Cost-Effectiveness of a Community Health Workers-Led Multicomponent Hypertension Intervention in Selected Health Centers in Rwanda: 12-Month Trial- Based Analysis from a Health Care System Perspective

Background Hypertension is a major, modifiable risk factor for cardiovascular illness and death, and diagnosis requires repeated standardized readings of systolic BP above 130 mmHg and/or diastolic BP above 80 mmHg in a seated patient. Sedentary lifestyles, increasingly common in high-income settings, further elevate disease and mortality risk. We evaluated the costs, effectiveness, and overall cost-effectiveness of a community health worker (CHW)-led multicomponent intervention (MCI) to control hypertension among patients with uncontrolled hypertension attending selected health centers non-communicable diseases (NCD) clinics in Rwanda. Methods We conducted an economic evaluation of CHW-led MCI using health care perspective, from December 2024 to November 2025. Two hundred hypertensive patients from eight primary health centers received a CHW-led MCI (health and adherence education, home BP monitoring, and CHW home visits) compared to standard care. Cost and quality-of-life data (EQ-5D-5L) were collected prospectively over 12 months from a health system perspective, and intention-to-treat analyses estimated changes in SBP and QALYs. Cost-effectiveness was assessed using a threshold of 1× GDP per capita per QALY (1 642 000 Rwandan francs). Results The intervention arm incurred higher per-patient costs of 24,710 RWF compared to 5,250 RWF in the control arm, yielding an incremental cost of 19,460 RWF per patient across all subgroups. It produced consistent systolic blood pressure (SBP) reductions ranging from − 8.9 to -19.7 mmHg, with larger effects in younger patients (< 60 years: -12.19 mmHg), men (-13.34 mmHg), and BMI < 30 kg/m² (-19.69 mmHg). ICERs per QALY were high, while cost per 1 mmHg SBP reduction (ICER2) ranged 990-2,180 RWF/mmHg, lowest in younger patients (1,596 RWF/mmHg), men (1,459 RWF/mmHg), BMI < 30 kg/m²; base case ICER was 1,146 RWF per SBP unit. Conclusions CHW-led MCI achieved substantial reductions in SBP and higher control rates, but generated only modest short-term QALY gains, leading to relatively high cost-per-QALY estimates when judged over brief horizons in Rwanda. Nevertheless, analyses indicate that when longer time horizons, and distributional equity are considered, these strategies can be attractive or highly cost-effective at context-appropriate willingness-to-pay levels, supporting their prioritization in health systems that explicitly value cardiovascular risk reduction and improved access for high-risk, underserved populations.