Cost-Effectiveness of Community Health Worker Interventions for Type 2 Diabetes Mellitus: A Systematic Review

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 .