A Systematic Review of Using Social Return on Investments Within Healthcare Service Evaluations: Methodological Opportunity and Challenges
Author(s)
Megan Dale, MSc, Katherine Woolley, PhD, Kathleen Withers, MSc.
CEDAR, Cardiff and Vale University Health Board, Cardiff, United Kingdom.
CEDAR, Cardiff and Vale University Health Board, Cardiff, United Kingdom.
OBJECTIVES: Social return on investment (SROI) is a stakeholder driven framework for measuring and accounting for a broad concept of value, and is aligned to value-based healthcare principles. SROI is increasingly used in public health interventions but less widely in other healthcare areas. This systematic review aims to understand how SROI methods are being used in healthcare, and if there are consistent methodological approaches.
METHODS: Academic and grey literature databases were searched. Included publications reported an SROI ratio from a health service change or intervention provided by healthcare professionals at an individual level, as described in PROSPERO CRD420251011430. A new assessment for risk of bias was developed combining elements from two previous publications.
RESULTS: Searches identified 453 publications or reports, resulting in 29 included studies. Of these, 14 were forecast and 15 were primarily retrospective. Three studies were comparative. System wide forecast analyses accounted for 30% (9/29). Other settings were secondary care (5), community settings (7), patient’s home (4), primary care (2), and specialised settings (3). Outcome identification was primarily via stakeholder interviews for retrospective, or expert panels for forecast SROIs. Outcome collection was primarily using surveys either bespoke (40%, 12/29), or validated (38%, 11/29). The majority valued each outcome individually (28/29) with a mixture of methods frequently used within one study. Assumed financial proxies were used in 47% (14/29), direct cost in 37% (11/29), wellbeing databases for 23% (7/29) and direct elicitation in 28% (8/29). Variable quality sensitivity analysis was reported in 77% (22/29).
CONCLUSIONS: This review highlights unresolved methodological challenges. There are trade-offs in many of the methodological choices, and the best approach may depend on the purpose of the evaluation. As methods evolve, it is essential to ensure that readers and decision makers who use SROI results understand the limitations, uncertainties and the intended purposes.
METHODS: Academic and grey literature databases were searched. Included publications reported an SROI ratio from a health service change or intervention provided by healthcare professionals at an individual level, as described in PROSPERO CRD420251011430. A new assessment for risk of bias was developed combining elements from two previous publications.
RESULTS: Searches identified 453 publications or reports, resulting in 29 included studies. Of these, 14 were forecast and 15 were primarily retrospective. Three studies were comparative. System wide forecast analyses accounted for 30% (9/29). Other settings were secondary care (5), community settings (7), patient’s home (4), primary care (2), and specialised settings (3). Outcome identification was primarily via stakeholder interviews for retrospective, or expert panels for forecast SROIs. Outcome collection was primarily using surveys either bespoke (40%, 12/29), or validated (38%, 11/29). The majority valued each outcome individually (28/29) with a mixture of methods frequently used within one study. Assumed financial proxies were used in 47% (14/29), direct cost in 37% (11/29), wellbeing databases for 23% (7/29) and direct elicitation in 28% (8/29). Variable quality sensitivity analysis was reported in 77% (22/29).
CONCLUSIONS: This review highlights unresolved methodological challenges. There are trade-offs in many of the methodological choices, and the best approach may depend on the purpose of the evaluation. As methods evolve, it is essential to ensure that readers and decision makers who use SROI results understand the limitations, uncertainties and the intended purposes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE36
Topic
Economic Evaluation, Patient-Centered Research, Study Approaches
Topic Subcategory
Novel & Social Elements of Value
Disease
No Additional Disease & Conditions/Specialized Treatment Areas