Effectiveness and Cost-effectiveness of General Health Checks in Adults: A Systematic Review

Abstract Introduction: General health checks (GHCs) are widely used for disease prevention, yet their clinical effectiveness, psychological impact, and economic value remain uncertain. This study systematically evaluated the effectiveness and cost-effectiveness of GHCs in adults. Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, SinoMed, CNKI, and WanFang from inception to July 1, 2025, using a comprehensive strategy combining controlled vocabulary (e.g., MeSH, Emtree) and free-text terms. Multiple reviewers independently screened titles, abstracts, and full texts. We included randomized clinical trials (RCTs), nonrandomized controlled trials (NRCTs), observational studies with control groups, and economic evaluations comparing GHCs with usual care in adults. Risk of bias was assessed using Cochrane RoB 2.0, ROBINS-I, and other validated tools. Data were synthesized narratively due to heterogeneity. Results: A total of 74 articles representing 56 unique studies (including 22 RCTs, 5 NRCTs, 25 observational studies, 3 economic evaluation studies, and 1 mixed-methods study) involving more than 17 million participants were included. RCTs consistently showed no significant reduction in all-cause mortality or cardiovascular events compared with usual care, whereas high-risk subgroups and observational studies frequently suggested protective associations. GHCs were associated with increased detection of chronic diseases, greater uptake of preventive services, and modest improvements in patient-reported outcomes. While GHCs modestly improve diet and physical activity, most trials found little or no effect on smoking or hazardous alcohol use. Economically, GHCs reduced short-term healthcare costs and high-cost service utilization, but long-term cost-effectiveness remains debatable. While psychological effects were generally positive or neutral, increased suicide risk was observed in older adults in one large cohort. Conclusions: General health checks do not reduce mortality or cardiovascular events in the general population but are associated with earlier disease detection, modest risk-factor improvements, greater use of preventive care, small psychological benefits, and reductions in short-term healthcare costs. Current evidence does not support a "one-size-fits-all" approach. Future implementation should prioritize risk-stratified models targeting high-risk groups to ensure we aren't just wasting resources but actually delivering clinical value. Systematic review registration: The study protocol was registered with PROSPERO (CRD42022326697).