Investigating the cost-effectiveness of strengthening the integration of community based active case-finding for hypertension and type 2 diabetes mellitus at primary health care level in Western Kenya

Non-communicable diseases (NCDs) pose a significant and growing burden in Kenya, exacerbated by low awareness, suboptimal screening, and fragmented care. Integrated community-based approaches have emerged as a key strategy for strengthening health systems and improving the prevention and management of NCDs including hypertension (HTN) and type 2 diabetes mellitus (T2DM). This study evaluated the cost-effectiveness of strengthening integrated community-based active case-finding (ACF) using community health promoters for HTN and T2DM at primary health care Western Kenya.

A multi-method approach was employed, including a systematic review, stakeholder engagement, conceptual modelling, and the development of an individual state-transition microsimulation model. The model simulated the long-term clinical and economic pathways for a cohort of 500,000 individuals over a lifetime horizon, comparing the strengthened ACF intervention against usual care from both health system (provider) and patient perspectives.

Key findings demonstrated that the intervention was cost-effective from a health system perspective, with an incremental cost-effectiveness ratio (ICER) of 57,176 KES (408 US$) per disability-adjusted life year (DALY) averted dominating the usual care scenario. The ICER was 1,745,779.96 KES (12,469.86 US$) per DALY averted from a patient perspective, hence not cost-effective. The intervention averted 14,476 DALYs, preventing 3,594 strokes, 13,213 myocardial infarctions, and 7,588 cardiovascular disease-related deaths. These health gains were attributed to increased screening, improved linkage to care, and better disease management. However, the analysis revealed a significant financial shift to patients, who incurred high costs, particularly those with HTN/T2DM comorbidity, those with health insurance, patients visiting private health facilities, older participants, and females.

The study concludes that strengthening integrated community-based ACF into primary health care produces substantial health gains and is a cost-effective strategy for the health system. For successful scale-up, policymakers must address the identified financial burden on patients through financial risk protection mechanisms and strengthening of health system integration across multiple domains.