A Scoping Review of Economic Evaluations to Inform the Reorientation of...

[Full title: A Scoping Review of Economic Evaluations to Inform the Reorientation of Preventive Health Services in Australia]

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Citation: Taylor, R.; Sullivan, D.; Reeves, P.; Kerr, N.; Sawyer, A.; Schwartzkoff, E.; Bailey, A.; Williams, C.; Hure, A. A Scoping Review of Economic Evaluations to Inform the Reorientation of Preventive Health Services in Australia Int. J. Environ Res. Public Health 2023 , 20 , 6139 https://doi.org/10.3390/ ijerph 20126139 Academic Editor: Thomas Davidson Received: 28 April 2023 Revised: 22 May 2023 Accepted: 6 June 2023 Published: 15 June 2023 Copyright: © 2023 by the authors Licensee MDPI, Basel, Switzerland This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/) International Journal of Environmental Research and Public Health Review A Scoping Review of Economic Evaluations to Inform the Reorientation of Preventive Health Services in Australia Rachael Taylor 1,2 , Deborah Sullivan 1 , Penny Reeves 1 , Nicola Kerr 3 , Amy Sawyer 3 , Emma Schwartzkoff 3 , Andrew Bailey 4 , Christopher Williams 4,5 and Alexis Hure 1,2, * 1 Health Economics and Impact, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia; rachael.taylor@newcastle.edu.au (R.T.); deborah.sullivan@newcastle.edu.au (D.S.); penny.reeves@hmri.org.au (P.R.) 2 School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia 3 Health Promotion, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia; nicola.kerr@health.nsw.gov.au (N.K.); amy.sawyer@health.nsw.gov.au (A.S.); emma.schwartzkoff@health.nsw.gov.au (E.S.) 4 Research and Knowledge Translation Directorate, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; andrew.bailey@health.nsw.gov.au (A.B.); christopher.williams 1@health.nsw.gov.au (C.W.) 5 University Centre for Rural Health, School of Health Sciences, University of Sydney, 61 Uralba Street, Lismore, NSW 2480, Australia * Correspondence: alexis.hure@newcastle.edu.au Abstract: The Australian National Preventive Health Strategy 2021–2030 recommended the establishment of evidence-based frameworks to enable local public health services to identify strategies and interventions that deliver value for money. This study aimed to review the cost-effectiveness of preventive health strategies to inform the reorientation of local public health services towards preventive health interventions that are financially sustainable. Four electronic databases were searched for reviews published between 2005 and February 2022. Reviews that met the following criteria were included: population: human studies, any age or sex; concept 1: primary and/or secondary prevention interventions; concept 2: full economic evaluation; context: local public health services as the provider of concept 1. The search identified 472 articles; 26 were included. Focus health areas included mental health ( n = 3 reviews), obesity ( n = 1), type 2 diabetes ( n = 3), dental caries ( n = 2), public health ( n = 4), chronic disease ( n = 5), sexual health ( n = 1), immunisation ( n = 1), smoking cessation ( n = 3), reducing alcohol ( n = 1), and fractures ( n = 2). Interventions that targeted obesity, type 2 diabetes, smoking cessation, and fractures were deemed cost-effective, however, more studies are needed, especially those that consider equity in priority populations Keywords: economic evaluation; health services; prevention; local public health services; review; value-based healthcare 1. Introduction Driven by the unsustainable burden of chronic disease, a shift is occurring within healthcare systems globally from curative, treatment-focused health towards preventive health. The preventive health approach aims to improve the health and well-being of a population by “reducing the likelihood of a disease or disorder, interrupt or slow the progression or reduce disability” [ 1 ]. In conjunction with this shift is an emphasis on health system changes that align with value-based healthcare. While there is no universal definition of what constitutes “value”, fundamentally the approach attempts to deliver financially sustainable healthcare, as opposed to cost reduction, while keeping the needs, experiences, and outcomes that matter to the patient at the core [ 2 ]. Int. J. Environ. Res. Public Health 2023 , 20 , 6139. https://doi.org/10.3390/ijerph 20126139 https://www.mdpi.com/journal/ijerph

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 2 of 47 Integration and adoption of preventive health into existing health systems require leadership and support for significant health service reorientation. Indeed, the World Health Organization (WHO) recognises that of the five actions identified in the Ottawa Charter, reorientation of health services has been the most challenging [ 3 ]. Several recommendations have been made on how nations can develop strategies that positively influence the reorientation of health services, emphasising that development and design be contextual; achievable within the current health system, resource, and economic capabilities; and aligned with local values and preferences [ 3 ]. Like many other high-income countries, Australia’s current health systems focus heavily on treatment of illness and disease, with issues of access to healthcare and health inequity. The National Preventive Health Strategy 2021–2030 aims to rebalance the health system through a long term, systems-based approach [ 4 ]. This strategy acknowledges that the burden of ill health is not shared equally among the Australian community, and any service reorientation planning must include concerted efforts to reduce disparities and improve health outcomes among priority populations. In Australia, these groups include, but are not limited to, Aboriginal and Torres Strait Islander people, culturally and linguistically diverse (CALD), lesbian, gay, transgender, queer or questioning, intersex, and/or sexuality and gender diverse people (LGBTQI+), people with mental illness, people of low socioeconomic status, people with disability, and rural, regional, and remote communities One of the policy goals identified within the National Preventive Health Strategy is the establishment of local prevention frameworks [ 4 ]. Ideally, these frameworks are evidence based, incorporating the elements of value. Economic evaluations can assist local public health services identify strategies and interventions within their local framework that demonstrate cost-effectiveness, representing value for money. Such evaluations need to consider local contextual factors, such as resource allocation, and what is within jurisdictional purchasing power [ 5 ]. Both the Australian Institute of Health and Welfare and the Productivity Commission have highlighted the need to ensure sustainability of Australia’s health expenditure by addressing the growing disparity in investment in preventive health compared to clinical services, specifically noting that despite the potential for significant returns from investments into preventive health, the field suffers from a relative lack of funding [ 6 , 7 ]. This review specifically seeks to identify where there is evidence of cost-effectiveness or returns on investment in preventive health A scoping review is a type of evidence synthesis that can be used to systematically map the scope, characteristics, and findings in an area, which is useful for identifying priority areas for future research, policy, and practice. Therefore, this type of research design is highly appropriate for summarising the evidence base to support the development of local prevention frameworks. To our knowledge, no scoping reviews have been conducted that have identified and mapped the evidence for preventive health strategies for multiple health risk factors and/or health conditions for predominately high-income countries This review is important to provide a synthesis of relevant findings and draw conclusions based on the strength of the evidence to support translation. The aim of this scoping review was to identify and synthesise the available evidence from systematic reviews on the cost-effectiveness of preventive health strategies with relevance to local public health services, to inform the reorientation of preventive health services and delivery of value-based healthcare 2. Materials and Methods This scoping review was conducted in accordance with JBI methodology for scoping reviews [ 8 ] and reported using the PRISMA-ScR Reporting Standards (Table A 1 ) [ 9 ] (Appendix A , Table 1 ). The protocol for the scoping review is provided in Appendix A , Table A 2 . Due to the exploratory nature of scoping reviews and the breadth of preventive health, a review of reviews approach was used [ 10 ], searching for publications that include high-level aggregate data and/or an evidence synthesis of primary trials. The purpose was

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 3 of 47 to extract evidence that has already been synthesised and identify cost-effective focus areas for intervention in preventive health Table 1. Keywords included in search strategy Construct Search Terms Study design Review Prevention Primary prevention, secondary prevention, health promotion Economic Cost effectiveness, value for money, cost benefit analysis, cost utility analysis, cost consequence analysis, return on investment, social return on investment, cost minimisation analysis, economic evaluation, cost saving, cost efficient Context Healthcare service, public health a a “Local public health services” was not used as search term but introduced during screening process 2.1. Definition of Key Terms 2.1.1. Types of Preventive Health Types of preventive health were based on the National Preventive Health Strategy definitions, which represents a continuum spanning from wellness to ill health [ 4 ]. Primordial prevention, as defined by the strategy, is focused on the wider determinants of health by addressing the social and environmental factors across the entire population through strategies such as taxation, regulation, and infrastructure [ 4 ]. Primordial strategies require multilevel, multisectoral collaboration and investment and therefore fall outside the remit of local public health services. Primary prevention is focused on reducing risk factors to prevent ill health before it occurs through population-level strategies such as vaccination and targeted strategies for high-risk individuals, such as people with high blood pressure, low physical activity, poor dietary intake, or overweight/obesity [ 4 ]. Secondary prevention is focused on identifying individuals at high risk of ill health as well as early detection and management of a disease or disorder to either prevent or slow the long-term effects, using strategies such as health screening and counselling and education programmes [ 4 ]. Both primary and secondary health promotion are within the remit and purchasing power and embedded in service-level agreements of local public health services. Tertiary prevention focuses on managing established disease or disorder to maximise functional ability [ 4 ]. Quaternary prevention focuses on reducing harm from medical interventions used to manage a disease or disorder [ 4 ]. Health promotion is the process of “empowering people to increase control over their health and its determinants through health literacy efforts and multisectoral action to increase healthy behaviors” [ 11 ]. Disease prevention and health promotion share considerable overlap in goals and functions. The WHO characterise disease prevention services as those primarily concentrated within the healthcare sector, whereas health promotion services depend on intersectoral actions and/or are concerned with the social determinants of health 2.1.2. Economic Evaluation and Evaluation Methods For this scoping review, economic evaluation was defined as the “comparative analysis of alternative courses of action in terms of both their costs and consequences” [ 12 ]. There are several economic evaluation methods that can be used to evaluate cost-effectiveness While measurement of cost is common to all methods, measurement and valuation of outcomes vary Cost-effectiveness analysis (CEA) measures outcomes in natural health units such as deaths prevented, units of blood pressure, or minutes of physical activity. Cost–utility analysis (CUA) measures outcomes in quality-adjusted life years (QALYs), disability-adjusted life years (DALYs), or health-adjusted life years (HALYs), combining survival with quality of life, measured using preference-based, multiattribute utility instruments [ 13 ]. Both CEA and CUA compare alternatives using a summary measure, incremental cost-effectiveness ratio (ICER). ICERs can be compared against a pre-determined cost-effectiveness thresh-

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 4 of 47 old, recognised as a willingness to pay for a QALY [ 14 ]. While thresholds vary between countries and debate surrounds their origins and limitations [ 15 ], ICERs provide decision makers with a benchmark to guide value-based decisions and some level of comparability when allocating scarce resources. The United Kingdom has published their willingness to pay threshold for a QALY as from GBP 20,000–30,000 [ 16 ]. However, empirical evidence suggests in practice the true threshold sits at GBP 13,000 [ 17 ]. In the United States, ICER thresholds range from USD 50,000 to USD 200,000 [ 18 ]. The WHO have a published threshold, generally for lowand middle-income countries, set at one to three times the per capita gross domestic product [ 19 ]. While Australia has no explicitly stated or public threshold, empirical studies have reported thresholds around AUD 28,000 based on decision-making patterns for pharmaceutical reimbursement [ 20 ]. Cost–benefit analysis (CBA) values outcomes in monetary terms with an action deemed cost-effective if the benefit to cost ratio is greater than 1. Cost–consequence analysis (CCA), a form of CBA, includes monetised outcomes where available alongside non-monetised outcomes reported in natural units, allowing decision makers to assess value, albeit subjectively. Cost-minimisation analysis (CMA) is a method commonly associated with non-inferiority trials. Where outcomes are shown to be statistically equivalent between comparators, the analysis is constrained to looking at differences in cost only and the alternative with the lowest cost is favourable. Return on investment (ROI), while not strictly a comparative analytical approach, is the monetary benefit minus cost expressed as a proportion of the cost [ 21 ]. For example, a programme that spends AUD 1 and saves AUD 9 in future spending has an ROI of 800%. Social return on investment (SROI) and social cost–benefit analysis (SCBA) are emerging approaches, which attempt to monetise outcomes not typically captured, such as wider social and environmental outcomes [ 22 ]. 2.2. Search Strategy The search strategy was developed and tested in consultation with a research librarian (JB) following the mixed method Population, Concept, Context (PCC) framework [ 23 ]. The search strategy included grey literature to find reviews of economic evaluations, relevant to local public health services, contained within reports and government documents, and not typically located in peer-reviewed publications An initial search strategy was piloted in MEDLINE with iterative screening of the first 100 titles and abstracts until the search terms were set (Table 1 ). The final search was performed in the following databases: MEDLINE, Embase, APO, and MedNar, for review articles published between 2005 and February 2022. The search of the academic literature was limited to 2 databases for pragmatic reasons. The year 2005 was chosen as data from PubMed indicated that 79% of articles related to preventive health interventions and economic evaluation were published after this date (Table A 3 ). Furthermore, health economic evaluations were not vigorously reported until the introduction of the International Society for Pharmacoeconomics and Outcomes Research Task Force guidance for economic evaluation alongside clinical trials which occurred in 2005 [ 24 ]. Australian health economic and tertiary institution websites were manually searched for the same period, using search filters/terms defined by the institutions’ own search engines. The full search strategy is available in Appendix A (Tables A 4 and A 5 ). Citations identified by the search were collated and uploaded into EndNote X 9 [ 25 ] and duplicates removed 2.3. Selection of Articles Articles were included if they described a review of economic evaluations for primaryand/or secondary-level prevention interventions within or relevant to a local public health service setting. Health promotion was included only when the intervention fell within the resourcing of local public health services. Economic evaluations were restricted to full evaluations, excluding partial economic evaluations (e.g., micro-costings), methodological reviews, or economic frameworks. Reviews were excluded if the authors identified the preventive health strategies as primordial, tertiary, or quaternary. Even though local public

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 5 of 47 health services engage in tertiary preventive health strategies, the scope of this review was focused on primary and secondary prevention, with a view to reorienting health services from illness to wellness Clinical treatments, such as medical devices and pharmacotherapy for established disease, were excluded, except for therapies specifically for reducing tobacco use and nicotine addiction. In the absence of a stated level of prevention classification, the National Preventive Health Strategy was used as a reference point [ 4 ]. To increase generalisability to the Australian context, reviews of studies predominantly conducted in high-income countries, as defined by the World Bank for 2022 fiscal year [ 26 ], were included. Where reviews included studies in both highand middle-income countries, a cut-off of ≤ 25% of all studies being from middle-income countries was applied Reviews of low-income countries, global data, or aggregates of large regions (such as the European Union) were excluded. Non-English publications were also excluded due to resource constraints. Table 2 outlines the full inclusion and exclusion criteria applied for the screening of articles Table 2. Scoping review inclusion and exclusion criteria Criteria Include Exclude Date 2005 to February 2022 Pre-2005 Language English Non-English language Country High-income 1 countries Low-income countries, Whole regions (e.g., European Union), Global data Publication, Study Design Systematic review, Umbrella review, Aggregate report or evaluation Thesis, Narrative review, Editorial, Discussion, Protocol, Conference abstract Population Human studies, Universal or population groups, including priority populations, any age or sex Animal or In vitro studies Concept 1: Prevention Primary and/or secondary prevention, (e.g., Smoking, Nutrition, Alcohol, Physical activity, High cholesterol etc.) Primordial, tertiary, or quaternary prevention, Pharmacotherapy for treatment of established disease, medical devices, COVID-19 Concept 2: Economic Full economic evaluation (cost-effectiveness analysis, cost–benefit analysis, cost–utility analysis, cost–consequence analysis, cost-minimisation analysis), Return on investment, Value for money, Social return on investment Methodological paper or framework, Partial economic evaluation (e.g., costing study) Context Public health service/setting/local public health services as the provider of Concept 1 Nationalor state-level strategies/initiatives (e.g., regulation, taxation, mass media campaigns, transport, infrastructure, urban planning), Privatised health systems, Workplaces 1 Maximum of 25% of studies in the review from middle-income countries 2.4. Evidence Screening and Selection Pilot screening was conducted on titles and abstracts by two independent reviewers (DS, AH) for assessment against the initial eligibility criteria, with discrepancies resolved and revisions made to clarify eligibility criteria (Table 2 ). The remainder of the screening and selection process was undertaken primarily by one reviewer (DS), with 20% screened in duplicate by a second reviewer (AH); agreement was high at >95% 2.5. Data Extraction and Synthesis Data extraction was completed by two reviewers (DS, RT) with 20% screened by a third reviewer (AH). Data extraction was conducted within Microsoft Excel software (v 16). Characteristics of the studies in each review were extracted, including the number of countries represented, date range of publication, review aim, population included, median sample size, and type of prevention intervention. Extracted data were then descriptively or quantitatively summarised (i.e., median, minimum, maximum). Detailed mapping of the priority populations, as defined by the National Preventive Health Strategy [ 4 ], included in each of the reviews was undertaken The economic evaluation characteristics and results of each review were extracted, including the number of economic evaluations, method of analysis, study design, valuation of outcomes, and key economic findings. There is debate in the literature regarding the value of meta-analysis for economic evaluations that are heterogeneous [ 27 , 28 ]; therefore, a narrative approach was taken to summarise the study findings. Intuitive conclusions were drawn from the economic evidence within each focus area, classified into the following categories: cost-effective, not cost-effective, lack of evidence, and unclear, based on the cri-

