Numerous guidelines recommend physical activity interventions (PAIs) for children and adolescents with overweight/obesity to manage weight. This study aimed to evaluate the availability and methodological quality of economic evaluations of PAIs for children and adolescents with overweight/obesity.

We conducted a systematic search of six electronic databases (Medline, Embase, Scopus, Web of Science, EconLit, and SportDiscus) for literature published between 2009 and 2024. Study quality was evaluated using the Health Economic Criteria (CHEC) checklist, while the risk of bias was assessed using the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Review results were presented using narrative synthesis.

The majority (13/17, 76%) of studies suggested that PAIs had positive effectiveness, with 0.004-30.3 quality-adjusted life years (QALYs) gained and weight-related indicators decreased. The maximum incremental cost-effectiveness ratio (ICER) for this intervention was £7,455.21 per QALY. Very limited evidence indicated that girls might be more likely to benefit from PAIs for overweight/obesity. Despite the possibility of bias, most of the studies were of high quality.

The evidence supports that not all PAIs are cost-effective for children and adolescents with overweight/obesity, and not all of them could gain from PAIs. To ascertain the cost-effectiveness of PAIs in various subgroup populations, more research is desperately needed.