Cost-Effectiveness and Cost-Benefit of a Lifestyle Intervention for Workers in the Construction Industry at Risk for Cardiovascular Disease

A Scoping Review of Interventions to Improve Occupational Safety and Health of Construction Workers

OBJECTIVE

This review comprehensively examines interventions which sought to improve the occupational safety and/or health of construction workers. Factors that explain the (in)effectiveness of interventions were also summarized.

DATA SOURCE

This review consisted of a search using two electronic databases, PubMed and Web of Science.

STUDY INCLUSION AND EXCLUSION CRITERIA

Targeted workers in the construction industry; had at least one primary outcome that aimed to improve occupational safety and/or health; were published between January 01, 1990 and December 01, 2019; and were written in English.

DATA EXTRACTION AND SYNTHESIS

Two researchers independently carried out the process of reviewing the titles, abstracts and full texts, and extracted all data. If there were differences, discussions were held until a consensus was reached.

RESULTS

A total of 1297 articles were retrieved and 24 were selected for final evaluation. Seventeen studies reported significant intervention effects, while 7 found their primary outcome not significantly improved.

CONCLUSION

Future research should place more effort on interventions aimed at improving both occupational safety and health outcomes in an integrated manner, with environmental interventions that accompany behavioral interventions at the individual level. Besides, additional effort is also needed to ensure the involvement of relevant stakeholders in designing the intervention, avoiding contamination effects (through cluster randomization), optimizing the "dosage" of intervention, and improving measurement of outcomes.

Workplace wellness programs targeting weight outcomes in men: A scoping review

Workplaces have been identified as a priority setting for the delivery of wellness programs to address risk factors for overweight and obesity. Men in particular may benefit greatly from these types of programs as they are typically harder to engage in health promotion. A scoping review was performed to provide an overview of interventions that have been implemented within the workplace that target weight outcomes in men. A searched of six electronic databases (Medline, Embase, CINAHL, Scopus, Cochrane Database of Systematic Review, and Business Source Ultimate) was conducted from January 2010 to August 2020. Of the 2191 articles identified, 25 were included. The majority took place in North America or Europe (72%). Over half (n = 17, 68%) utilized both a nutrition and physical activity component. Thirteen of the 19 articles (68%) that reported weight as an outcome showed the program to be efficacious in reducing weight. Overall, only seven articles were solely focused on an all-male population. Workplace wellness programs targeting weight outcomes in men have been conducted to some extent, with majority being successful in reducing weight. However, there is a need for more randomized controlled trials (RCTs), long-term follow-up, and male-only programs.

Return on Investment of Workplace Wellness Programs for Chronic Disease Prevention: A Systematic Review

CONTEXT

Individuals with noncommunicable diseases account for a disproportionate share of medical expenditures, absenteeism, and presenteeism. Therefore, employers are increasingly looking to worksite wellness programs as a cost-containment strategy. Previous reviews examining whether worksite wellness programs deliver a positive return on investment have shown mixed results, possibly because the more optimistic findings come from studies with poorer methodologic quality. The purpose of this systematic review is to critically revisit and update this literature to explore that hypothesis.

EVIDENCE ACQUISITION

A total of 4 databases were systematically searched for studies published before June 2019. Included studies were economic evaluations of worksite wellness programs that were based in the U.S., that lasted for at least 4 weeks, and that were with at least 1 behavior change component targeting 1 of the 4 primary modifiable behaviors for chronic disease: physical activity, healthy diet, tobacco use, and harmful consumption of alcohol. Methodologic quality was assessed using Consensus for Health Economic Criteria guidelines and the risk for selection bias associated with the study design. Data extraction (September 2019-February 2020) was followed by a narrative synthesis of worksite wellness programs characteristics and return on investment estimates.

EVIDENCE SYNTHESIS

A total of 25 relevant studies were identified. After conducting a quality and bias assessment, only 2 of the 25 studies were found to have both high methodologic rigor and lower risk for selection bias. These studies found no evidence of a positive return on investment in the short term.

CONCLUSIONS

The highest-quality studies do not support the hypothesis that worksite wellness programs deliver a positive return on investment within the first few years of initiation.

Economic evaluation of workplace health promotion interventions focused on Lifestyle: Systematic review and meta-analysis

AIM

To identify and evaluate randomized clinical trials focusing on economic evaluation of workplace health promotion (WHP) interventions based on healthy lifestyles, physical activity and nutrition.

DESIGN

A systematic review and meta-analysis was carried out between March and May 2019, following the PRISMA statement.

