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Cost-Effectiveness of Community Health Worker Interventions for Type 2 Diabetes Mellitus: A Systematic Review
Laura R Porterfield1, H Shelton Brown2, Dallin Swanson3
1Department of Family Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA. lauporte@utmb.edu.
Background:
Type 2 diabetes contributes substantially to healthcare costs, disability, and premature mortality worldwide. Although community health worker (CHW) interventions improve glycemic outcomes and address social determinants of health, current cost-effectiveness evidence has not been systematically synthesized. We reviewed the economic evidence for CHW interventions in type 2 diabetes management.
Methods:
We searched Ovid MEDLINE, Scopus, CINAHL, and ProQuest from inception through August 2025 for peer-reviewed primary studies evaluating economic outcomes of CHW interventions for adults with type 2 diabetes. We extracted data and assessed study quality. Owing to heterogeneity in design, cost reporting, and limited variance estimates, we conducted a narrative synthesis.
Results:
Of 753 records, 11 met inclusion criteria. All studies focused on low-income and/or ethnic minority populations. Ten reported program costs ($29-6235 per patient/year; 2025 USD). Nine reported incremental cost-effectiveness ratios. Two of three short-term studies (< 5 years) found interventions cost-effective; all six long-term studies (≥ 20 years) found the same.
Conclusions:
Available evidence suggests that CHW interventions are likely cost-effective for adults with T2D, particularly when evaluated over longer time horizons.
Prospero Registration:
CRD420251101900. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251101900 .
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