Public health interventions aimed at children aged 5-19 years funded by local authorities in England: a scoping review of economic analyses.

backgroundEnglish Local authorities are responsible for delivering the Healthy Child Programme (HCP), to improve the health and wellbeing of children. Despite the importance of prevention, economic evidence to guide investment is limited, particularly for school-aged children. This scoping review aimed to map UK-based economic evidence relevant to the HCP for children aged 5-19 years, to inform policy and highlight gaps in the evidence.

methodsWe searched sixteen databases in December 2023 to January 2024, in addition to citation and key websites searching. Eligible studies included economic evaluations and return on investment analyses of interventions that could be potentially delivered by local authorities under the HCP. Two reviewers screened titles and abstracts, and extracted data on study characteristics, methods, and outcomes. We assessed risk of bias using the Economic Evaluation Bias (ECOBIAS) checklist, synthesised the available evidence descriptively, and presented findings using summary tables and an evidence gap map.

resultsWe included 39 economic analyses. The most commonly evaluated interventions focused on mental health (12 studies), followed by physical activity (9 studies), healthy eating (4 studies, of which 2 were in combination with physical activity), risk behaviours (4 studies), bullying (3 studies), obesity (2 studies), hearing or vision screening (2 studies), social workers in schools (2 studies) and sexual health, ADHD prevention and improving oral health (each one study). Ten studies reported an incremental cost-effectiveness ratio (ICER), five studies reported either a benefit-cost ratio (BCR) or incremental net monetary benefit (INMB), whilst others described quality-adjusted life years (QALYs), costs or willingness to pay. In general, robust evidence of the value of these interventions was partial because the interventions and methods of analysis were heterogenous. School nurse delivered services were particularly underrepresented despite their central role in the HCP delivery.

conclusionsThis review highlights the diverse range of interventions available to local authorities and the lack of robust economic evidence to support prioritisation of investment as part of the HCP 5-19 years. Further research should focus on developing more robust evidence of the value of public health interventions in this age group, using economic analysis to enable priority-setting, and addressing the evidence gaps identified.