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 6 of 47 teria reported in Table 3 . Where there were multiple reviews concluding cost-effectiveness within the same focus area (e.g., type 2 diabetes), the individual studies were compared across reviews to identify overlap and avoid misrepresenting the strength of evidence Table 3. Criteria for evaluating the economic evidence from the systematic reviews Assessment Categories Criteria Cost-effective • 5 or more studies were included in the systematic review • ≥ 70% of studies or interventions were cost-effective or • median ICERs < USD 50,000 or GBP 30,000 Not cost-effective • 5 or more studies were included in the systematic review • ≥ 70% of studies or interventions were not cost-effective or • median ICERs > USD 50,000 or GBP 30,000 Lack of evidence • <5 studies were included in the systematic review Unclear • Findings from the studies were mixed or inconclusive or • the studies included were too heterogeneous to draw conclusions ICER, Incremental cost-effectiveness ratio 2.6. Risk of Methodological Bias Appraisal of the Body of Evidence In accordance with scoping review methods, appraisal of the risk of economic methodological bias in the included reviews was not conducted [ 9 ]. However, methodological appraisals conducted within the reviews, including assessment tools used, were extracted as part of the study characteristics 3. Results A total of 472 records were identified during the initial search with 192 duplications, returning 317 unique articles for screening. At title and abstract screening, 198 records were excluded, and 1 article not able to be retrieved. One hundred and eighteen full text articles were assessed for eligibility. A total of 26 systematic reviews were included in full data extraction. The results of each stage are illustrated in Figure 1 . 3.1. Characteristics of Included Reviews The characteristics of the 26 included systematic reviews are described in Table 4 . The systematic reviews were predominately (19 of 26) published between 2015 and 2021. Across the systematic reviews, there were 674 economic evaluation studies, conducted in highincome ( n = 22 countries) and middle-income ( n = 10) countries (Figure A 1 ). All systematic reviews (26 of 26) had ≥ 90% of included studies from high-income countries. Many of the reviews ( n = 18) included studies conducted in Australia. Vos et al. [ 29 ] exclusively included 150 preventive health interventions that were modelled with the Australian population in 2003 as well as 21 interventions for the Australian indigenous population. The authors of these reviews did not report there was a significant difference in the findings of Australian studies versus other high-income countries. The sample population of the studies in the systematic reviews included universal ( n = 7), adults ( n = 13), adults and adolescents ( n = 3), and children ( n = 3). The systematic reviews that included priority populations are summarised in Table 5 . The highest proportion of systematic reviews in priority populations included people with disabilities (11 of 26 reviews) and mental illness (10 of 26). Very few systematic reviews included Indigenous people (1 of 26) and LGBTQI+ (1 of 26). Only half (13 of 26) reported the sample sizes of the included studies; for these the median sample was 911 individuals (minimum = 196, maximum = 1,216,000).

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 7 of 47 Int. J. Environ. Res. Public Health 2023 , 20 , x FOR PEER REVIEW 7 of 54 articles were assessed for eligibility. A total of 26 systematic reviews were included in full data extraction. The results of each stage are illustrated in Figure 1. Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) depicting the identi fi cation, screening, and inclusion of reviews. 3.1. Characteristics of Included Reviews The characteristics of the 26 included systematic reviews are described in Table 4. The systematic reviews were predominately (19 of 26) published between 2015 and 2021. Across the systematic reviews, there were 674 economic evaluation studies, conducted in high-income ( n = 22 countries) and middle-income ( n = 10) countries (Figure A 1). All systematic reviews (26 of 26) had ≥ 90% of included studies from high-income countries. Many of the reviews ( n = 18) included studies conducted in Australia. Vos et al. [29] exclusively included 150 preventive health interventions that were modelled with the Australian population in 2003 as well as 21 interventions for the Australian indigenous population. The authors of these reviews did not report there was a signi fi cant di ff erence in the fi ndings of Australian studies versus other high-income countries. The sample population of the studies in the systematic reviews included universal ( n = 7), adults ( n = 13), adults and adolescents ( n = 3), and children ( n = 3). The systematic reviews that included priority Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) depicting the identification, screening, and inclusion of reviews Table 4. Characteristics of included systematic reviews First Author, Year No. of Countries Included Date Range of Publications Aim of the Systematic Review Population Included Sample Size of Included Studies, Median (Min, Max) Prevention Type (Primary, Secondary) Mental Health Le, 2021 [ 30 ] 20 a 2007 to 2020 To evaluate the cost-effectiveness of mental health promotion and prevention interventions Universal 407 b (51, 12,864) Primary Park, 2013 [ 31 ] 3 2000 to 2012 To evaluate the cost-effectiveness of physical health promotion interventions Adults and older adults with clinically diagnosed mental health disorders 232 b (87, 2160) Secondary Soneson, 2020 [ 18 ] 1 2007 to 2017 To evaluate the cost-effectiveness of psychological interventions for psychotic experiences c Adolescents and adults with psychotic experiences 196 (196, 196) Secondary

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 8 of 47 Table 4. Cont First Author, Year No. of Countries Included Date Range of Publications Aim of the Systematic Review Population Included Sample Size of Included Studies, Median (Min, Max) Prevention Type (Primary, Secondary) Obesity Lehnert, 2012 [ 32 ] 7 a 2006 to 2017 To evaluate the long-term ( ≥ 40 years) cost-effectiveness of obesity prevention interventions Universal NR Primary Type 2 diabetes Glechner, 2018 [ 33 ] 8 a 2003 to 2016 To evaluate the cost-effectiveness of lifestyle intervention for the prevention of T 2 D and secondary diseases c Adults with pre-diabetes NR Primary Li, 2015 [ 34 ] 10 a 1998 to 2014 To evaluate the cost-effectiveness of diet and physical activity promotion for the prevention of T 2 D Adults and older adults at increased risk of T 2 D 3234 b (552, 3887) Primary Zhou, 2020 [ 35 ] 9 a 2008 to 2017 To evaluate the cost-effectiveness of T 2 D prevention interventions Adolescents, adults, and older adults at high-risk of T 2 D and universal NR Primary Dental caries Anopa, 2020 [ 36 ] 6 a 1986 to 2017 To review economic evaluations on primary caries prevention interventions Pre-school children 964 b (161, 209,285) Primary Fraihat, 2019 [ 37 ] 8 a 1976 to 2018 To evaluate the cost-effectiveness of primary caries prevention interventions for dental diseases c Pre-school and primary aged children 419 b (51, 209,285) Primary Public health Ashton, 2020 [ 22 ] 6 2007 to 2019 To evaluate SROI and SCBA evidence of public health interventions for health and well-being Universal NR Primary Banke-Thomas, 2015 [ 38 ] 11 a 2005 to 2014 To assess studies where SROI has been applied in public health, lessons learnt, and recommendations for future Universal NR Primary Masters, 2017 [ 21 ] 6 1976 to 2015 To evaluate the return of investment of public health interventions Universal 1454 b (123, 16,375) Primary Reeves, 2019 [ 39 ] 5 2000 to 2017 To review economic evaluations of strategies for enhancing the implementation of public health interventions and policies Universal NR Primary Chronic disease Dubas-Jakobczyk, 2017 [ 40 ] 11 2000 to 2015 To review the cost-effectiveness of health promotion and/or primary prevention programmes for chronic disease Older adults 412 b (76, 33,152) Primary Gordon, 2007 [ 41 ] 7 1995 to 2005 To evaluate the cost-effectiveness of face-to-face health behaviour interventions for smoking, physical activity, diet, and alcohol for the prevention of chronic disease Adults NR Primary

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 9 of 47 Table 4. Cont First Author, Year No. of Countries Included Date Range of Publications Aim of the Systematic Review Population Included Sample Size of Included Studies, Median (Min, Max) Prevention Type (Primary, Secondary) Mattli, 2020 [ 42 ] 5 2000 to 2018 To review the literature from RCT-based economic evaluations of physical activity interventions outside the workplace setting for chronic disease prevention Adults and older adults 911 (51, 2140) Primary Pennington, 2013 [ 43 ] 2 2002 to 2006 To synthesise the evidence on cost-effectiveness of health-related lifestyle advice delivered by peer or lay advisors for chronic disease prevention c Adults NR Primary Vos, 2011 [ 29 ] 1 2003 To evaluate the cost-effectiveness of preventive interventions for non-communicable diseases Universal NR Primary, secondary Sexual health Bloch, 2021 [ 44 ] 7 2000 to 2018 To synthesise the economic evidence on interventions for the prevention and management of sexually transmitted infections and HIV Adolescents and adults NR Primary, secondary Immunisation Boccalini, 2021 [ 45 ] 5 2013 to 2020 To evaluate the cost-effectiveness of influenza vaccination Children NR Primary Smoking cessation Cheung, 2017 [ 46 ] 1 2013 to 2016 To review the cost-effectiveness of eHealth smoking cessation interventions Adults NR Secondary Lee, 2019 [ 47 ] 5 1993 to 2016 To appraise the methodological quality and evaluate cost-effectiveness studies of inpatient smoking cessation programmes Adults hospitalised with any conditions 433 b (224, 4404) Secondary Mahmoudi, 2012 [ 48 ] 8 2008 to 2010 To review the cost-effectiveness of non-nicotine therapies for smoking cessation, compare the types of models used, and determine if any variables impact on the cost-effectiveness Adults NR Secondary Reducing alcohol Kruse, 2020 [ 49 ] 1 2011 To evaluate cost-effectiveness of telemedicine for the management of alcohol abuse, addiction, and rehabilitation c Adults with alcohol use disorder 1,216,000 (1,216,000, 1,216,000) Secondary Fractures Ganda, 2013 [ 50 ] 4 2007 to 2011 To evaluate the cost-effectiveness of secondary preventions for osteoporotic fractures c Adults and older adults 1140 (349, 620,000) Secondary Wu, 2018 [ 51 ] 6 2007 to 2017 To evaluate the cost-effectiveness of fracture liaison services or secondary fracture preventive programmes Adults and older adults 1000 b (100, 10,000) Secondary a <25% from middle-income countries; b not all studies in review reported sample size; c clinical efficacy of the interventions was also evaluated. HIV, Human immunodeficiency virus; NR, Not reported; RCT, Randomised control trial; SCBA, Social cost–benefit analysis; SROI, Social return on investment; STI, Sexually transmitted infections; T 2 D, Type 2 diabetes.

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 10 of 47 Table 5. Priority populations a of included systematic reviews First Author, Year Indigenous b Culturally and Linguistically Diverse Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, and/or Other Sexuality and Gender Diverse Mental Illness Low Socioeconomic Status Disability Rural, Regional, Remote Anopa, 2020 [ 36 ] X Ashton, 2020 [ 22 ] X X X Banke-Thomas, 2015 [ 38 ] X X Bloch, 2021 [ 44 ] X X Boccalini, 2021 [ 45 ] Cheung, 2017 [ 46 ] Dubas-Jakobczyk, 2017 [ 40 ] X Fraihat, 2019 [ 37 ] X Ganda, 2013 [ 50 ] Glechner, 2018 [ 33 ] X Gordon, 2007 [ 41 ] Kruse, 2020 [ 49 ] X Le, 2021 [ 30 ] X Lee, 2019 [ 47 ] X X Lehnert, 2012 [ 32 ] Li, 2015 [ 34 ] X X Mahmoudi, 2012 [ 48 ] X Masters, 2017 [ 21 ] X X X Mattli, 2020 [ 42 ] Park, 2013 [ 31 ] X X X X Pennington, 2013 [ 43 ] X X X Reeves, 2019 [ 39 ] X X Soneson, 2020 [ 18 ] X X Vos, 2010 [ 29 ] X a X X X X Wu, 2018 [ 51 ] X Zhou, 2020 [ 35 ] X X X X indicates that the study sample included the specified priority population a Priority populations identified in the National Preventive Health Strategy [ 4 ]; b Aboriginal and Torres Strait Islander people, Australia Most systematic reviews (22 of 26) aimed to identify studies related to specific interventions (e.g., psychological) for a risk factor or condition (e.g., psychotic experiences). The remaining four aimed to identify economic evaluations in public health, without limiting to any particular focus area. Within reviews, studies were often grouped by characteristics such as population, intervention sub-types, intervention approach (i.e., universal vs. targeted), method of economic evaluation, methodological quality, and type of economic outcomes reported. More than half of the reviews (16 of 26) included interventions that targeted primary prevention. Prevention focus areas included mental health ( n = 3 reviews), obesity ( n = 1), type 2 diabetes ( n = 3), dental caries ( n = 2), public health ( n = 4), chronic disease ( n = 5), sexual health ( n = 1), immunisation ( n = 1), smoking cessation ( n = 3), reducing alcohol ( n = 1), and fractures ( n = 2) 3.2. Economic Evaluation Methods The economic evaluation methods and key findings are described in Table 6 . The median number of economic evaluation studies included in the systematic reviews was 16 (minimum = 1, maximum = 150). Economic analysis methods included CEA, CUA, CBA, CCA, SROI, and ROI Table 6. Economic evaluation methods, risk of bias assessment, and key findings First Author, Year No. of Economic Evaluation Studies Economic Analysis Method Used Study Design Risk of Bias Methodological Assessment Tool Used Economic Outcomes Key Economic Findings Reported by the Reviews Mental health Le, 2021 [ 30 ] 65 CEA, CUA, ROI 30 RCTs, 29 simulation models, 2 quasi, 2 pre–post, 1 cross-sectional, 1 ecological Quality of Health Economic Studies Instrument QALYs DALYs, ICER In children and adolescents (<18 years) ( n = 23 studies): interventions targeted depression ( n = 7), anxiety ( n = 4), behaviour ( n = 3), suicide ( n = 4), eating disorders ( n = 2), cannabis use ( n = 1), maltreatment ( n = 1), and general mental health ( n = 1). In children and adolescents, screening plus psychological interventions at school and parenting interventions were the most cost-effective interventions. In adults (18 to 65 years) ( n = 35 studies): interventions targeted depression ( n = 11), suicide ( n = 8), general mental health ( n = 7), eating disorders ( n = 2), psychosis ( n = 2), substance use ( n = 1), anxiety ( n = 1), and panic disorder ( n = 1). In adults, screening plus psychological interventions were shown to be cost-effective. In older adults (>65 years) ( n = 7 studies): interventions targeted depression ( n = 6), anxiety ( n = 4), and general mental health ( n = 1). The cost-effectiveness of mental health interventions in older adults is inconclusive due to limited evidence.

