Systematic review on the use of cost-benefit analysis to evaluate food environment interventions

The global obesity epidemic is a complex issue influenced by various factors, including the food system and its environment. Increasingly, interventions targeting systemic changes in the food environment are being implemented to address obesity. Cost-benefit analysis (CBA) is gaining recognition as a valuable tool for evaluating these interventions, due to its ability to capture broader societal impacts beyond health outcomes. However, its application in this context remains poorly understood.

A systematic review was conducted following PRISMA guidelines, searching academic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, EconLit, CRD). Study quality was assessed using the Making an Early Intervention Business Case checklist, designed to evaluate CBA studies.

Of 6508 references screened, 28 studies met the inclusion criteria. The review identified common methodological approaches, summarized key findings, challenges and implications, and provided clear recommendations for improvement. The review also synthesized evidence to show that food environment interventions offer value for money with positive returns.

This first systematic review of CBAs in food environment interventions identified common methods, challenges, and areas for improvement. While CBA is a valuable tool for evaluating food environment interventions, more robust and standardized methodological approaches are needed to enhance its reliability and applicability.Registration: PROSPERO (CRD42024503615).