Building healthier and sustainable cities: A scoping review to establish the cost-effectiveness of place-based interventions

Place-based interventions—modifying physical and social environments—are promising in reducing non-chronic disease risks but lack comprehensive economic evaluations. This scoping review aims to identify, evaluate, and synthesise evidence on the cost-effectiveness of urban place-based interventions, to better inform policy and resource allocation.

Following PRISMA-ScR guidelines, we searched MEDLINE, Embase, PsycINFO, and grey literature for full economic evaluations of urban place-based interventions with no date restrictions. Standardised tools were used for data extraction, critical appraisal, and synthesis of methodological quality, geographic distribution, and intervention types.

Among 53 studies included, transport-related interventions dominated (70 %), followed by green/blue spaces (19 %), housing (7.5 %), and services and facilities (4 %). Only four out of 53 studies classified the intervention as not cost-effective. Geographically, included studies were concentrated in the United States and the United Kingdom. Cost-benefit analysis (64 %) is the most used economic evaluation method, and a societal perspective is used in 59 % of cases. However, significant inconsistencies were noted, particularly in synthesising effectiveness estimates and justifying discount rates. Key gaps included limited equity considerations and non-health outcomes.

While place-based interventions demonstrate potential for improving health outcomes, conclusions regarding their cost-effectiveness are limited by methodological shortcomings and gaps in geographic and intervention scope. To enhance policy relevance, future research should adopt more rigorous methodologies, incorporate equity considerations, and expand the scope of outcomes to capture the full societal value of these interventions. Addressing these gaps will be essential for informing policies that maximise health and societal benefits.