A Scoping Review on the Economic Impacts of Healthy Ageing Promotion and Disease Prevention in OECD Member Countries

The economic impact of health promotion and disease prevention interventions in ageing populations remains debated, as theories of morbidity compression and expansion offer contrasting views on the relationship between life expectancy and duration of morbidity. A MEDLINE search was conducted to identify studies evaluating the economic impact of health promotion or primary or secondary prevention interventions in OECD countries, over a lifetime time horizon. Among the 29 studies included, 16 reported cost-saving interventions (reducing costs while improving health outcomes), 11 reported cost-effective interventions (health gains at an acceptable additional cost based on an established threshold), and two presented cost-ineffective interventions (costs exceeding the threshold for the health benefits achieved). Interventions targeting diabetes and obesity prevention were cost-saving; cancer screening and fall prevention strategies were cost-effective; whereas interventions targeting rare diseases were cost-ineffective. Regulatory interventions were also cost-saving, while most programme-based interventions were cost-effective. Cost-saving or cost-effective interventions generally adopted broader analytical perspectives, while cost-ineffective ones employed narrower perspectives. The four studies that incorporated competing risks-despite using a narrower healthcare sector perspective-still found the interventions to be cost-saving or cost-effective interventions. None of the included studies assessed whether interventions led to morbidity compression or expansion. Only a few studies considered equity impact; those that did reported improved outcomes for disadvantaged groups, in regulatory and community-based interventions. Further research is needed to quantify morbidity outcomes and enhance methodological consistency, particularly with respect to analytical perspectives, the integration of competing risks, and the inclusion of equity analyses.