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 11 of 47 Table 6. Cont First Author, Year No. of Economic Evaluation Studies Economic Analysis Method Used Study Design Risk of Bias Methodological Assessment Tool Used Economic Outcomes Key Economic Findings Reported by the Reviews Park, 2013 [ 31 ] 11 CCA, CEA, CUA 8 RCTs, 2 simulation models, 1 pre–post No tool used Incremental cost per: successful quit, life year gained, QALY gained Interventions targeted sedentary behaviour ( n = 3), substance misuse ( n = 3 studies), infectious diseases ( n = 4), and smoking ( n = 1). Physical activity interventions ranged from cost-effective for supervised walks (99.9% probability) and tailored exercise programmes (89.0%) to not cost-effective for facilitated support (57.0%). Substance abuse support programmes using case managers were not cost-effective. The cost-effectiveness of HIV interventions was gender specific or they were not cost-effective. The prevention or management of blood-borne disease using mobile specialist teams was evaluated, however, the cost-effectiveness of this intervention was unclear Multistrategy smoking cessation programme in outpatient setting was cost-effective (74.0%) Soneson, 2020 [ 18 ] 2 CEA, CUA 2 RCTs Drummond Critical Appraisal of Economic Evaluations Checklist Transition to psychosis averted, QALYs CEA found routine care plus CBT had a 64% probability of being cost-effective at 18 months and 83% at 4 years compared with routine care. CUA found routine care plus CBT had an 83% probability of being cost-effective at 18 months and 86% at 4 years compared with routine care Obesity Lehnert, 2012 [ 32 ] 16 CUA All simulation models No tool used QALY, DALY Across the 16 publications, 21 behavioural and 12 community interventions were identified. For behavioural interventions, 16 interventions were cost-effective, 1 was cost-saving, and 5 were not cost-effective. For community interventions, 9 interventions were cost-effective and 3 were not cost-effective Type 2 diabetes Li, 2015 [ 34 ] 22 CEA 18 simulation models, 4 RCTs Community Guide protocol for economic evaluations CBR ICER per LYG, QALY saved, DALY averted Fifteen of sixteen studies that reported cost per QALY saved indicated that combined diet and physical activity promotion interventions were cost-effective (median of USD 13,761). Three studies reported cost savings and two studies found the interventions to be cost-effective based on cost per DALY averted (AUD 21,195 and AUD 50,707 per DALY) Glechner, 2018 [ 33 ] 14 CEA 8 simulation models, 6 RCTs Drummond Critical Appraisal of Economic Evaluations Checklist Costs per life year gained, costs per QALY, costs per DALY, costs per avoided diabetes-associated outcome Across the 13 studies (14 articles), 11 studies found that lifestyle interventions are cost-effective compared with no interventions or usual care. Cost per QALY ranged from USD 1100–1300 over a lifelong time horizon and from USD 31,500–34,500 over a 3-year time horizon Zhou, 2020 [ 35 ] 28 CEA 20 simulation models, 8 RCTs Guidelines for authors and peer reviewers of economic submissions to the British Medical Journal ICER, cost saved In high-risk individuals, lifestyle interventions were the most cost-effective interventions (median ICERs of USD 12,520 per QALY) followed by metformin interventions (USD 17,089 per QALY). Diabetes prevention programme was the most cost-effective type of lifestyle intervention compared with non-diabetes prevention programme (USD 6212 vs. USD 13,228) Dental caries Anopa, 2020 [ 36 ] 16 CBA, CEA, CUA 7 simulation models 6 quasi, 2 RCTs, 1 cohort CHEERS Checklist ICER, ACER, B/C ratio, cost per carious surface averted, cost per incremental change in dmfs, cost per tooth saved, cost per child saved from caries experience, cost per child saved from extraction experience, number of avoided restorative or surgical treatment visits Six of fifteen studies that conducted CEA found that a dental disease management programme, education programmes, fluoridated milk and milk–cereal, and five caries prevention interventions were cost-effective. Only 1 of 2 studies that conducted CBA demonstrated benefits of a combined hand hygiene and OH promotion programme Only 1 study reported QALY as an outcome and found that home visits and telephone intervention were dominant and cost-saving compared with usual care Fraihat, 2019 [ 37 ] 19 CEA 10 RCTs, 9 simulation models Drummond Critical Appraisal of Economic Evaluations Checklist Decayed, missing, filled teeth, QALY, dental visits Oral health promotion was found to be effective for reducing the costs in 97 of 100 interventions (95% CI 89–99%, I 2 : 99%, p = 0). Sub-group analyses by age group identified that oral health promotion interventions were effective in reducing incremental cost for children 6 years and older but were not cost-effective for children less than 6 years old Public health Ashton, 2020 [ 22 ] 40 SROI 39 case studies, 1 simulation model Krlev et al.’s framework Crude SROI ratio Public health interventions were identified across the life course for the included studies which were stage 1: birth, neonatal period, post-natal period, and infancy ( n = 2 studies); stage 2: childhood and adolescence ( n = 17); stage 3: adulthood (main employment and reproductive years) ( n = 8); and stage 4: older adulthood ( n = 6), as well as studies across the life course ( n = 7). Interventions during stage 1 targeted breastfeeding and crude SROI ranged from GBP 6.50 per GBP 1 invested to EUR 15.85 per EUR 1 invested. Interventions during stage 2 targeted general health and well-being, substance misuse, mental well-being, sexual health and teenage pregnancy, employment, physical activity, and anti-social behaviour SROI ratios ranged from GBP 2 to GBP 9.20 per GBP 1 invested. Intervention during stage 3 targeted mental well-being, general health and well-being interventions, smoking, employment, and substance misuse. The SROI ratios ranged from GBP 0.66 to GBP 7 per GBP 1 invested Interventions during stage 4 targeted mental well-being and isolation and loneliness. The SROI ratios ranged from GBP 1.20 to GBP 11 per GBP 1 invested. Across the life course interventions targeted general health and well-being, physical activity, and diet. SROI ratios ranged from GBP 44.56 per GBP 1 invested to GBP 2.56 per GBP 1 invested.

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 12 of 47 Table 6. Cont First Author, Year No. of Economic Evaluation Studies Economic Analysis Method Used Study Design Risk of Bias Methodological Assessment Tool Used Economic Outcomes Key Economic Findings Reported by the Reviews Banke-Thomas, 2015 [ 38 ] 40 SROI 39 case studies, 1 simulation model Krlev et al.’s framework SROI ratios SROI evaluations were identified across a wide range of public health areas including health promotion (12 studies), mental health (11), sexual and reproductive health (6), child health (4), nutrition (3), healthcare management (2), health education, and environmental health (1 each). Across these studies there was a lack of agreement on who to include as beneficiaries and how to account for counterfactual and appropriate study-time horizons. Reported SROI ratios varied widely (1.1:1 to 65:1). Authors interpreted an SROI ratio > 1 as a worthwhile investment Masters, 2017 [ 21 ] 44 CEA, ROI 23 simulation models, 4 RCTs, 5 cohort matched control, 4 quasi, 2 mixed methods, 2 case studies, 1 cohort, 1 cross-sectional, 1 pre–post NICE quality appraisal checklist for economic evaluations CBR, ROI Public health interventions were stratified by specialism including health protection interventions, health promotion interventions, and healthcare public health interventions. The median (range) ROI and CBR were 34.2 ( − 21.3 to 221) and 41.8 (1.2 to 167) for health protection interventions, 2.2 (0.7 to 6.2) and 14.4 (2.0 to 29.4) for health promotion interventions, while ROI was 5.1 (1.15 to 19.35) and no studies reported a CBR for healthcare public health interventions Reeves, 2019 [ 39 ] 14 CBA, CCA, CEA, CUA 12 RCTs, 2 simulation models Drummond Critical Appraisal of Economic Evaluations Checklist, CHEERS Checklist ICER, net monetary benefit statistics, CBR Interventions targeted cancer, physical activity, combination of physical activity and diet, alcohol-related crime, and infectious diseases. Most studies (9 of 14) reported that public health interventions were cost-effective or had a positive cost–benefit ratio. Three studies reported that the interventions were not cost-effective while two studies made no conclusion regarding the cost-effectiveness Chronic disease Dubas-Jakobczyk, 2017 [ 40 ] 29 CBA, CCA, CEA, CUA 16 RCTs, 10 simulation models, 3 quasi Drummond Critical Appraisal of Economic Evaluations Checklist QALYs, the number of falls or number of falls prevented, avoidance of health service utilisation, and the number of femoral/hip fracture incidents prevented or time free of these fractures Interventions targeted falls amongst the older population, disability, general health, physical activity, and oral health. Ten interventions which predominately (80%) focused on fall prevention were cost-effective or cost-saving. For 13 studies the cost-effectiveness of the intervention was unclear. Six studies concluded that the intervention was not cost-effective Gordon, 2007 [ 41 ] 64 CEA 31 RCTs, 23 simulation models, 3 quasi, 3 pre–post, 1 randomised trial, 1 cohort matched control, 1 cross-sectional study, 1 comparative study Guidelines for authors and peer reviewers of economic submissions to the British Medical Journal ICERs, per QALY gained, cost per LYS Favourable cost-effectiveness was reported for smoking interventions (EUR 14,000 per QALY gained), physical activity interventions (EUR 53,119 per QALY gained), and multiple behaviour intervention in high-risk groups (cost-saving of EUR 40,094). The cost-effectiveness of alcohol and dietary interventions is unclear due to significant heterogeneity in the outcomes reported Mattli, 2020 [ 42 ] 12 CEA 12 RCTs Consensus on Health Economics Criteria List ICER per MET hour gained Most interventions (18 of 22) were not cost-effective and reported an ICER above the authors’ cut-off benchmark of USD 0.44–0.63 per MET hour gained Pennington, 2013 [ 43 ] 3 CEA All RCTs Quality Assessment Tool for Quantitative Studies QALYs, cost per additional mammogram, cost per LYS Interventions targeted general chronic disease, T 2 D management, and breast cancer. A chronic disease self-management programme was found to be cost-effective (94% probability). Study findings indicated a telemedicine support programme for T 2 D was cost-effective (GBP 43,400/quality-adjusted life year). The cost-effectiveness of mammography promotion interventions varied depending on the target population Vos, 2011 [ 29 ] 150 interventions CEA All simulation models ACE Priority Setting Checklist DALYs Specific topic areas that had ≥ 5 preventive interventions that both improved health and contributed to net cost savings or cost <USD 10,000 per DALY prevented (defined as “dominant” or “very cost-effective”) included: alcohol (7 of 9 interventions), mental disorders (7/11), tobacco (5/8), and other interventions (5/11). Specific topic areas that had ≥ 3 treatment interventions classified as dominant or very cost-effective included: mental disorders (5/10) and other treatment (3/6) Sexual Health Bloch, 2021 [ 44 ] 31 CBA, CCA, CEA, CUA 30 simulation models, 1 pilot RCT Guidelines for authors and peer reviewers of economic submissions to the British Medical Journal MOAs, such as PID, ectopic pregnancy, or infertility, QALYs, monetary outcomes, or the number of patients cured Studies analysed different screening options for chlamydia trachomatis, gonorrhoea, and HIV. Sixteen found chlamydia trachomatis screening is likely to be cost-effective for those <30 years of age. Nine studies concluded that chlamydia trachomatis screening was likely to be cost-effective under certain assumptions (e.g., appropriate uptake rate). However, the remaining 4 studies did not find STI screening to be cost-effective Immunisation Boccalini, 2021 [ 45 ] 8 CEA, CUA All simulation models No tool used Cost/QALYs, cost/life year All study authors concluded that childhood influenza vaccination with live attenuated vaccine, specifically the quadrivalent formulation, was cost-effective compared with the trivalent inactivated influenza vaccine or no vaccination (ICER: GBP 7234 vs. GBP 7989 per QALY gained) Smoking cessation Cheung, 2017 [ 46 ] 2 CEA 2 RCTs No tool used Prolonged abstinence Both studies reported the intervention to be highly cost-effective ranging from EUR 1500 for video-based counselling to EUR 5100 for an online programme and phone-based counselling to be paid for each additional abstinent participant compared with usual care Lee, 2019 [ 47 ] 9 CEA 4 RCTs, 5 simulation models British Medical Journal’s checklist for reporting economic evaluations The number of quitters, LYGs, QALYs, episode of non-fatal acute myocardial infarction, death, hospitalisation days Smoking cessation programmes for hospitalised patients are highly cost-effective. No significant difference was found in the distribution of ICERs between studies that provide nicotine replacement therapy interventions compared with interventions without nicotine replacement therapy. ICERs for nicotine replacement therapy interventions ranged from dominant to USD 8354 per LY compared with dominant to USD 5568 per LY for interventions without nicotine replacement therapy Mahmoudi, 2012 [ 48 ] 10 CEA 10 simulation models Drummond Critical Appraisal of Economic Evaluations Checklist Relapse rate, ICER Eight studies used a Markov BENESCO model for analysis, six of these studies found that varenicline dominated bupropion while the remaining two studies identified that varenicline was cost-effective. The 2 non-BENESCO model studies found varenicline to be cost effective with ICERs of USD 14,729 and USD 3303 per LYG.

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 13 of 47 Table 6. Cont First Author, Year No. of Economic Evaluation Studies Economic Analysis Method Used Study Design Risk of Bias Methodological Assessment Tool Used Economic Outcomes Key Economic Findings Reported by the Reviews Reducing alcohol Kruse, 2020 [ 49 ] 1 CEA 1 simulation model No tool used DALYs Only 1 study investigated the cost-effectiveness of telemedicine for alcohol-related disorders. This study reported that the implementation of new eHealth technologies would improve the value of returns from EUR 1.08 per EUR 1 spent to EUR 1.62 in health-related value Fractures Ganda, 2013 [ 50 ] 5 CEA 2 simulation models, 1 quasi, 1 cohort study, 1 clinical audit No tool used Fracture prevented, fracture date, refracture rate, QALY gained Four of four studies of interventions involving identification, assessment, and treatment of patients as part of the service were predicted or shown to be cost saving or cost-effective, with a cost of AUD 20,000 to AUD 30,000 per QALY gained. One study identifying and assessing people with a minimal trauma fracture, then making treatment recommendations to the primary care physician, without initiating treatment was found to be cost-effective, reporting cost per QALY gained was GBP 5740 Wu, 2018 [ 51 ] 16 CBA, CEA 17 simulation models, 2 cohort matched controls Drummond Critical Appraisal of Economic Evaluations Checklist QALYs, DALYs, ICER Overall, the FLS was shown to be cost-effective compared with usual care or no treatment, regardless of the programme intensity. The least expensive programmes such as mail-based interventions costing CAD 7 to CAD 8 per patient were associated with CAD 18,000 to CAD 22,000 in savings for a population of 1000 post-fracture patients. The upscaled implementation of FLS at 122 sites across the UK was estimated to prevent 31,000 fractures over the lifetimes of patients each year ACE, Assessing Cost-Effectiveness; BENESCO, Benefits of Smoking Cessation on Outcomes; CBT, Cognitive behavioural therapy; CCA, Cost–consequence analysis; CEA, Cost-effectiveness analysis; CER, Cost-effectiveness ratio; CHEERS, Consolidated Health Economic Evaluation Reporting Standards; CUA, Cost–utility analysis; DALY, Disability-adjusted life year; DMFS, Decayed, missing, filled surface; FLS, Fracture liaison service; ICER, Incremental cost-effectiveness ratio; MET, Metabolic equivalent of task; MOA, Major outcomes averted; National Institute for Health and Care Excellence, NICE; LYG, Life year gained; PID, Pelvic inflammatory disease; QALY, Quality-adjusted life year; RCT, Randomised control trial; ROI, Return on investment; SCBA, Social cost–benefit analysis; SROI, Social return on investment; T 2 D, Type 2 diabetes 3.3. Risk of Methodological Bias of the Evidence from the Systematic Reviews Twenty of twenty-six systematic reviews used an assessment tool to appraise the risk of economic methodological bias (Table 6 ). The quality assessment tools used included: the Drummond Critical Appraisal of Economic Evaluations Checklist ( n = 6) [ 52 ], guidelines for authors and peer reviewers of economic submissions to the British Medical Journal ( n = 4) [ 52 ], Krlev et al.’s framework ( n = 2) [ 53 ], Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Checklist ( n = 2) [ 54 ], Assessing Cost Effectiveness (ACE) Study Priority-Setting Checklist ( n = 1) [ 29 ], Community Guide protocol for economic evaluations ( n = 1) [ 55 ], Consensus on Health Economics Criteria list ( n = 1) [ 56 ], Quality Assessment Tool for Quantitative Studies ( n = 1) [ 57 ], Quality of Health Economic Studies Instrument ( n = 1) [ 58 ], National Institute for Health and Care Excellence (NICE) quality appraisal checklist for economic evaluations ( n = 1) [ 59 ], and Philips’s Checklist ( n = 1) [ 60 ]. Eleven systematic reviews [ 18 , 21 , 22 , 30 , 33 , 35 , 38 , 40 , 42 , 43 , 48 ] concluded that at least 70% of studies were highly rated for their methodological quality (Table 7 ). Limitations of the evidence commonly related to the use of a short time horizon, limited perspective for the economic analysis, and a higher proportion of studies from the United States Table 7. Categorisation of the cost-effectiveness of intervention by health area for the included systematic reviews ( n = 26) First Author, Publication Year of the Systematic Review (Number of Articles Included) CE Not CE Lack of Evid. Not Clear Risk of Methodological Bias Assessment Reported in the Systematic Review Mental health Le, 2021 [ 30 ] ( n = 65 articles) X Most (92%) studies were assessed as fair to high methodological quality Park, 2013 [ 31 ] ( n = 11 articles) X Not assessed Soneson, 2020 [ 18 ] ( n = 2 articles) X All studies were of high methodological quality (met 87–90% of checklist components).

