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

Background: 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). Methods: 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. Results: 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. Conclusion: Hypertension management by NPHCWs appears cost-effective in LMICs, though more studies are needed for generalizability.