IFGH 2012: Using Community Health Workers to Manage Hypertension in Urban India: A Cost- Effectiveness Analysis

January 29, 2012

Authors:Murphy A.1,2, Schulman-Marcus J.3, Prabhakaran D.4, Gaziano T.2,5

Author Affiliations:1London School of Hygiene and Tropical Medicine (London, UK), 2Harvard School of Public Health (Boston, US), 3Columbia Medical School (New York, US), 4Centre for  Chronic Disease Control (New Delhi, India), 5Harvard Medical School (Boston, UK)

Option 1– Scientific / Empirical Research Findings Presented as – Oral Presentation


Our objective was to estimate the net costs and cost per Disability-adjusted Life Year (DALY) averted associated with a hypothetical intervention using Community Health Workers (CHWs) to manage hypertension in India.


Using a Global Markov Cardiovascular Disease (CVD) model, we assessed the cost-effectiveness of a hypothetical CHW intervention in urban India. Demographic information and prevalence of risk factors were taken from the UN Population Division and the Global Burden of Disease study. Ten-year risk of CVD events was calculated using the Framingham Risk Score. The annual probability of non-CVD death is based on WHO life tables.

The necessary inputs of a CHW intervention and the associated blood pressure reduction (3 mm/Hg) were estimated based on literature from other settings. Cost estimates were obtained from WHO CHOICE.


The estimated cost of an intervention where 30 CHWs are trained and each paid roughly $3900/year (USD) to make 2 visits to 22050 patient homes over one year is $ 141 904.10 (USD), or $6.44/patient, $3.22/visit.

Over 10 years the annual $141 000 cost of the program would be offset by $110 000 saved each year in health care expenditures through reduced strokes and ischemic heart disease events, resulting in a net cost of $31 000 per year. Sixty-five DALYs would be averted annually leading to a cost-effectiveness ratio of approximately $475/DALY averted over the course of the 10 years.

If the annual salary of a CHW drops below $1400, or the number of visits per patient is reduced to one per year, or the blood pressure reduction is above 5.3 mm Hg, the intervention becomes cost saving.


We demonstrated that the use of CHWs for improving adherence to medications and changes in lifestyle among hypertensive patients is a cost-effective strategy for addressing increased incidence of CVD in India.




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