[Find the meaning and references behind the names: Every, Single, Good]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 14 of 47 Table 7. Cont First Author, Publication Year of the Systematic Review (Number of Articles Included) CE Not CE Lack of Evid. Not Clear Risk of Methodological Bias Assessment Reported in the Systematic Review Obesity Lehnert, 2012 [ 32 ] ( n = 16 articles, intervention targeted adults) X Not assessed Lehnert, 2012 [ 32 ] ( n = 3 articles, intervention targeted children) X Not assessed Type 2 diabetes Glechner, 2018 [ 33 ] ( n = 14 articles) X Most studies were of high methodological quality as only 2 checklist components were not met on average across the studies Li, 2015 [ 34 ] ( n = 22 articles) X Assessed but results not reported Zhou, 2020 [ 35 ] ( n = 28 articles) X Review only included studies with a quality score > 7 points (max. 13 points) Dental caries Anopa, 2020 [ 36 ] ( n = 16 articles) X Many (63%) of the studies had a quality appraisal score of ≥ 94% Fraihat, 2019 [ 37 ] ( n = 19 articles) X Many (60%) studies had a quality appraisal score of ≥ 8 points (max. 10 points) Public health Ashton, 2020 [ 22 ] ( n = 40 articles) X Many (71%) studies received the highest quality appraisal rating Banke-Thomas, 2015 [ 38 ] ( n = 40 articles) X Many (70%) studies received the highest quality appraisal rating Masters, 2017 [ 21 ] ( n = 44 articles) X Many (71%) studies received the highest quality appraisal rating Reeves, 2019 [ 39 ] ( n = 14 articles) X No single study met every reporting criterion and compliance was highly variable for the following quality measures: identification of the effects (29–79% of studies), measurement of effects (50–86%), and valuation of the effects (50–100%) Chronic disease Dubas-Jakobczyk, 2017 [ 40 ] ( n = 29 articles) X Most studies (86%) were assessed as “good” or moderate methodological quality Gordon, 2007 [ 41 ] ( n = 64 articles) X Assessed but results not reported Mattli, 2020 [ 42 ] ( n = 12 articles) X Most studies (83%) met ≥ 70% methodological quality checklist items Pennington, 2013 [ 43 ] ( n = 3 articles) X Only publications assessed as “strong” in methodological quality were included in the review Vos, 2011 [ 29 ] ( n = 150 articles) X Assessed but results not reported Sexual health Bloch, 2021 [ 44 ] ( n = 31 articles) X Less than half (32%) of studies met ≥ 70% of quality checklist items Immunisation Boccalini, 2021 [ 45 ] ( n = 8 articles) X Not assessed Smoking cessation Cheung, 2017 [ 46 ] ( n = 2 articles) X Not assessed Lee, 2019 [ 47 ] ( n = 9 articles) X More than half (56%) of studies met >70% of quality checklist items Mahmoudi, 2012 [ 48 ] ( n = 10 articles) X Most (80%) studies met ≥ 90% of quality checklist items Reducing alcohol Kruse, 2020 [ 49 ] ( n = 1 article) X Not assessed Fractures Ganda, 2013 [ 50 ] ( n = 5 articles) X Not assessed Wu, 2018 [ 51 ] ( n = 16 articles) X More than half (63%) of studies were assessed as high quality X indicates the assessment category that has been assigned to the review based on the strength of the evidence.

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 15 of 47 3.4. Cost-Effective or Not Cost-Effective? The categorisation of the cost-effectiveness of the interventions by health area for the included systematic reviews is reported in Table 7 and summarised below. Details about the type of interventions included in the reviews are provided in Appendix A Table A 6 . 3.4.1. Mental Health Three systematic reviews [ 18 , 30 , 31 ] evaluated the economic evidence of mental health interventions. Le at al. [ 30 ] reviewed primary intervention studies ( n = 65) for mental health disorders and mental health promotion across all life stages. The main types of interventions included were cognitive behavioural therapy, standard psychological intervention, school-based interventions, parenting interventions, and screening plus psychological interventions. Li et al. [ 34 ] classified 64% of the interventions as “unclear” since the health benefits associated with the intervention were at a higher cost. Thirty four percent of the interventions were classified as “favoured” which focused on children, adolescents, or adults and targeted the prevention of depression and suicide or promotion of mental health. The cost-effectiveness of these interventions was classified as not clear due to the broad scope of the systematic review which considered interventions that targeted multiple mental health conditions across different life stages Park et al. [ 31 ] reviewed secondary intervention studies ( n = 11) for physical health promotion in adults and older adults with mental health disorders. There was a wide range of interventions that were included, such as cognitive behavioural therapy, physical exercise, and smoking cessation programmes. The cost-effectiveness of these interventions was classified as not clear. While there were 11 studies in the review the studies were too heterogeneous to draw conclusions on cost-effectiveness Soneson et al. [ 18 ] reviewed secondary prevention interventions ( n = 2) for psychotic experiences in adolescents and adults. There was insufficient evidence to determine the cost-effectiveness of cognitive behavioural therapy interventions; the two articles identified were based on data from a single RCT 3.4.2. Obesity One systematic review [ 32 ] evaluated the long-term ( ≥ 40 years) impact of primary prevention intervention studies ( n = 16) for obesity for all life stages. The main types of interventions included diet, physical activity, and lifestyle. Lehnert et al. [ 32 ] reported that 81% of behavioural and 75% of community interventions were cost-effective or cost-saving. In particular, this systematic review found that seven of nine lifestyle interventions were cost-effective [ 32 ]. These interventions were predominately (83%) in adults and the economic evidence for interventions that targeted children was not favourable. Interventions targeting adults were therefore classified as cost-effective, while interventions in children were classified as lacking evidence as only three studies were included. Nine of sixteen studies included in the review were based on economic evidence from the Australian ACE study on prevention of obesity, which overlapped with studies included in the systematic review by Vos et al. [ 29 ] included in this scoping review; however, this did not change the interpretation of obesity prevention being cost-effective 3.4.3. Type 2 Diabetes Three systematic reviews [ 33 – 35 ] evaluated the economic evidence of type 2 diabetes interventions for adults. Interventions were classified as cost-effective across all three systematic reviews. Glechner et al. [ 33 ] reported that 94% of studies ( n = 14) found that diet and physical activity intervention studies were cost-effective. Li et al. [ 34 ] reported that 85% of diet and physical activity intervention studies ( n = 22) were cost-effective Group-based programmes were found to be more cost-effective compared with individualbased programmes [ 33 ]. Zhou et al. [ 35 ] reported that lifestyle interventions targeting diet and physical activity were the most cost-effective interventions, followed by metformin interventions. The median ICERs for group-based interventions were less than half of

[Find the meaning and references behind the names: Molar]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 16 of 47 those for individual-based interventions [ 35 ]. In total there were 64 studies included across the 3 systematic reviews; 18 studies (28%) overlapped between reviews. There were sixteen studies that overlapped between two reviews, and two studies between three systematic reviews; this did not change the interpretation of type 2 diabetes prevention being cost-effective 3.4.4. Dental Caries Two systematic reviews [ 36 , 37 ] evaluated the economic evidence of dental caries interventions in children. Anopa [ 36 ] reviewed primary prevention intervention studies ( n = 16) for dental caries in pre-school-aged children. The main types of interventions included were multicomponent interventions, fluoride treatment, molar sealant, and oral hygiene and diet education. The cost-effectiveness of these interventions was classified as unclear since only 40% and 50% of studies that conducted CEA and CBA, respectively, reported the interventions to be cost-effective. Fraihat et al. [ 37 ] also reviewed prevention studies ( n = 19) but for both pre-school-aged and primary-aged children. A wide variety of interventions were included and sub-group analyses indicated that primary prevention interventions were only effective in reducing incremental cost for children older than six years ( n = 4) and were not cost-effective for children less than six years old ( n = 14). These interventions were classified as not clear due to the mixed findings 3.4.5. Public Health Four systematic reviews [ 21 , 22 , 38 , 39 ] evaluated the economic evidence of public health interventions. A wide variety of interventions were included such as physical activity, substance misuse, child behavioural management, community-based programmes, and healthy lifestyle interventions. These reviews were broad in scope and included interventions that targeted multiple health conditions across different life stages. As the studies included were too heterogeneous to draw conclusions, cost-effectiveness was classified as unclear for the four systematic reviews 3.4.6. Chronic Disease Five systematic reviews [ 29 , 40 – 43 ] evaluated the economic evidence for chronic disease prevention. Three systematic reviews [ 29 , 40 , 41 ], including one review in which the interventions were modelled exclusively on the Australian population, were broad in scope and included interventions that targeted multiple health conditions across different life stages. Therefore, the cost-effectiveness of interventions was assessed as unclear for these three systematic reviews. Mattli et al. [ 42 ] reviewed physical activity intervention studies ( n = 12) for chronic disease in adults. These interventions were classified as not cost-effective since 82% of the studies reported an ICER above the cut-off defined by Mattli et al. [ 42 ]. The systematic review of lifestyle interventions for chronic disease prevention in adults by Pennington et al. [ 43 ] only included three studies; therefore, it was classified as lacking evidence 3.4.7. Sexual Health One systematic review [ 44 ] evaluated primary and secondary intervention studies ( n = 31) for sexually transmitted infections and human immunodeficiency virus. The majority (25 of 31 studies) of the included studies assessed the cost-effectiveness of different screening approaches for chlamydia trachomatis. The cost-effectiveness of these interventions was classified as unclear, because findings were mixed with 52% of the studies indicating that chlamydia trachomatis screening is cost-effective for adults less than 30 years of age 3.4.8. Immunisation One systematic review [ 45 ] evaluated economic evidence of influenza vaccination studies ( n = 8) for children. Influenza vaccines were classified as cost-effective since

[Find the meaning and references behind the names: Enough, Might, Balance, Superior]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 17 of 47 all included studies in the systematic review concluded that vaccinations, specifically the quadrivalent formulation, were cost-effective. Six of eight studies were funded by pharmaceutical companies or employees were co-authors of articles 3.4.9. Smoking Cessation Three systematic reviews [ 46 – 48 ] evaluated the economic evidence of smoking cessation interventions for adults. Cheung et al. [ 46 ] reviewed online smoking cessation interventions in the Netherlands. There was a lack of evidence to draw conclusions about the cost-effectiveness of these interventions, as only two eligible studies were identified The two other reviews on smoking cessation were classified as cost-effective Lee et al. [ 47 ] reviewed adult inpatient smoking cessation interventions ( n = 9) and found they were highly cost-effective and the degree of cost-effectiveness might not be related to the components of the programme or methodological variations in the cost-effectiveness analysis. Mahmoudi et al. [ 48 ] reviewed non-nicotine therapies for smoking cessation ( n = 10) and found varcenicline (a drug that blocks nicotine from triggering the release of dopamine) was clinically superior and cost-saving compared to bupropion (a drug used to balance dopamine levels when nicotine is excreted from the body) in most costeffectiveness models. Variations in time horizon, cost of bupropion, efficacy of either drug, age, and the incidence of smoking-related disease were noted as factors that could change the interpretation of results 3.4.10. Reducing Alcohol One systematic review [ 49 ] evaluated the economic evidence of telehealth medicine for alcohol abuse, addiction, and rehabilitation. There was a lack of evidence to draw conclusions about the cost-effectiveness as only one study was included in the review 3.4.11. Fractures Two systematic reviews [ 50 , 51 ] evaluated the economic evidence for a fracture liaison service programme and it was categorised as cost-effective. Ganda et al. [ 50 ] reported that four of four studies on identification, assessment, and treatment of patients as part of the service showed it was cost-saving or cost-effective. One study on identification, assessment, and then referral for treatment by a primary care physician also showed it was cost-effective. Wu et al. [ 51 ] reported that the fracture liaison service was cost-effective regardless of the intensity of the service delivery or the country of the implemented service. In total there were twenty-four studies included across the two systematic reviews; one study (4%) was identified in both systematic reviews; however, this did not change the interpretation of fracture prevention being cost-effective 4. Discussion This review used a systematic approach to map the best of the available evidence regarding the cost-effectiveness of preventive health strategies. The accessibility of economic evidence nationally and internationally and the health economics knowledge and skills of health decision makers are significant barriers for the use of economic evidence in decision making [ 61 , 62 ]. Therefore, the scope, characteristics, and findings of research in this area were synthesised and summarised to provide visibility to existing evidence for local public health services. This can be used in priority setting and to inform the development of local prevention frameworks that support the reorientation and delivery of value-based healthcare Our evidence synthesis of 26 systematic reviews found obesity (in adults), type 2 diabetes, smoking cessation, immunisation, and fracture prevention were cost-effective preventive health areas, based on existing evidence. For more than half (65%) of the reviews there was either not enough evidence to draw conclusions or the findings were unclear. This review provides clear guidance for where further economic evaluations are needed within preventive health.

