Engaging Community Health Workers to Increase Cancer Screening: A Community Guide Systematic Economic Review

Am J Prev Med. 2021 Apr;60(4):e189-e197. doi: 10.1016/j.amepre.2020.08.011. Epub 2020 Dec 11.


Context: The Community Preventive Services Task Force recommends engaging community health workers to increase breast, cervical, and colorectal cancer screenings on the basis of strong evidence of effectiveness. This systematic review examines the economic evidence of these interventions.

Evidence acquisition: A systematic literature search was performed with a search period through April 2019 to identify relevant economic evaluation studies. All monetary values were adjusted to 2018 U.S. dollars, and the analysis was completed in 2019.

Evidence synthesis: A total of 19 studies were included in the final analysis with 3 on breast cancer, 5 on cervical cancer, 9 on colorectal cancer, and 2 that combined costs for breast and cervical cancers and for breast, cervical, and colorectal cancers. For cervical cancer screening, 2 U.S. studies reported incremental cost per quality-adjusted life year saved of $762 and $34,405. For colorectal cancer screening, 2 U.S. studies reported both a negative incremental cost and an increase in quality-adjusted life years saved with colonoscopy screening.

Conclusions: Engaging community health workers to increase cervical and colorectal cancer screenings is cost effective on the basis of estimated incremental cost-effectiveness ratios that were less than the conservative $50,000 per quality-adjusted life year threshold. In addition, quality-adjusted life years saved from colorectal screening with colonoscopy were associated with net healthcare cost savings.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Colorectal Neoplasms* / diagnosis
  • Colorectal Neoplasms* / prevention & control
  • Community Health Workers
  • Cost-Benefit Analysis
  • Early Detection of Cancer
  • Female
  • Humans
  • Mass Screening
  • Quality-Adjusted Life Years
  • Uterine Cervical Neoplasms* / diagnosis
  • Uterine Cervical Neoplasms* / prevention & control