Effectiveness and cost-effectiveness of general health checks in adults: A systematic review

General health checks (GHCs) are widely used for disease prevention, however, their clinical effectiveness, psychological impact, and economic value remain debated. This study systematically evaluated the effectiveness and cost-effectiveness of GHCs in adults to update and expand upon existing reviews.

We searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, SinoMed, CNKI, and WanFang from inception to July 1, 2025. Three reviewers independently screened titles and abstracts, and two reviewers assessed full-text eligibility, with disagreements resolved through discussion or consultation with a senior reviewer. We included randomized controlled trials, nonrandomized controlled trials, observational studies with control groups, mixed-methods studies, and economic evaluations comparing GHCs with usual care in adults. Risk of bias was assessed using Cochrane RoB 2.0, ROBINS-I, and other validated tools. The certainty of evidence was evaluated using the GRADE approach. Due to substantial heterogeneity, findings were synthesized narratively.

We included 74 articles representing 56 unique studies (22 RCTs, 5 NRCTs, 25 observational studies, 3 economic evaluations, 1 mixed-methods study), involving more than 17 million participants. RCTs generally did not show a significant reduction in all-cause mortality (76.9% of RCTs) or cardiovascular events (100% of RCTs) compared with usual care, whereas observational studies (6 of 8 studies) and analyses of high-risk subgroups suggested possible protective associations. GHCs were associated with increased detection of chronic diseases, greater uptake of preventive services, and modest improvements in patient-reported outcomes. Although GHCs modestly improved diet and physical activity, most trials (87.5%) reported little or no effect on smoking or hazardous alcohol use. Economically, GHCs reduced short-term healthcare costs and high-cost service utilization, but long-term cost-effectiveness remained uncertain (ICERs ranging from £900 to > AU$133,000 per QALY). Psychological effects were mostly neutral or showed small improvements, although increased suicide risk was reported in older adults in one large cohort.

Current evidence suggests that GHCs may not substantially reduce mortality or cardiovascular events in the general population. However, they may be associated with earlier disease detection, modest risk-factor improvements, greater use of preventive care, and small psychological benefits. The long-term economic value remains uncertain. Overall, the evidence may not support a "one-size-fits-all" approach. Future implementation could prioritize risk-stratified models targeting high-risk populations to potentially improve clinical and economic outcomes.

The study protocol was registered with PROSPERO (CRD420251080763).