[Find the meaning and references behind the names: Million, Pros, Frame, Cons, Shorter, Given, Rather, Boost]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 18 of 47 In Australia, the National Preventive Health Strategy 2021–2030 identified seven focus areas for the prevention of chronic disease which include nutrition, physical activity, tobacco, immunisation, cancer screening, alcohol and other drug use, and mental health [ 4 ]. These focus areas were given priority to boost prevention in the first years of the strategy as cancer, mental health, and substance abuse disorders were the leading national burden of disease groups in 2015 [ 63 ]. Tobacco use, overweight and obesity, and dietary risks are the main modifiable factors contributing to the national disease burden [ 63 ]. Cadilhac et al. [ 64 ] reported that by targeting five risk factors (poor diet, physical activity, tobacco use, excessive alcohol consumption, and overweight and obesity), cost savings of AUD 2334 million over the lifetime of the Australian adult population could be achieved. While the strategy aims to promote health benefits particularly in communities with health inequalities and generate health gains across all life stages through impactful and coordinated initiatives within these focus areas [ 4 ], local public health services are required to implement state-level frameworks that are not well aligned with the strategy The economic methodology of the studies included in the systematic review varied widely based on modelling approach (e.g., trial-based analysis, modelled dichotomy economic evaluations), time frame, perspective of analysis, and study context. This heterogeneity was acknowledged within various systematic reviews [ 35 , 40 , 47 ] and precluded meta-analysis, therefore a narrative approach was taken. There are pros and cons for each of the modelling approaches. An advantage of “trial-based analysis” is that the relative treatment effect is based on a study design that minimises the risk of selection bias through use of randomisation. However, it is argued that “trial-based analysis” represents only a partial form of analysis because the study design only compares a limited number of interventions, the length of follow-up is shorter than what is required for economic analysis, it may not be relevant to the decision context, it does not incorporate all evidence that is available, and the decision uncertainty can only be quantified based on evidence from the trial (a single input) [ 65 ]. “Modelled” dichotomy economic evaluations have the advantage of being able to fully characterise decision uncertainty by combining data from multiple inputs including clinical efficiency data from trials. Two systematic reviews [ 22 , 38 ] evaluated studies that used SROI and SCBA which are recently adopted approaches for conducting economic evaluations. These systematic reviews identified that SROI and SCBA studies have predominately been implemented in the United Kingdom and published in the grey literature [ 22 , 38 ]. The methodological weaknesses (e.g., use of estimated or subjective parameters, assumptions are required) associated with these approaches have been acknowledged as a contributing factor for the lack of published studies in the peer-reviewed literature This scoping review has several strengths. Firstly, health service stakeholders cocreated the design, conduct, analysis, interpretation, and drafting of the manuscript. The scoping review was conducted and reported in accordance with the PRISMA-ScR Reporting Standards. The review synthesised the highest level of evidence (systematic review) and included preventive health strategies that targeted any type of health problem across different life stages. The review also has some limitations that should be considered. The search of the academic literature was limited to two databases: MEDLINE and Embase The search terms were not exhaustive and included studies were limited to those published in English between 2005 and 2022. Reviews were only included if primary and secondary preventive health strategies were relevant to local public health services and studies were predominately conducted in high-income countries. Studies were conducted in a wide variety of healthcare settings which may limit the generalisability of the findings to other local public health services. However, reviews in the type 2 diabetes focus area included the prescription of metformin as the study intervention which is a treatment rather prevention and is outside the scope of local public health services. These reviews were included to avoid excluding diabetes prevention programme interventions as the study intervention or comparator which is relevant to local public health services.

[Find the meaning and references behind the names: Just, Step, Sohn, Prior, Weise, Still]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 19 of 47 Preventive health interventions, such as sustained behaviour change compared with clinical interventions, require a long-term follow-up period or modelled dichotomy economic evaluations to observe the anticipated health gains. Many of the trial-based analyses were reliant on interventions with a short-term follow-up period and, therefore, the economic benefits were limited to intermediate indicators. The perspective of the analysis varied considerably by the studies included in the systematic reviews. This may reflect the lack of consensus on the recommendations from the study perspective provided by national healthcare economic evaluation guidelines [ 65 , 66 ]. Weise et al. [ 67 ] recently reviewed the assessment approaches for transferability and recommended that the assessment methods chosen should be relevant to the health area and the context of the decision making 4.1. Implications In this review, the following preventive interventions were concluded to be cost effective: adult obesity (behavioural and community interventions), type 2 diabetes (lifestyle interventions), smoking cessation (adult inpatient programme and non-nicotine therapies), immunisation, and fracture prevention (fracture liaison service programme). However, to enable the use of economic evidence to inform public policy agendas and political prioritisation, local public health services may still want to consider if systematic review evidence is transferable to their local context prior to setting policies and implementing the evidence. One study by Nystrand et al. [ 64 ] examined delivery differences, feasibility of implementation, costings, and intervention outcomes when assessing the potential transferability of systematic review evidence of the cost-effectiveness of public health interventions targeting the use of alcohol, illicit drugs, and tobacco, as well as problematic gambling behaviour. While this approach may have utility, it is resource intensive. In comparison, Welte et al. [ 68 ] and Goeree et al. [ 69 ] developed user-friendly decision charts and a classification system that indicates transferability factors and approaches for improving transferability to support decision-making processes 4.2. Future Research Directions For many (65%) of the systematic reviews, the authors of the current scoping review concluded there was not enough evidence or the evidence was unclear regarding the cost-effectiveness of the interventions. This highlights the need for further research so more definitive conclusions can be drawn regarding the economic evidence for preventive health interventions. Greater consideration is also needed for priority populations in future research, especially for Indigenous people and LGBTQI+. Wider determinants of health such as social, environmental, structural, economic, cultural, biomedical, commercial, and digital factors prevent these priority populations from having fair and just opportunities to attain the highest level of health and lead to inequity [ 4 ]. The United National 2030 Agenda for Sustainable Development strives to “leave no one behind”; this commitment is reflected in 17 Sustainable Development Goals (SDGs) [ 70 ]. A call to achieve health equity is implied in SDG 3 “ensure healthy lives and promote well-being for all at all ages” [ 70 ]. The National Health Strategy also aims to address health equity in priority populations [ 4 ]. Therefore, ensuring that equity is considered in future research is important as this is a high priority for local public health services for informing policy. However, cost-effectiveness analysis was primarily designed to optimise efficiency in the allocation of healthcare resources without considering health equity [ 71 ]. This prevents local public health services from understanding if there are any trade-offs between efficiency and equity. Alternative methods to the traditional cost-effectiveness analysis have been developed, such as equity-informative costeffectiveness analysis and distributional cost-effectiveness analysis, which is an important step for the consideration of health equity in future economic evaluations [ 72 – 75 ]. Conducting prospective economic evaluations in which costs are recorded for the intervention design and local adaptation, implementation, and scale-up will be essential. Sohn et al. [ 76 ] has provided a conceptual framework consisting of three phases: design, initiation, and maintenance, to assist researchers in assessing implementation costs.

[Find the meaning and references behind the names: Board, Pages, Read, Original, Lines, Birchall, Anthea, Thank, Bill, Jessica]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 20 of 47 Jalai et al. [ 77 ] recently reviewed statistical approaches for addressing missing data when conducting prospective economic evaluations alongside clinical trials. This evidence will assist local public health services in understanding the application of potential interventions for use in different contexts 5. Conclusions This scoping review identified a large amount of evidence from systematic reviews on the cost-effectiveness of preventive health strategies, however, for most reviews there was a lack of evidence or the evidence was unclear. Interventions targeting obesity, type 2 diabetes, smoking cessation, and fractures were found to be cost-effective. We found limited evidence related to equity in priority populations. Local contextual factors need consideration in the translation of these findings into practice, including local public health services Author Contributions: Conceptualisation, P.R., N.K., A.S., A.B. and A.H.; methodology, D.S., R.T and A.H.; writing—original draft preparation, R.T., D.S. and A.H.; writing—review and editing, R.T., D.S., P.R., N.K., A.S., E.S., A.B., C.W. and A.H.; supervision, P.R. and A.H. All authors have read and agreed to the published version of the manuscript Funding: This research received no external funding Institutional Review Board Statement: Not applicable Informed Consent Statement: Not applicable Data Availability Statement: Data are contained within the article Acknowledgments: We would like to thank and acknowledge the support from Research Librarian Jessica Birchall (JB), University of Newcastle, who assisted with developing the search strategy. We thank Anthea Bill for expertise and assistance in reviewing the content of the drafted manuscript Conflicts of Interest: The authors declare no conflict of interest Appendix A Table A 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist Section Item PRISMA-ScR Checklist Item Reported on Page Title Title 1 Identify the report as a scoping review Page 1, Lines 2–3 Abstract Structured summary 2 Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives Page 1, Lines 16–29 Introduction Rationale 3 Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach Pages 1–2 Lines 34–84

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 21 of 47 Table A 1. Cont Section Item PRISMA-ScR Checklist Item Reported on Page Objectives 4 Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives Page 2 Lines 84–88 Methods Protocol and registration 5 Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number Page 2, Line 92 Eligibility criteria 6 Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale Pages 4–5 Lines 189–210 Information sources * 7 Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed Page 4 Lines 165–185 Search 8 Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated Page 4, Lines 183–184 Selection of sources of evidence † 9 State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review Page 5, Line 212–216 Data charting process ‡ 10 Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators Page 5, Lines 218–236 Data items 11 List and define all variables for which data were sought and any assumptions and simplifications made Page 5, Lines 218–236 Critical appraisal of individual sources of evidence § 12 If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate) Page 5, Lines 238–241 Synthesis of results 13 Describe the methods of handling and summarizing the data that were charted Page 5, Lines 218–236 Results Selection of sources of evidence 14 Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram Page 7, Figure 1

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 22 of 47 Table A 1. Cont Section Item PRISMA-ScR Checklist Item Reported on Page Characteristics of sources of evidence 15 For each source of evidence, present characteristics for which data were charted and provide the citations Pages 8–11 Table 4 Critical appraisal within sources of evidence 16 If done, present data on critical appraisal of included sources of evidence (see item 12) Pages 21–22, Table 7 Results of individual sources of evidence 17 For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives Pages 16–20, Table 6 Synthesis of results 18 Summarize and/or present the charting results as they relate to the review questions and objectives Pages 21–22, Table 7 Discussion Summary of evidence 19 Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups Page 22–23 Lines 478–529 Limitations 20 Discuss the limitations of the scoping review process Page 23 Lines 536–547 Conclusions 21 Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps Page 24, Lines 560–605 Funding Funding 22 Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review Page 25, Line 622 JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. * Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms, and websites † A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g., quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be confused with information sources (see first footnote) ‡ The frameworks by Arksey and O’Malley (6) and Levac and colleagues (7) and the JBI guidance (4, 5) refer to the process of data extraction in a scoping review as data charting § The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of “risk of bias” (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g., quantitative and/or qualitative research, expert opinion, and policy document) Table A 2. Scoping review protocol Scoping Review Details Scoping review title Health Economic Considerations in the Development of a Local Health District Preventive Care Framework Review objectives (a) Identify cost-effective strategies that have been developed and trialled in other jurisdictions/districts on district level preventative health frameworks and (b) generate evidence for the valuation of downstream final outcomes that can be expressed as a result of the upfront investment in prevention

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 23 of 47 Table A 2. Cont Scoping Review Details Review questions 1 What is known from the existing literature about cost-effective strategies that have been developed and trialled in health service jurisdictions in preventative health frameworks? 2 What is known from the existing evidence on the valuation of downstream final outcomes achieved after the initial investment in preventative health? Databases MEDLINE, Embase, Scopus Grey literature Analysis & Policy Observatory (APO), MedNar Institutions and associations within the fields of • Health economics—Sax Institute, Centre for Economic Evaluation etc • Tertiary institutions Records limited to • Reports, health system publications • Policies and clinical practice frameworks/guidelines • Evidence briefs Search period Published in the period 2005 to 2022 Inclusion/Exclusion Criteria Inclusion Exclusion Population, patient, or problem Studies that relate to the whole district population Key terms include: • Population • Whole of population * No age, gender, cultural, and geographical limitations apply • Small-scale study samples • Animal studies • Lowand middle-income countries • Individual disease or risk factor Intervention Studies that relate district-level strategies and frameworks to implement preventive health • Framework • Policy • Improvement plan • Strategies/strategic plan • Model of care • Concept • Guidelines • Protocol • Intervention that is contrived/conceptual • Individual disease or risk factor • Tertiary prevention Comparator • Status quo or current model (medical and/or preventive) • No comparator/usual care Context/Content Studies relating to preventive care frameworks from the public health service perspective • Public health service • Public health system • Local health district * No age, gender, cultural, and geographical limitations apply • Private health setting • Solely private/corporate enterprise (i.e., private health funds, pharmaceutical, NGOs) • Individual hospital setting (i.e., ED, inpatient, outpatient) • Individual disease or risk factor

[Find the meaning and references behind the names: Aus, Screen, Ajh]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 24 of 47 Table A 2. Cont Scoping Review Details Outcomes Studies in which the cost-effectiveness of the intervention and/or downstream final outcomes are measured and valued Economics • Economic analysis • Valuation • Value for money • Cost-effectiveness • Downstream outcomes • Organisational outcomes • Final outcomes • Sustainable • Scalability • Public health spending • Expenditure • Outcomes specific to only one disease or risk factor • Valuation of outcomes not quantified • Downstream/final outcomes not specified • Studies that mention cost-effective interventions but lack sufficient evidence to identify specific strategies and/or cost data Types of studies • Human • Quantitative • Qualitative • International • Animal Study design • Full economic evaluation • Studies of any design that reported public health interventions delivered in industrialised countries providing universal healthcare • Partial evaluation (cost analysis only) • Studies with poor generalisability to AUS were excluded, including a number from the USA that may poorly reflect AUS healthcare systems, structure, and demographics Types of evidence sources • Published and unpublished primary studies • Systematic reviews • Meta-analysis • Policy documents/guidelines/standards/framework • Websites for grey literature sources Evidence source details and characteristics Citation details Author(s) Publication year Source origin/country of origin Details/results extracted from source of evidence Study characteristics Publication type No. of reviews or studies included Population type Preventive care strategy type Cost-effective outcome Valuation of final downstream outcomes Screening the evidence Number of reviewers 2 Process for piloting screening, inclusion, and identification process A single reviewer (DS) will screen possible records based on title and abstract for inclusion and then in full-text article retrieval. Identification of records will be performed by DS and AJH

[Find the meaning and references behind the names: Manual]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 25 of 47 Table A 2. Cont Scoping Review Details Management of disagreements If there are disagreements between the two reviewers and consensus cannot occur, a third reviewer (PR) will assess the source to determine its eligibility Software used in selection EndNote * Adapted from JBI Manual for Evidence Synthesis, Chapter 6 Systematic reviews of economic evaluations and Chapter 11 (Scoping reviews) Table A 3. PubMed search of articles published between 1965 and 2022. Search query: preventive health intervention and economic evaluation Year of Publication Number of Articles Published 2022 512 2021 647 2020 719 2019 809 2018 820 2017 785 2016 726 2015 748 2014 672 2013 647 2012 623 2011 540 2010 474 2009 458 2008 432 2007 382 2006 349 2005 310 2004 261 2003 228 2002 229 2001 239 2000 240 1999 200 1998 190 1997 168 1996 166 1995 118 1994 116 1993 116 1992 92 1991 91 1990 63 1989 52 1988 39 1987 26 1986 28 1985 22 1984 26 1983 22 1982 14 1981 14 1980 8 1979 7 1978 15 1977 9 1976 12 1975 6 1974 1 1973 1 1972 1 1971 4 1965 1

