Health economics analysis of restrictive school smartphone policies in secondary schools in England (SMART Schools).
Level 3 - non-randomized controlled study
Cross-sectional comparative observational study with economic modeling
PubMed 41667290 · doi:10.1136/bmjment-2025-301892
What was done
A cost-utility analysis was conducted as part of the cross-sectional SMART Schools study in England, comparing secondary schools with restrictive smartphone policies (no recreational use permitted, n=13) to those with permissive policies (recreational use permitted, n=7). Outcomes for 815 pupils aged 12–15 were evaluated using quality-adjusted life years (QALYs) and mental well-being adjusted life years (MWALYs). Costs were estimated from the school perspective based on staff time spent enforcing policies, analyzed via mixed-effects and linear regression models.
What was found
Differences between restrictive and permissive schools were minimal for QALYs (0.009, 95% CI -0.014 to 0.032) and MWALYs (-0.004, 95% CI -0.044 to 0.036). Enforcement required 3.1 full-time equivalent (FTE) staff in restrictive schools versus 3.3 FTE staff in permissive schools. The incremental per-pupil cost difference for restrictive schools was -£94 per school year (95% CI -£229 to £41). The probability of restrictive policies being cost-effective was 90% at thresholds of £20,000 to £30,000 per QALY, driven by minor staff time savings rather than health gains.
Why it matters
This study provides initial health-economic evidence that restrictive school phone bans have negligible direct impacts on pupil mental well-being or quality of life, but may modestly lower teacher workload associated with managing device use.
Limits
The cross-sectional design cannot establish causality. Sample size was limited to complete cases across 20 schools with an uneven distribution (13 restrictive vs 7 permissive). Confidence intervals for cost savings and outcome gains crossed zero. Cost calculations were limited to staff enforcement time and did not evaluate academic outcomes, parental costs, or broader societal effects.