26; 95% confidence interval -0.45 to -0.07, daily functioning: g 0.08; 95% confidence interval 0.03 to 0.12, patient satisfaction: g 0.25; 95% confidence interval 0.08 to 0.42, and total cholesterol: g -0.38; 95% confidence interval -0.71 to -0.06). They also improved efficiency in health resource utilization (outpatient visit: g -0.33; 95% confidence interval -0.56 to -0.11, hospitalization: g -0.11; 95% confidence interval -0.18 to -0.04, length of stay: g -0.05; 95% confidence interval -0.10 to -0.01, generalist MP consultation: g -0.16; 95% confidence interval -0.25 to -0.08), and exhibited substantial cost-effectiveness (incremental net monetary benefit-payer: US$910.99; 95% confidence interval US$561.74 to US$1260.24 and societal: US$1485.2; 95% confidence interval US$273.24 to US$2697.18) compared with medical practitioners.

Primary community health care nurses are a cost-effective solution for achieving universal health coverage and sustainable health care, demonstrating significant cost-effectiveness from payer and societal perspectives. They improve patient health and health resource utilization especially in reducing outpatient visits, hospitalization, length of stay. Strategic investment in their function is essential for advancing health equity and accessible, high-quality primary health care.

PROSPERO: CRD420251018431.

This meta-analysis of economic evaluation revealed that primary community health care nurses are cost-effective, improve patient outcomes, and reduce health resource utilization. @4_INAns.