[Find the meaning and references behind the names: Adj]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 26 of 47 Table A 4. Peer-reviewed literature search strategy Search Set MEDLINE Primary Prevention Results MEDLINE Secondary Prevention Results EMBASE Primary Prevention Results EMBASE Secondary Prevention Results 1 Public Health/ec 3675 Public Health/ec 3677 public health/ 216,169 public health/ 89,658 2 Health Promotion/ec 2945 Health Promotion/ec 2946 health promotion/ 104,403 health promotion/ 78,797 3 Primary Prevention/ec 748 Secondary Prevention/ec 214 primary prevention/ 43,974 secondary prevention/ 22,101 4 Efficiency, Organizational/ec [Economics] 2007 Efficiency, Organizational/ec [Economics] 2007 organizational efficiency/ 1185 organizational efficiency/ 22,304 5 conceptual framework.mp 14,252 conceptual framework.mp 14,291 conceptual framework.mp 41,767 conceptual framework.mp 14,308 6 health care service *.mp 17,729 health care service *.mp 17,751 health care service *.mp 21,337 health care service *.mp 17,761 7 1 or 2 or 3 or 4 or 5 or 6 40,968 1 or 2 or 3 or 4 or 5 or 6 40,589 1 or 2 or 3 or 4 or 5 or 6 411,813 1 or 2 or 3 or 4 or 5 or 6 237,994 8 (prevent * or promot *).mp 3,672,540 (prevent * or promot *).mp 3,677,713 (prevent * or promot *).mp 4,543,210 (prevent * or promot *).mp 3,679,847 9 (health prevention or health promotion).mp 100,740 (health prevention or health promotion).mp 100,830 (health prevention or health promotion).mp 121,932 (health prevention or health promotion).mp 100,857 10 8 or 9 3,672,540 8 or 9 3,677,713 8 or 9 4,543,210 8 or 9 3,679,847 11 Cost-Benefit Analysis/or Value for Money.mp. or Health Care Costs/ 122,325 Cost-Benefit Analysis/or Value for Money.mp. or Health Care Costs/ 122,423 Cost-Benefit Analysis/or Value for Money.mp. or Health Care Costs/ 250,377 Cost-Benefit Analysis/or Value for Money.mp. or Health Care Costs/ 122,489 12 Economic evaluation.mp 11,627 Economic evaluation.mp 11,651 Economic evaluation.mp 26,535 Economic evaluation.mp 11,654 13 ((Cost Effective or Cost Utility or Cost Benefit or Cost Consequence or Cost minimis *) adj Analys?s).mp 92,632 ((Cost Effective or Cost Utility or Cost Benefit or Cost Consequence or Cost minimis *) adj Analys?s).mp 92,721 ((Cost Effective or Cost Utility or Cost Benefit or Cost Consequence or Cost minimis *) adj Analys?s).mp 103,559 ((Cost Effective or Cost Utility or Cost Benefit or Cost Consequence or Cost minimis *) adj Analys?s).mp 92,762 14 (Return of Investment or return to investment or Social Return of Investment or social return to investment).mp 2199 (Return of Investment or return to investment or Social Return of Investment or social return to investment).mp 2202 (Return of Investment or return to investment or Social Return of Investment or social return to investment).mp 2903 (Return of Investment or return to investment or Social Return of Investment or social return to investment).mp 2200 15 (cost effective * or efficien * or cost saving * or cost analys?s or return on).mp 1,351,342 (cost effective * or efficien * or cost saving * or cost analys?s or return on).mp 1,353,818 (cost effective * or efficien * or cost saving * or cost analys?s or return on).mp 1,627,269 (cost effective * or efficien * or cost saving * or cost analys?s or return on).mp 1,354,960 16 11 or 12 or 13 or 14 or 15 1,417,128 11 or 12 or 13 or 14 or 15 1,419,644 11 or 12 or 13 or 14 or 15 1,819,368 11 or 12 or 13 or 14 or 15 1,420,811 17 7 and 10 and 16 3050 7 and 10 and 16 2756 7 and 10 and 16 17,744 7 and 10 and 16 9822 18 review.m_titl 585,846 review.m_titl 587,375 review.m_titl 697,162 review.m_titl 588,146 19 17 and 18 166 17 and 18 156 17 and 18 796 17 and 18 498 20 limit 19 to (english language and humans and yr = “2005–Current”) 128 limit 19 to (english language and humans and yr = “2005–Current”) 122 limit 19 to (human and english language and yr = “2005–Current”) 679 limit 19 to (human and english language and yr = “2005–Current”) 414 21 limit 20 to COVID-19 31 limit 20 to COVID-19 7 22 20 not 21 648 20 not 21 407 23 “cost effect *”.m_titl 45,637 “cost effect *”.m_titl 31,253 24 22 and 23 61 22 and 23 47 * Search operator Table A 5. Grey literature search strategy APO Results MedNar Results Date accessed 15 February 2022 Date accessed 15 February 2022 Subject Economics Search terms population health framework economic evaluation Search terms Preventive health 1375 Cluster Medical 1400 Subject Preventive health 50 Topics Cost-effective 62 Date published All 2012–2021 50 Authors All 62 Collection All 50 Publications All 62 Publisher All 50 Source All 62 Author/creator All 50 Dates All (2008 to 2022) 59 Geographic coverage All 50 Document Format All 59 Resource type All 50 Document Type All 59 Results 50 Results 59

[Find the meaning and references behind the names: Parent]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 27 of 47 Table A 6. Summary of cost-effective interventions for studies included in the review First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Mental health Le, 2021 [ 30 ] Anxiety Children CBT 2 of 2 1 RCT, 1 model study Le, 2021 [ 30 ] Anxiety Parents and children CBT 1 of 1 1 model study Le, 2021 [ 30 ] Anxiety Parents CBT 2 of 2 1 RCT, 1 model study Le, 2021 [ 30 ] Depression Children School-based intervention 1 of 2 1 model study Le, 2021 [ 30 ] Depression Children Psychological intervention 1 of 1 1 model study Le, 2021 [ 30 ] Behavioural problems Children Psychological intervention 1 of 1 Pre–post study Le, 2021 [ 30 ] Behavioural problems Parents and children Screening and parent psychoeducation 0 of 1 N/A Le, 2021 [ 30 ] Behavioural problems Parents Parent psychoeducation 1 of 1 1 model study Le, 2021 [ 30 ] Suicide prevention Children CBT 0 of 1 N/A Le, 2021 [ 30 ] Suicide prevention Children School-based intervention 0 of 1 N/A Le, 2021 [ 30 ] Suicide prevention Children Screening 0 of 1 N/A Le, 2021 [ 30 ] General mental health Divorced families Parenting programme or child and parenting programme 1 of 1 1 RCT Le, 2021 [ 30 ] Maltreatment Children Psychological intervention 1 of 1 1 RCT Le, 2021 [ 30 ] Depression Adolescents CBT 2 of 2 1 RCT, 1 model study Le, 2021 [ 30 ] Depression Adolescents School-based CBT 0 of 1 N/A Le, 2021 [ 30 ] Depression Adolescents Physical activity intervention 1 of 1 1 RCT Le, 2021 [ 30 ] Eating disorders Adolescents School-based intervention 1 of 2 1 model study Le, 2021 [ 30 ] Drug use Adolescents Education and training programmes 1 of 1 1 model study Le, 2021 [ 30 ] Bullying Adolescents School programme 1 of 1 1 model study Le, 2021 [ 30 ] Depression Adults Psychological intervention 4 of 4 1 RCT, 3 model studies Le, 2021 [ 30 ] Depression Adults CBT 3 of 3 1 RCT, 2 model studies Le, 2021 [ 30 ] Depression Adults Psychological intervention 3 of 4 1 RCT, 2 model studies Le, 2021 [ 30 ] Depression Adults Brief bibliotherapy 1 of 1 N/A Le, 2021 [ 30 ] Depression Adults Workplace education 1 of 1 1 pre–post-test study Le, 2021 [ 30 ] Depression Adults Peer support intervention 1 of 1 N/A

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 28 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Le, 2021 [ 30 ] Depression Adults Training for visiting new mothers 1 of 1 1 RCT Le, 2021 [ 30 ] Suicide prevention Adults Psychological intervention 4 of 4 4 model studies Le, 2021 [ 30 ] Suicide prevention Adults CBT 1 of 2 1 model study Le, 2021 [ 30 ] Suicide prevention Adults Screening and psychological intervention 1 of 1 1 model study Le, 2021 [ 30 ] Suicide prevention Adults Workplace education 0 of 1 N/A Le, 2021 [ 30 ] General mental health Adults Psychological intervention 4 of 5 2 RCTs, 1 non-RCT, 1 cross-sectional study Le, 2021 [ 30 ] General mental health Adults Screening 1 of 1 1 RCT Le, 2021 [ 30 ] General mental health Adults Physical activity intervention 1 of 1 1 RCT Le, 2021 [ 30 ] Eating disorders Adults Cognitive dissonance 1 of 1 1 RCT Le, 2021 [ 30 ] Eating disorders Adults Screening and psychological intervention 1 of 1 1 model study Le, 2021 [ 30 ] Eating disorders Adults Psychological intervention 1 of 1 1 model study Le, 2021 [ 30 ] Generalised anxiety disorder Adults CBT 2 of 2 2 model studies Le, 2021 [ 30 ] Psychosis Adults CBT 2 of 2 1 RCT, 1 model study Le, 2021 [ 30 ] Panic disorder Adults CBT 1 of 1 1 RCT Le, 2021 [ 30 ] Substance abuse Adults Peer-based prevention programme 1 of 1 1 retrospective ecological study Le, 2021 [ 30 ] Depression Older adults Psychological intervention 2 of 3 2 RCTs Le, 2021 [ 30 ] Depression Older adults CBT 1 of 1 1 RCT Park 2013 [ 31 ] Mental and substance abuse disorders Adults Integrated management programme 0 of 3 N/A Park 2013 [ 31 ] Sedentary behaviour Adults Primary care physical activity intervention 2 of 2 2 RCTs Park 2013 [ 31 ] HIV Adults Small-group intervention 1 of 2 1 model study Park 2013 [ 31 ] Blood-borne infectious diseases Adults Specialist brief programme 0 of 2 N/A

[Find the meaning and references behind the names: Active]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 29 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Park 2013 [ 31 ] Mental health Adults Physical exercise programme 1 of 1 1 RCT Park 2013 [ 31 ] Smoking cessation Adults Smoking cessation programme 1 of 1 1 RCT Soneson, 2020 [ 18 ] Psychosis Adolescents and adults CBT 1 of 2 1 RCT Obesity Lehnert 2012 [ 32 ] Obesity Children School curriculum programme 0 of 1 N/A Lehnert 2012 [ 32 ] Obesity Children Active after school programme 0 of 2 N/A Lehnert 2012 [ 32 ] Obesity Children Family-based GP-mediated intervention 0 of 1 N/A Lehnert 2012 [ 32 ] Obesity Adults Diet intervention 3 of 4 3 model studies Lehnert 2012 [ 32 ] Obesity Adults Diet and exercise intervention 0 of 3 N/A Lehnert 2012 [ 32 ] Obesity Adults Diet and pharmacotherapy intervention 0 of 3 N/A Lehnert 2012 [ 32 ] Obesity Adults Diet, exercise, and behaviour modification intervention 6 of 7 6 model studies Lehnert 2012 [ 32 ] Obesity Adults Community programme 2 of 2 3 model studies Lehnert 2012 [ 32 ] Obesity Adults Physical activity 1 of 1 1 model study Type 2 diabetes Glechner 2018 [ 33 ] Type 2 diabetes Adults Lifestyle intervention 10 of 13 5 model studies, Glechner 2018 [ 33 ] Type 2 diabetes Adults Pharmacotherapy 8 of 10 4 model studies, 4 RCTs Glechner 2018 [ 33 ] Type 2 diabetes Adults Screening + lifestyle intervention 1 of 1 1 model study Glechner 2018 [ 33 ] Type 2 diabetes Adults Pharmacotherapy + lifestyle intervention 1 of 1 1 RCT Li 2015 [ 34 ] Type 2 diabetes Adults Lifestyle intervention 15 of 16 13 model studies, 2 RCTs Li 2015 [ 34 ] Type 2 diabetes Adults Pharmacotherapy 7 of 8 5 model studies, 2 RCTs Li 2015 [ 34 ] Type 2 diabetes Adults Screening 2 of 3 3 model studies Li 2015 [ 34 ] Type 2 diabetes Adults Primary care intervention 1 of 1 1 model study Li 2015 [ 34 ] Type 2 diabetes Adults Dietary intervention 1 of 1 1 model study

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 30 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Zhou 2020 [ 35 ] Type 2 diabetes Adults Lifestyle intervention 17 of 20 11 model studies, 6 RCTs Zhou 2020 [ 35 ] Type 2 diabetes Adults Screening + lifestyle intervention 4 of 7 4 model studies Zhou 2020 [ 35 ] Type 2 diabetes Adults Screening + pharmacotherapy 2 of 2 2 model studies Zhou 2020 [ 35 ] Type 2 diabetes Adults Screening + physical activity intervention 1 of 1 1 model study Zhou 2020 [ 35 ] Type 2 diabetes Adults Screening + diet intervention 1 of 1 1 model study Zhou 2020 [ 35 ] Type 2 diabetes Adults Screening 1 of 1 1 model study Dental caries Anopa 2020 [ 36 ] Dental caries Children Multicomponent intervention 8 of 10 4 model studies, 1 RCT, 1 cohort study, 2 non-RCTs Anopa 2020 [ 36 ] Dental caries Children Fluoride treatment 3 of 4 1 model studies, 2 non-RCTs Anopa 2020 [ 36 ] Dental caries Children Molar sealant 3 of 3 3 model studies Anopa 2020 [ 36 ] Dental caries Children Oral hygiene and diet education 1 of 1 1 non-RCT Fraihat 2019 [ 37 ] Dental caries Children Multicomponent intervention 5 of 7 2 model studies, 3 RCTs Fraihat 2019 [ 37 ] Dental caries Children Education 1 of 4 1 model study Fraihat 2019 [ 37 ] Dental caries Children Teeth brushing 2 of 3 1 model study, 1 RCT Fraihat 2019 [ 37 ] Dental caries Children Fluoride varnish 1 of 3 1 RCT Fraihat 2019 [ 37 ] Dental caries Children Screening 0 of 2 N/A Fraihat 2019 [ 37 ] Dental caries Children Counselling 0 of 1 N/A Public health Ashton 2020 [ 22 ] Breastfeeding Post-partum women Breastfeeding promotion programme 1 of 1 1 case study Ashton 2020 [ 22 ] Post-natal depression Post-partum women Community-based support programme 1 of 1 1 case study Ashton 2020 [ 22 ] Behavioural problems Parents and children Behaviour management programme for parents/families 4 of 4 4 case studies

[Find the meaning and references behind the names: Music, Arts, Living]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 31 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Ashton 2020 [ 22 ] Substance misuse Parents and children Substance misuse programme 1 of 1 1 case study Ashton 2020 [ 22 ] General health Children Childcare programme 1 of 1 1 case study Ashton 2020 [ 22 ] General health Children School music programme 1 of 1 1 case study Ashton 2020 [ 22 ] Substance misuse Adolescents Substance misuse programme 2 of 2 2 case studies Ashton 2020 [ 22 ] Sexual health Adolescents Community programme for the prevention of teenage pregnancy 2 of 2 2 case studies Ashton 2020 [ 22 ] Behavioural problems Adolescents Sporting programme 1 of 1 1 case study Ashton 2020 [ 22 ] Behavioural problems Adolescents Community programme 1 of 1 1 case study Ashton 2020 [ 22 ] Mental health Adults Training and employment programme 3 of 3 3 case studies Ashton 2020 [ 22 ] Mental health Adults Education 1 of 1 1 case study Ashton 2020 [ 22 ] Mental health Adults Living assistance community programme 1 of 1 1 case study Ashton 2020 [ 22 ] General health Adults Community family programme 1 of 2 1 case study Ashton 2020 [ 22 ] Smoking Adults Smoking cessation programme 1 of 1 1 case study Ashton 2020 [ 22 ] Substance misuse Adults Substance misuse programme 1 of 1 1 case study Ashton 2020 [ 22 ] Mental health Older adults Creative arts programme 4 of 4 4 case studies Ashton 2020 [ 22 ] Mental health Older adults Home care programme 1 of 1 1 case study Ashton 2020 [ 22 ] Mental health Older adults Peer support groups 1 of 1 1 case study Ashton 2020 [ 22 ] General health Universal Community programme 1 of 1 1 case study Ashton 2020 [ 22 ] General health Universal Healthy eating programme 1 of 1 1 case study Ashton 2020 [ 22 ] Chronic disease Universal Lifestyle intervention 2 of 2 2 case studies Ashton 2020 [ 22 ] Sedentary behaviour Universal Physical activity intervention 3 of 3 3 case studies Banke-Thomas 2015 [ 38 ] Post-natal depression Post-partum women Community programme 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Sexual health Parents and children Sexual health intervention 2 of 2 2 case studies Banke-Thomas 2015 [ 38 ] Chronic disease Parents and children Mobility equipment service 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Substance misuse Parents and children Support programme 1 of 1 1 case study

