Health economic evaluation of health promotion and disease prevention in Germany: a scoping review.

BACKGROUND: Health promotion and disease prevention are receiving increasing attention in Germany because of their potential to improve population health and reduce healthcare costs. Health-economic evaluations (HEEs) are essential for informing evidence-based decision-making in this field. However, HEEs of preventive interventions often face methodological challenges. This scoping review examines the current state and characteristics of HEEs conducted in the context of health promotion and disease prevention in Germany. METHODS: A scoping review was conducted to map the landscape of HEE of health promotion and disease prevention interventions in Germany, following a priori-registered protocol. Three bibliographic databases (MEDLINE, EMBASE and Web of Science) were searched from their inception to March 2025. The screening of titles, abstracts, and full texts was performed in a blinded, double-reviewer, and stepwise manner using predefined inclusion criteria: (i) focus on the German population, (ii) application of an HEE as the primary research method, and (iii) evaluation of a health-promoting or disease-preventing intervention. Studies focusing on tertiary prevention were excluded. RESULTS: Of the 4,632 records identified, 162 eligible original studies met the inclusion criteria. The volume of published HEEs has increased over time. Most studies (53.7%) assessed primary preventive interventions. Cost-effectiveness analysis was the most frequently applied HEE analysis type. Incremental cost-effectiveness ratios (ICERs) are commonly reported as incremental costs per quality-adjusted life year (QALY) gained (42.4% of all ICERs). In 85.2% of the studies, the intervention was judged to be cost-effective. A model-based approach was used in 75.9% of the studies, and 81.3% of these studies relied partly on non-German data sources. More than half of all studies (56.1%) reported limitations due to a lack of German-specific data. CONCLUSIONS: HEEs related to health promotion and disease prevention interventions in Germany exhibit substantial methodological heterogeneity. Frequent reliance on non-German data and the large proportion of interventions deemed cost-effective may reflect contextual data gaps and potential publication bias. These issues complicate the interpretation of economic evidence and pose challenges for decision-makers seeking to prioritize preventive strategies. TRIAL REGISTRATION: https://osf.io/h6749/overview.