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

Differences in quality-adjusted life years between restrictive and permissive school smartphone policies were minimal.

• Incremental QALY difference was 0.009 (95% CI -0.014 to 0.032) in favor of restrictive policies.
• Incremental MWALY difference was -0.004 (95% CI -0.044 to 0.036), also minimal.
• 815 pupils aged 12-15 from 20 schools (13 restrictive, 7 permissive) were included in a complete case analysis.
• Outcomes were valued using both quality-adjusted life years (QALYs) and mental well-being adjusted life years (MWALYs).

Staff time spent on phone policy implementation was slightly lower in restrictive schools than permissive schools.

• Time implementing and enforcing policies was equivalent to 3.1 FTE staff in restrictive schools and 3.3 FTE staff in permissive schools.
• Costs were estimated from the school's perspective and comprised staff time spent on policy implementation.
• The incremental difference in per pupil school year cost was -£94 (95% CI -£229 to £41), indicating potential cost savings for restrictive schools.

Restrictive smartphone policies had a high probability of being cost effective at conventional willingness-to-pay thresholds.

• 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.
• Cost-utility analysis compared schools with restrictive (recreational phone use not permitted) versus permissive (recreational phone use permitted) policies.
• Mixed effects and linear regression models were used to estimate incremental differences in outcomes and per pupil costs.

The study was a cross-sectional analysis of school smartphone policies in England (SMART Schools study).

• 20 secondary schools participated: 13 with restrictive policies and 7 with permissive policies.
• 815 pupils aged 12-15 were included in the complete case analysis.
• A cost-utility analysis framework was applied, estimating both QALYs and MWALYs as outcome measures.

A significant amount of teacher time is spent managing phone use regardless of policy type.

• Both restrictive and permissive schools required substantial staff resources equivalent to over 3 FTE staff for phone policy management.
• The authors concluded that 'school policies and practices require development to address the significant amount of time teachers spend managing phone use.'
• This finding held across both policy types, suggesting phone management is a pervasive burden independent of restriction level.