Health economics analysis of restrictive school smartphone policies in secondary schools in England (SMART Schools)

BACKGROUND: Many countries have introduced restrictive smartphone policies in schools, aiming to improve adolescent health and educational outcomes. However, whether these policies represent value for money to schools remains unclear. OBJECTIVE: The aim of this study was to estimate the costs and quality of life and mental well-being outcomes associated with restrictive and permissive phone policies in secondary schools in England, and conduct an economic evaluation to determine whether restrictive phone policies are cost effective for schools. METHODS: A cost-utility analysis was conducted as part of a cross-sectional study on school smartphone policies in England (SMART Schools), comparing schools with restrictive (recreational phone use not permitted) and permissive (recreational phone use permitted) policies. Outcomes were valued using quality-adjusted life years (QALYs) and mental well-being adjusted life years (MWALYs). Costs were estimated from the school's perspective and comprised staff time spent on policy implementation. Mixed effects and linear regression models were used to estimate incremental differences in outcomes and per pupil costs. FINDINGS: 815 pupils (aged 12-15) from 20 schools (13 restrictive, 7 permissive) were included in a complete case analysis. Differences between restrictive and permissive schools in incremental QALYs (0.009, 95% CI -0.014 to 0.032) and MWALYs (-0.004, 95% CI -0.044 to 0.036) were minimal. Time implementing and enforcing policies was equivalent to 3.1 FTE staff in restrictive and 3.3 FTE staff in permissive schools. The incremental difference in per pupil school year cost was -£94 (95% CI -£229 to £41). The cost-effectiveness acceptability curve indicated a 90% probability of restrictive policies being cost effective at a threshold of £20 000 and £30 000 per QALY. CONCLUSIONS: Restrictive school policies were associated with minimal differences in quality of life or mental well-being of pupils. However, they may offer some cost savings to schools by reducing staff time spent managing phone-related activities. CLINICAL IMPLICATIONS: School policies and practices require development to address the significant amount of time teachers spend managing phone use.