This critical review explores the current state of health economic evaluations of community-based public health interventions. Referencing 79 systematic reviews, it highlights the diversity of interventions, target populations, and evaluation methods while identifying promising cost-effectiveness evidence and significant methodological challenges. Key issues include inconsistent terminology, limited data from low- and middle-income countries, and variability in assessment approaches, which hinder comparability and policy application. The article emphasizes the need for standardized frameworks, tailored guidelines to inform evidence generation and decision-making, and stronger research capacity for conducting high-quality economic evaluations, particularly in resource-constrained settings. We highlight the importance of incorporating broader perspectives, such as spillover effects, and developing innovative modeling techniques to better capture community dynamics. Addressing these gaps will enhance the quality, rigor, and relevance of evaluations, supporting more sustainable investments in community health initiatives worldwide. Strengthening evaluation practices will ultimately improve resource allocation and health outcomes across populations and settings globally.

PMID: 41197154 DOI: 10.1146/annurev-publhealth-081424-040849