Costs of Caring: Community Health Workers/Promotores at the HEART of a Community-Based Randomized Trial

The Health Education Awareness and Research Team (HEART) is a university and community partnership at the U.S.-Mexico border (El Paso, Texas) funded by the National Institutes of Health National Center on Minority Health and Health Disparities. The HEART pilot assessed the outcomes of a four month Community Health Worker/Promotor (CHW/P) intervention based on the Salud Para Su Corazon curriculum among Hispanic adults. HEART took a community-based participatory research (CBPR) approach to a randomized controlled trial (RCT) with only cases exposed to CHW/Ps. This paper reports on a cost-effectiveness analysis undertaken by the research team with University-based funding linked to the larger NIH study. Costs analyzed include the resources that the organization delivering the service incurred (accounting costs) as well as the opportunity costs (e.g. time) and financial costs (e.g. transportation) that participants incurred. Clinical and self-reported outcomes are assessed over time contrasting cases and controls in terms of costs. The study also reports on findings from a supplemental interview undertaken with a sample of study participants that included questions soliciting participant perspectives on "willingness to pay" for prevention services and positive health outcomes. As the study overall was funded as a pilot, findings are limited to that scope. This analysis offers an opportunity to look at methodological issues and sheds light on CHW cost-effectiveness data.