Use of cost analysis in examinations of health coaching interventions: a scoping review

Health coaching is the process of using conversation, clinical strategies and interventions to engage clients in setting goals and identifying strategies to facilitate behaviour changes that allow clients to better self-manage their health. Health coaching is a new and growing industry in the USA. With increasing budgetary strain and limited resources, understanding the financial outcomes of adding health coaching is critical.

The objective of this review was to examine what is known in the literature about health coaching and cost analyses since 2017, building and expanding on the findings of a prior review. This review seeks to identify existing and persisting gaps in the literature and suggest future directions for cost analyses in health coaching interventions.

Full-text publications, excluding editorials and opinion pieces, included in this scoping review were published in 2017 or later. Included publications had to be written in English and align with the definition of health coaching described by the National Board for Health and Wellness Coaching. They also had to contain some measurement of cost or cost analysis, indicated by the mention of cost or a related synonym in the methods section.

PubMed, Embase and the Health Medicine Collection were searched from 1 January 2017 to 7 January 2025 for peer-reviewed research, with an additional search on 5 May 2026 to reflect any additions to the literature since the initial submission.

The scoping review was structured according to the enhancement by Levac et al to Arksey and O'Malley's framework for conducting scoping reviews.Information related to the cost analysis methodology and results was extracted from each of the included articles. Trends across articles were summarised based on key characteristics of the study and the main questions being addressed in the review.

Only two studies found statistically significant effects on healthcare costs from health coaching: one found an increase in costs and the other found a decrease. Only one study found health coaching to be cost-effective, with another two studies finding it to be not cost-effective or cost-effective only if the coaching costs less than a certain amount or has an assumed efficacy threshold. Overall, the cost analyses for health coaching lacked transparency in methodology reporting and had a wide variety of methodology and costs included. Synthesis of results was not possible due to inter-study heterogeneity.

As there is a move towards standardisation and credentialing of health coaches, there needs to be a similar move towards the standardisation of their cost analyses. This scoping review found mixed, limited evidence regarding the cost outcomes and cost-effectiveness of health coaching. Future research should conduct cost analyses of health coaching interventions according to the structured framework listed in the Consolidated Health Economic Evaluation Reporting Standards, with greater transparency of methods, longer-term results and greater generalisability of results to other geographic locations and health conditions. Cost analysis of health coaching remains an urgent area for standardised and rigorous analysis to better understand the financial implications of adding health coaching to an institution.