Abstract
OBJECTIVE: This systematic review assessed trial-based economic evaluations to provide empirical evidence on the cost-effectiveness of non-drug interventions (NDIs) that are currently recommended within the Royal Australian College of General Practitioners Handbook of Non-Drug Interventions (HANDI). METHODS: Medline, CINAHL and PsycINFO along with clinical trial registries (clinicaltrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 1 July 2025. Randomised controlled trials (RCTs) that reported cost effectiveness for a prescribed non-drug intervention (NDI) from HANDI were included in the study. The primary outcome was the incremental cost-utility ratio (ICUR) derived from cost-utility analyses (CUAs). RESULTS: A total of 11 187 citations were identified, from which 156 RCTs were included. These RCTs enrolled a total of 66 926 participants (median=214, IQR 139-342), with a median follow-up duration of 12 months (IQR 6-12 months). Over half of the CUA NDIs were for mental health conditions (n=81; 54.0%), one-third were for were for musculoskeletal conditions (n=44; 29.3%), while only 16.0% (n=24) were for those with cardiovascular/metabolic conditions. Out of the 150 NDIs that reported CUAs, 40% were deemed to be in the south-east (SE) quadrant (cheaper and more effective) and 49.3% fell in the north-east (NE) quadrant (more costly but more effective), with 70% considered cost effective against a £25 000/quality-adjusted life-year (QALY) willingness to pay threshold. The overall median ICUR was £2400/QALY (IQR -18 986 to 20 027). CONCLUSIONS: Most of the HANDI NDIs that were included within this systematic review are cost-effective compared with a variety of alternatives including usual care or waiting list controls. HANDI NDIs warrant use as a first line of treatment when clinically appropriate.