[Find the meaning and references behind the names: Reading, Cord]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 32 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Banke-Thomas 2015 [ 38 ] Asthma Children Community asthma programme 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Poor dietary behaviours Children School breakfast programme 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] General health Children and adolescents General healthcare intervention 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Sexual health Adolescents Sexual health intervention 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Mental health Adults Skills training and employment programme 3 of 3 3 case studies Banke-Thomas 2015 [ 38 ] Mental health Adults Clubhouse for mental health support 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Mental health Adults Mental health awareness training courses 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Mental health Adults Reading programme 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Suicide Adults Support programme 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Substance misuse Adults Recovery programme 2 of 2 2 case studies Banke-Thomas 2015 [ 38 ] Substance misuse Adults Self-management course 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Substance misuse Adults Skills training and employment 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Smoking Adults Smoking cessation policy 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Sedentary behaviour Adults Walking programme 3 of 3 3 case studies Banke-Thomas 2015 [ 38 ] HIV Adults Stigma and discrimination training 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] HIV and AIDs Adults Football support programme 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Spinal cord injury Adults Community rehabilitation programme 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Chronic disease Adults Self-care training 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] General health Adults Integrated healthcare 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Poor nutrition Older adults Meals home delivery programme 2 of 2 2 case studies

[Find the meaning and references behind the names: Safe, Hazard]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 33 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Banke-Thomas 2015 [ 38 ] Mental health Older adults Mental health support programme 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] General health and HIV Universal Community-based care and support 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] HIV and AIDS Universal Community-based care and support 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] HIV Universal Adherence to anti-retroviral therapies intervention 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] General health Universal Hospital-based services 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Environmental health Universal Household-based water treatment and safe storage 1 of 1 1 case study Banke-Thomas 2015 [ 38 ] Chronic disease Universal Healthy lifestyle intervention 2 of 2 2 case studies Masters 2017 [ 21 ] Smoking Pregnant women Smoking cessation programme 1 of 1 1 RCT Masters 2017 [ 21 ] Influenza Post-partum women Influenza vaccination programme 1 of 1 1 model study Masters 2017 [ 21 ] Haemophilus influenzae type b Children Haemophilus influenzae type b vaccination programme 2 of 2 2 model studies Masters 2017 [ 21 ] General health Children Early education programme 2 of 2 1 RCT and 1 matched cohort study Masters 2017 [ 21 ] General health Parents and children Early education programme 1 of 1 1 matched cohort study Masters 2017 [ 21 ] Child behaviour Parents and children Parenting programme 1 of 1 1 model study Masters 2017 [ 21 ] Environmental health Children Household lead paint hazard control 1 of 1 1 model study Masters 2017 [ 21 ] General health Adolescents Multisystematic therapy 1 of 1 1 RCT Masters 2017 [ 21 ] Chronic disease Adults Workplace health promotion 3 of 4 1 quasi experimental study, 1 pre–post study, 1 case study Masters 2017 [ 21 ] Chronic disease Adults Medication management 2 of 2 1 controlled intervention study, 1 cohort matched control study

[Find the meaning and references behind the names: Work, Heart, Bike, Partner]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 34 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Masters 2017 [ 21 ] Chronic disease Adults Prevention programme 1 of 1 1 cohort matched control study Masters 2017 [ 21 ] Heart disease Adults Disease management programme 1 of 1 1 cohort study Masters 2017 [ 21 ] Heart disease Adults Home blood pressure monitoring 1 of 1 1 model study Masters 2017 [ 21 ] Heart disease Adults Tobacco cessation 1 of 1 1 model study Masters 2017 [ 21 ] HIV Adults Needle and syringe programme 4 of 4 3 model studies, 1 mixed methods study Masters 2017 [ 21 ] HIV Adults HIV testing 1 of 1 1 model study Masters 2017 [ 21 ] HIV Adults HIV counselling, testing, referral, and partner notification services 1 of 1 1 model study Masters 2017 [ 21 ] Mental health Adults Awareness campaign 0 of 1 N/A Masters 2017 [ 21 ] Mental health Adults Telemedicine for depression 1 of 1 1 model study Masters 2017 [ 21 ] Work-related injuries Adults Workplace health promotion 2 of 2 1 RCT, 1 controlled intervention study Masters 2017 [ 21 ] Alcohol misuse Adults Therapeutic services for alcoholism 1 of 1 1 cross-sectional study Masters 2017 [ 21 ] Obesity Adults Workplace obesity management 1 of 1 1 model study Masters 2017 [ 21 ] Sexual health Adults Family planning services 1 of 1 1 model study Masters 2017 [ 21 ] Influenza Adults Influenza vaccination 0 of 1 N/A Masters 2017 [ 21 ] Fall-related injuries Older adults Community-based fall prevention 1 of 1 1 model study Masters 2017 [ 21 ] Chronic disease Universal Preventive programme 2 of 2 1 model study, 1 mixed methods study Masters 2017 [ 21 ] Sedentary behaviour Universal Bike and pedestrian trails 2 of 2 2 model studies Masters 2017 [ 21 ] Smoking Universal Smoking cessation 1 of 1 1 model study Masters 2017 [ 21 ] Tobacco Universal Programmes to reduce tobacco consumption 1 of 1 1 mixed methods study Masters 2017 [ 21 ] Hepatitis B Universal Hepatitis B vaccination 1 of 1 1 model study

[Find the meaning and references behind the names: Road, Mmr, Hib]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 35 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Masters 2017 [ 21 ] Haemophilus influenzae type b Universal Hib vaccination 1 of 1 1 mixed methods study Masters 2017 [ 21 ] Measles, mumps, and rubella Universal MMR vaccination 0 of 1 1 mixed methods study Masters 2017 [ 21 ] Measles Universal Measles vaccination 1 of 1 1 mixed methods study Masters 2017 [ 21 ] HIV/AIDS Universal HIV/AIDS prevention programme 1 of 1 1 mixed methods study Masters 2017 [ 21 ] Vehicle-related injury Universal Road safety campaigns 1 of 1 1 mixed methods study Reeves 2019 [ 39 ] Infection control Children Education intervention for healthcare providers for immunisation practices 0 of 1 N/A Reeves 2019 [ 39 ] Sedentary behaviour Adolescents Multicomponent school-based physical activity intervention 1 of 1 1 RCT Reeves 2019 [ 39 ] Breast cancer Adults Education and counselling for screening 1 of 2 1 model study Reeves 2019 [ 39 ] Breast cancer Adults Financial incentives and tailored messaging for screening 1 of 1 1 RCT Reeves 2019 [ 39 ] Breast cancer Adults Education, counselling, and healthcare provider education for screening 1 of 1 1 RCT Reeves 2019 [ 39 ] Breast cancer Adults Mammography promotion 2 of 2 2 RCTs Reeves 2019 [ 39 ] Breast and cervical cancer Adults Education and counselling for screening 1 of 1 1 RCT Reeves 2019 [ 39 ] Cervical cancer Adults Tailored message, education, and counselling for screening 0 of 1 N/A Reeves 2019 [ 39 ] Colorectal cancer Adults Public awareness for screening 0 of 1 N/A Reeves 2019 [ 39 ] Alcohol misuse Adults Public awareness for alcohol consumption behaviours 1 of 1 1 RCT Reeves 2019 [ 39 ] Poor dietary patterns and sedentary behaviour Adults Tailored message, education, and counselling 0 of 1 N/A Reeves 2019 [ 39 ] Influenza Older adults Public awareness for influenza vaccination 1 of 1 1 model study

[Find the meaning and references behind the names: Material, Cold]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 36 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Chronic disease Dubas-Jakobczyk, 2017 [ 40 ] Falls Older adults Physical exercise 11 of 12 5 RCTs, 5 model studies, 1 controlled trial Dubas-Jakobczyk, 2017 [ 40 ] Falls Older adults Multifactorial intervention 6 of 11 4 model studies, 1 RCT, 1 controlled trial Dubas-Jakobczyk, 2017 [ 40 ] Falls Older adults Home assessment and modifications 4 of 5 3 model studies, 1 RCT Dubas-Jakobczyk, 2017 [ 40 ] Falls Older adults Medication withdrawal 3 of 3 3 model studies Dubas-Jakobczyk, 2017 [ 40 ] Falls Older adults Vitamin D and/or calcium supplementation 2 of 2 2 model studies Dubas-Jakobczyk, 2017 [ 40 ] Falls Older adults Cardiac pacing 1 of 2 1 model study Dubas-Jakobczyk, 2017 [ 40 ] Falls Older adults Expedited cataract surgery 1 of 1 1 model study Dubas-Jakobczyk, 2017 [ 40 ] Falls Older adults Gait-stabilizing device 1 of 1 1 model study Dubas-Jakobczyk, 2017 [ 40 ] General health status Older adults Physical exercise 3 of 3 2 RCTs, 1 controlled trial Dubas-Jakobczyk, 2017 [ 40 ] General health status Older adults Home assessment and modifications 1 of 2 1 RCT Dubas-Jakobczyk, 2017 [ 40 ] Sedentary behaviour Older adults Physical exercise 0 of 1 N/A Dubas-Jakobczyk, 2017 [ 40 ] Oral health Older adults Education 0 of 1 N/A Gordon 2007 [ 41 ] Smoking Adults Counselling 7 of 7 3 model studies, 2 RCTs, 1 controlled intervention study, 1 pre–post study Gordon 2007 [ 41 ] Smoking Adults Counselling + NRT 7 of 7 4 model studies, 3 RCTs Gordon 2007 [ 41 ] Smoking Adults Counselling + non-NRT 4 of 4 3 model studies, 1 RCT Gordon 2007 [ 41 ] Smoking Adults NRT 1 of 1 1 pre–post study Gordon 2007 [ 41 ] Smoking Adults Non-NRT 1 of 1 1 pre–post study Gordon 2007 [ 41 ] Smoking Adults Self-help material 0 of 1 N/A Gordon 2007 [ 41 ] Smoking Adults Cold turkey 1 of 1 1 pre–post study Gordon 2007 [ 41 ] Smoking Pregnant women Smoking cessation programme for pregnant women 0 of 1 N/A Gordon 2007 [ 41 ] Alcohol use disorder Adults Counselling 4 of 6 2 model studies, 1 RCT, 1 randomised trial

[Find the meaning and references behind the names: Weight]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 37 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Gordon 2007 [ 41 ] Alcohol use disorder Adults Primary care intervention 1 of 2 1 comparative study Gordon 2007 [ 41 ] Alcohol use disorder Adults Outpatient treatment 0 of 1 N/A Gordon 2007 [ 41 ] Alcohol use disorder Adults Pharmacotherapy 1 of 1 1 RCT Gordon 2007 [ 41 ] Alcohol use disorder Adults Screening 1 of 1 1 model study Gordon 2007 [ 41 ] Alcohol use disorder Adults Self-help material 1 of 1 1 RCT Gordon 2007 [ 41 ] Alcohol use disorder Families Counselling 1 of 1 1 RCT Gordon 2007 [ 41 ] Drug use Adolescents Counselling 1 of 1 1 model study Gordon 2007 [ 41 ] Weight management Adults Counselling 0 of 1 N/A Gordon 2007 [ 41 ] Weight management Adults Dietary intervention 0 of 1 N/A Gordon 2007 [ 41 ] Weight management Adults Multifactorial programme 2 of 2 1 model study, 1 RCT Gordon 2007 [ 41 ] Weight management Children School programme 1 of 1 1 model study Gordon 2007 [ 41 ] Diabetes management Adults Counselling 1 of 1 1 model study Gordon 2007 [ 41 ] Diabetes management Adults Dietary intervention 1 of 2 1 model study Gordon 2007 [ 41 ] Diabetes management Adults Primary care intervention 1 of 1 1 model study Gordon 2007 [ 41 ] Diabetes management Parents and children Primary care intervention 0 of 1 1 RCT Gordon 2007 [ 41 ] Diabetes management Adults Multidisciplinary care 1 of 1 1 quasi-experimental study Gordon 2007 [ 41 ] Diabetes management Adults Multifactorial programme 1 of 2 1 model study Gordon 2007 [ 41 ] Diabetes management Adults Pharmacotherapy 1 of 1 1 model study Gordon 2007 [ 41 ] Diabetes management Adults Surgery 1 of 1 1 model study Gordon 2007 [ 41 ] Cardiovascular disease prevention Adults Counselling 0 of 1 N/A Gordon 2007 [ 41 ] Cardiovascular disease prevention Adults Counselling + pharmacotherapy 0 of 1 N/A Gordon 2007 [ 41 ] Cardiovascular disease prevention Adults Dietary intervention 0 of 1 N/A Gordon 2007 [ 41 ] Cardiovascular disease prevention Adults Primary care intervention 0 of 1 N/A Gordon 2007 [ 41 ] Cardiovascular disease prevention Adults Multifactorial programme 5 of 7 2 model studies, 2 RCT, 1 cross-sectional study Gordon 2007 [ 41 ] Cardiovascular disease prevention Adults Physical activity intervention 4 of 5 2 model studies, 2 RCTs

[Find the meaning and references behind the names: Gps, Aid]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 38 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Gordon 2007 [ 41 ] Cardiovascular disease prevention Adults Screening 0 of 1 N/A Gordon 2007 [ 41 ] Cardiovascular disease prevention Adults Screening + counselling + pharmacotherapy 1 of 1 1 RCT Gordon 2007 [ 41 ] Cardiovascular disease prevention Adults Surgery 1 of 2 1 model study Gordon 2007 [ 41 ] Chronic disease prevention Adults Primary care intervention 1 of 1 1 RCT Gordon 2007 [ 41 ] Chronic disease prevention Adults GP + dietitian intervention 2 of 2 2 RCTs Gordon 2007 [ 41 ] Chronic disease prevention Adults Physical activity intervention 3 of 6 2 model studies, 1 RCT Mattli 2020 [ 42 ] Sedentary behaviour Adults Physical activity 8 of 10 8 RCTs Pennington 2013 [ 43 ] Chronic disease management Adults Self-care support skills 1 of 1 1 RCT Pennington 2013 [ 43 ] Diabetes management Adults Telehealth intervention 0 of 1 N/A Pennington 2013 [ 43 ] Chronic disease prevention Adults Mammography promotion 1 of 1 1 RCT Vos 2011 [ 29 ] Alcohol misuse Adults Brief intervention from GPs 1 of 1 1 model study Vos 2011 [ 29 ] Alcohol misuse Adults Brief intervention and telemarketing and support 1 of 1 1 model study Vos 2011 [ 29 ] Tobacco misuse Adults Cessation aid: varenicline 1 of 1 1 model study Vos 2011 [ 29 ] Tobacco misuse Adults Cessation aid: bupropion 1 of 1 1 model study Vos 2011 [ 29 ] Tobacco misuse Adults Cessation aid: nicotine replacement therapy 1 of 1 1 model study Vos 2011 [ 29 ] Sedentary behaviour Adults Wearing pedometers 1 of 1 1 model study Vos 2011 [ 29 ] Sedentary behaviour Adults Programme to encourage more active transport 1 of 1 1 model study Vos 2011 [ 29 ] Sedentary behaviour Adults GP prescription 1 of 1 1 model study Vos 2011 [ 29 ] Sedentary behaviour Adults GP referral to exercise physiologist 1 of 1 1 model study Vos 2011 [ 29 ] Sedentary behaviour Adults Internet intervention 1 of 1 1 model study

[Find the meaning and references behind the names: Dose, Fruit, Salt]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 39 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Vos 2011 [ 29 ] Poor dietary patterns Adults Multicomponent intervention to encourage fruit and vegetable consumption 4 of 14 4 model studies Vos 2011 [ 29 ] Poor dietary patterns Adults Multicomponent workplace intervention to encourage fruit and vegetable consumption 1 of 7 1 model study Vos 2011 [ 29 ] Poor dietary patterns Post-partum women Multicomponent intervention to encourage fruit and vegetable consumption 0 of 2 N/A Vos 2011 [ 29 ] Excessive salt consumption Adults Dietary advice on salt consumption 0 of 1 N/A Vos 2011 [ 29 ] Unhealthy lifestyle behaviours Adults Diet and physical activity intervention 0 of 1 N/A Vos 2011 [ 29 ] Overweight and obesity Adults Diet and physical activity intervention 1 of 2 1 model study Vos 2011 [ 29 ] Overweight and obesity Adults Dietary intervention 1 of 1 1 model study Vos 2011 [ 29 ] Overweight and obesity Adults Sibutramine 0 of 1 N/A Vos 2011 [ 29 ] Overweight and obesity Adults Orlistat 0 of 1 N/A Vos 2011 [ 29 ] Overweight and obesity Adults Surgery 1 of 1 1 model study Vos 2011 [ 29 ] High blood pressure and cholesterol Adults Usual care 1 of 1 1 model study Vos 2011 [ 29 ] High blood pressure and cholesterol Adults Community heart health programme 1 of 1 1 model study Vos 2011 [ 29 ] High blood pressure and cholesterol Adults Dietary intervention 2 of 3 2 model studies Vos 2011 [ 29 ] High blood pressure and cholesterol Adults Statins 1 of 1 1 model study Vos 2011 [ 29 ] High blood pressure and cholesterol Adults Statins and ezitimibe 1 of 1 1 model study Vos 2011 [ 29 ] High blood pressure and cholesterol Adults Low-dose diuretics 1 of 1 1 model study

[Find the meaning and references behind the names: Beta]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 40 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Vos 2011 [ 29 ] High blood pressure and cholesterol Adults Beta blockers 1 of 1 1 model study Vos 2011 [ 29 ] High blood pressure and cholesterol Adults CCBs 1 of 1 1 model study Vos 2011 [ 29 ] High blood pressure and cholesterol Adults ACE inhibitors 1 of 1 1 model study Vos 2011 [ 29 ] High blood pressure and cholesterol Adults Aspirin 1 of 1 1 model study Vos 2011 [ 29 ] High blood pressure and cholesterol Adults Polypill 2 of 2 2 model studies Vos 2011 [ 29 ] Osteoporosis Adults Screening and alendronate 1 of 1 1 model study Vos 2011 [ 29 ] Osteoporosis Adults Screening and raloxifene 0 of 1 N/A Vos 2011 [ 29 ] Substance misuse Children and adolescents School-based drug prevention programme 0 of 1 N/A Vos 2011 [ 29 ] Cervical cancer Adults Screening 4 of 6 4 model studies Vos 2011 [ 29 ] Skin care Universal Suncare programme 1 of 1 1 model study Vos 2011 [ 29 ] Prostate cancer Adults Screening 0 of 1 N/A Vos 2011 [ 29 ] Hepatitis B Children Hepatitis B vaccination 4 of 4 4 model studies Vos 2011 [ 29 ] Pre-diabetes Adults Screening and dietary intervention 1 of 1 1 model study Vos 2011 [ 29 ] Pre-diabetes Adults Screening and exercise intervention 1 of 1 1 model study Vos 2011 [ 29 ] Pre-diabetes Adults Screening, diet and exercise intervention 1 of 1 1 model study Vos 2011 [ 29 ] Pre-diabetes Adults Screening and pharmacotherapy 2 of 4 2 model studies Vos 2011 [ 29 ] Kidney disease Adults Screening and early treatment 2 of 2 2 model studies Vos 2011 [ 29 ] Depression Post-partum women Screening and psychological treatment 1 of 1 1 model study

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 41 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Vos 2011 [ 29 ] Depression Children and adolescents Screening and psychological treatment 1 of 1 1 model study Vos 2011 [ 29 ] Depression Children and adolescents Screening and bibliotherapy 1 of 1 1 model study Vos 2011 [ 29 ] Depression Adults Screening and bibliotherapy 1 of 1 1 model study Vos 2011 [ 29 ] Depression Adults Screening and psychological treatment 1 of 1 1 model study Vos 2011 [ 29 ] Self-harm/ suicide Adults Problem-solving therapy 1 of 1 1 model study Vos 2011 [ 29 ] Psychosis Adults Treatment for individuals at ultra-high risk for psychosis 1 of 1 1 model study Vos 2011 [ 29 ] Child anxiety disorders Parents Parenting intervention 1 of 1 1 model study Vos 2011 [ 29 ] Macular degeneration Adults Ranibizumab 0 of 1 N/A Vos 2011 [ 29 ] Dental health Children and adolescents Annual dental check 0 of 3 N/A Vos 2011 [ 29 ] Alcohol misuse Adults Residential treatment and naltrexone 0 of 2 N/A Vos 2011 [ 29 ] Alcohol misuse Adults Residential treatment 0 of 2 N/A Vos 2011 [ 29 ] Cannabis dependence Adults CBT 1 of 1 1 model study Vos 2011 [ 29 ] Breast cancer Adults Trastuzumab 1 of 1 1 model study Vos 2011 [ 29 ] Kidney disease Adults Renal replacement therapy 1 of 1 1 model study Vos 2011 [ 29 ] Kidney disease Adults Dialysis 0 of 1 N/A Vos 2011 [ 29 ] Depression Adults CBT 4 of 4 4 model studies Vos 2011 [ 29 ] Depression Adults SSRI 2 of 2 2 model studies Vos 2011 [ 29 ] Depression Adults TCA 2 of 2 2 model studies Vos 2011 [ 29 ] Depression Adults Bibliotherapy 1 of 1 1 model study Vos 2011 [ 29 ] Psychosis Adults Psychosis prevention 1 of 1 1 model study Vos 2011 [ 29 ] Cardiovascular disease Adults Angioplasty coated stents 1 of 2 1 model study Vos 2011 [ 29 ] Cardiovascular disease Adults Bypass surgery and stents 0 of 1 N/A Vos 2011 [ 29 ] Cardiovascular disease Adults Early stenting 1 of 1 1 model study

[Find the meaning and references behind the names: Triple]

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 42 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Vos 2011 [ 29 ] Cardiovascular disease Adults Rehabilitation 1 of 1 1 model study Vos 2011 [ 29 ] Asthma Adults Asthma clinic 1 of 1 1 model study Vos 2011 [ 29 ] Osteoarthritis Adults Hip replacement for osteoarthritis 1 of 1 1 model study Vos 2011 [ 29 ] Osteoarthritis Adults Knee replacement for osteoarthritis 1 of 1 1 model study Vos 2011 [ 29 ] Peptic ulcer disease Adults Eradication with triple therapy 1 of 1 1 model study Vos 2011 [ 29 ] Shingles Adults Vaccination 0 of 1 N/A Vos 2011 [ 29 ] Influenza Adults Vaccination 0 of 1 N/A Vos 2011 [ 29 ] HIV Adults Needle exchange programme 1 of 1 1 model study Vos 2011 [ 29 ] HIV Adults Intermittent pre-exposure prophylaxis 1 of 1 1 model study Vos 2011 [ 29 ] HIV Adults Circumcision 1 of 1 1 model study Vos 2011 [ 29 ] HIV Adults Early anti-retrovirals 0 of 1 N/A Vos 2011 [ 29 ] HIV Adults Post-exposure prophylaxis 0 of 1 N/A Vos 2011 [ 29 ] Blood pressure and cholesterol Adults (Indigenous) Lifestyle intervention 0 of 1 N/A Vos 2011 [ 29 ] Blood pressure and cholesterol Adults (Indigenous) Statins 0 of 1 N/A Vos 2011 [ 29 ] Blood pressure and cholesterol Adults (Indigenous) ACE inhibitors 0 of 1 N/A Vos 2011 [ 29 ] Blood pressure and cholesterol Adults (Indigenous) Polypill 1 of 1 1 model study Vos 2011 [ 29 ] HBV Children Vaccination 3 of 3 3 model studies Vos 2011 [ 29 ] Pre-diabetes Adults (Indigenous) Screening and dietary intervention 1 of 1 1 model study Vos 2011 [ 29 ] Pre-diabetes Adults (Indigenous) Screening and exercise intervention 1 of 1 1 model study Vos 2011 [ 29 ] Pre-diabetes Adults (Indigenous) Screening, diet and exercise intervention 1 of 1 1 model study

Int. J. Environ. Res. Public Health 2023 , 20 , 6139 43 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Vos 2011 [ 29 ] Pre-diabetes Adults (Indigenous) Screening and rosiglitazone 0 of 1 N/A Vos 2011 [ 29 ] Pre-diabetes Adults (Indigenous) Screening and metformin 1 of 1 1 model study Vos 2011 [ 29 ] Pre-diabetes Adults (Indigenous) Screening and acarbose 1 of 1 1 model study Vos 2011 [ 29 ] Pre-diabetes Adults (Indigenous) Screening and orlistat 0 of 1 N/A Vos 2011 [ 29 ] Kidney disease Adults (Indigenous) Screening and early treatment 2 of 2 2 model studies Vos 2011 [ 29 ] Kidney disease Adults (Indigenous) Dialysis 0 of 1 N/A Vos 2011 [ 29 ] Kidney disease Adults (Indigenous) Renal replacement therapy 1 of 1 1 model study Sexual health Bloch 2021 [ 44 ] Sexual health Adolescents and adults Screening for chlamydia trachomatis 18 of 24 18 model studies Bloch 2021 [ 44 ] Sexual health Adolescents and adults Screening for gonorrhoea and chlamydia trachomatis 2 of 3 2 model studies Bloch 2021 [ 44 ] Sexual health Adolescents and adults Screening for gonorrhoea 1 of 2 1 model studies Bloch 2021 [ 44 ] Sexual health Adolescents and adults STI screening 0 of 1 N/A Bloch 2021 [ 44 ] Sexual health Adolescents and adults Screening for HIV 0 of 1 N/A Immunisation Boccalini, 2021 [ 45 ] Influenza Children and adolescents Influenza vaccinations 7 of 8 7 model studies Smoking cessation Cheung, 2017 [ 46 ] Smoking Adults Counselling session + self-help education materials 2 of 3 2 RCTs Cheung, 2017 [ 46 ] Smoking Adults Self-help material 1 of 1 1 RCT Lee, 2019 [ 47 ] Smoking Adults Counselling session + self-help education materials 6 of 6 3 RCTs, 3 model studies Lee, 2019 [ 47 ] Smoking Adults Counselling + NRT + self-help education materials 1 of 1 1 model study Lee, 2019 [ 47 ] Smoking Adults GP advice + counselling 1 of 1 1 RCT Lee, 2019 [ 47 ] Smoking Adults Screening, counselling + NRT 1 of 1 1 model study Lee, 2019 [ 47 ] Smoking Adults Counselling session + NRT + self-help education materials 1 of 1 1 model study Mahmoudi, 2012 [ 48 ] Smoking Adults Varenicline (non-nicotine therapy) 9 of 10 9 model studies

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Int. J. Environ. Res. Public Health 2023 , 20 , 6139 44 of 47 Table A 6. Cont First Author, Year of Review Target Problem Target Population Type of Intervention Total No. of Cost-Effective Studies Design of the Cost-Effective Studies Reduce alcohol Kruse, 2020 [ 49 ] Alcohol abuse and addiction General population Telemedicine intervention 1 of 1 1 model study Fractures Ganda 2013 [ 50 ] Osteoporotic fractures Adults Multidisciplinary care model 1 of 3 1 model study Ganda 2013 [ 50 ] Osteoporotic fractures Adults Osteoporosis care with case coordinator 1 of 2 1 model study Wu, 2018 [ 51 ] Osteoporotic fractures Adults Multidisciplinary care model 11 of 12 11 model studies Wu, 2018 [ 51 ] Osteoporotic fractures Adults Osteoporosis care with case coordinator 3 of 3 3 model studies Wu, 2018 [ 51 ] Osteoporotic fractures Adults Anti-osteoporosis medication 1 of 1 1 cohort study Wu, 2018 [ 51 ] Osteoporotic fractures Adults Screening programme 1 of 2 1 model study ACE, Angiotensin-converting enzyme inhibitor; AIDS, Acquired immunodeficiency syndrome; CCB, Calcium channel blockers, CBT, Cognitive behavioural therapy; GP, General practitioner; HIV, Human immunodeficiency virus; MMR, Measles, mumps, and rubella, N/A, Not applicable, NRT, Nicotine replacement therapy; RCT, Randomised control trial, SSRI, Selective serotonin reuptake inhibitor; STI, Sexually transmitted infection; TCA, Tricyclic antidepressant Int. J. Environ. Res. Public Health 2023 , 20 , x FOR PEER REVIEW 50 of 54 Ganda 2013 [50] Osteoporotic fractures Adults Osteoporosis care with case coordinator 1 of 2 1 model study Wu, 2018 [51] Osteoporotic fractures Adults Multidisciplinary care model 11 of 12 11 model studies Wu, 2018 [51] Osteoporotic fractures Adults Osteoporosis care with case coordinator 3 of 3 3 model studies Wu, 2018 [51] Osteoporotic fractures Adults Anti-osteoporosis medication 1 of 1 1 cohort study Wu, 2018 [51] Osteoporotic fractures Adults Screening programme 1 of 2 1 model study ACE, Angiotensin-converting enzyme inhibitor; AIDS, Acquired immunode fi ciency syndrome; CCB, Calcium channel blockers, CBT, Cognitive behavioural therapy; GP, General practitioner; HIV, Human immunode fi ciency virus; MMR, Measles, mumps, and rubella, N/A, Not applicable, NRT, Nicotine replacement therapy; RCT, Randomised control trial, SSRI, Selective serotonin reuptake inhibitor; STI, Sexually transmi tt ed infection; TCA, Tricyclic antidepressant. Figure A 1. Countries in which the studies were conducted included in the reviews ( n = 26) [18,21,22,29–51]. Figure A 1. Countries in which the studies were conducted included in the reviews ( n = 26) [ 18 , 21 , 22 , 29 – 51 ].

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[Find the meaning and references behind the names: Van Den Broek, De Vries, Jefferson, Zhang, Liu, Seibel, Pronk, Wieser, Pharm, Puech, Carr, Oyibo, Hopkins, Searles, Edmunds, Hawkes, Kien, Donaldson, Charles, Forster, Kilian, Clin, Prim, Europe, Coleman, Siegel, Ross, Bagga, Broek, Sport, Macpherson, Von, Hung, Schirripa, Lobo, Watson, Eff, Graves, Mcintosh, Sommer, Bechini, Sobieraj, Bonanni, Mcdaid, Deane, Kao, Konig, Sonntag, Heller, Vries, Matyas, Frew, Wijnen, Becker, Varga, Albright, Probst, Chen, Proia, Schmidt, White, Chatterton, Hsieh, Wagner, Gregg, Weiser, March, Lin, Paoli, Riedel, Jackson, Yang, Engel, Wiggers]

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