DATA SOURCES

The literature search was conducted on Cochrane Library, Scopus, WOS and Medline databases.

REVIEW METHODS

The quality appraisal included the overall risk of bias (Cochrane Collaboration tool), the quality of the evidence (GRADEpro) and the quality of the health economic analysis (QHES instrument).

RESULTS

Of the 15 studies selected, 3 were interventions based on nutrition, 11 were focused on lifestyle and only one on physical activity. Given the heterogeneity of included studies, it was decided to do a subgroup analysis. For the weight loss (n = 5 studies), a general increase of 0.56 Kg (95% CI = 0.76, 0.84) I²  = 99.41%, and for the Quality-adjusted Life Years achieved (n = 5 studies) a very small increase of 0.003 (95% CI = 0.002, 0.004) I²  = 99.25%, were observed.

CONCLUSIONS

The implementation of lifestyle interventions in the workplace has proven to be cost-effective for both employers and society.

IMPACT

What problem did the study address? There are few studies aimed at evaluating the efficiency of WHP interventions. However, those that identify and assessing interventions related to lifestyle are particularly scarce, despite the evidence showing that these researchers improve the quality of care of occupational health. What were the main findings? This systematic review demonstrates the effectiveness of the WHP interventions, and in some cases, the efficiency of these interventions for both employers and society. Additional research in this area is necessary as well as the assessment of the cost-effectiveness of such interventions. Where and on whom will the research have an impact? To know the cost-benefit of different WHP interventions allows more efficient management of resources, which helps to make political and business decisions, becoming healthier and safer workplaces.

A Scoping Review of Economic Evaluations of Workplace Wellness Programs

OBJECTIVE

Debates about the effectiveness of workplace wellness programs (WWPs) call for a review of the evidence for return on investment (ROI) of WWPs. We examined literature on the heterogeneity in methods used in the ROI of WWPs to show how this heterogeneity may affect conclusions and inferences about ROI.

METHODS

We conducted a scoping review using systematic review methods and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We reviewed PubMed, EconLit, Proquest Central, and Scopus databases for published articles. We included articles that (1) were published before December 20, 2019, when our last search was conducted, and (2) met our inclusion criteria that were based on target population, target intervention, evaluation method, and ROI as the main outcome.

RESULTS

We identified 47 peer-reviewed articles from the selected databases that met our inclusion criteria. We explored the effect of study characteristics on ROI estimates. Thirty-one articles had ROI measures. Studies with costs of presenteeism had the lowest ROI estimates compared with other cost combinations associated with health care and absenteeism. Studies with components of disease management produced higher ROI than programs with components of wellness. We found a positive relationship between ROI and program length and a negative relationship between ROI and conflict of interest. Evaluations in small companies (≤500 employees) were associated with lower ROI estimates than evaluations in large companies (>500 employees). Studies with lower reporting quality scores, including studies that were missing information on statistical inference, had lower ROI estimates. Higher methodologic quality was associated with lower ROI estimates.

CONCLUSION

This review provides recommendations that can improve the methodologic quality of studies to validate the ROI and public health effects of WWPs.

The Office Work and Stretch Training (OST) Study: An Individualized and Standardized Approach to Improve the Quality of Life in Office Workers

In the context of workplace health promotion, physical activity programs have been shown to reduce musculoskeletal diseases and stress, and to improve the quality of life. The aim of this study was to examine the effects of using the “five-Business” stretch training device for office workers on their quality of life. A total of 313 office workers (173m/137f) participated voluntarily in this intervention–control study with an average age of 43.37 ± 11.24 (SD) years, 175.37 ± 9.35 cm in height and 75.76 ± 15.23 kg in weight, with an average BMI of 24.5 ± 3.81 kg/m². The participants completed the stretch training twice a week for approximately 10 min for a duration of 12 weeks. The SF-36 questionnaire was used to evaluate the effectiveness of the intervention at baseline and after 12 weeks. Significantly improved outcomes in mental sum score (p = 0.008), physical functioning (p < 0.001), bodily pain (p = 0.01), vitality (p = 0.025), role limitations due to physical problems (p = 0.018) and mental health (p = 0.012) were shown after the stretching training. The results suggest that a 12-week stretching program for office desk workers is suitable to improve significantly their health-related quality of life.

Promoting public health through nutrition labeling - a study in Brazil

BACKGROUND

Food and nutrition education allows individuals to build knowledge and values, reframe their food practices, and develop strategies for a healthy diet. Food choices within the diet represent a determinant of individual health status. Regardless of the food quality, the consumption of calorie-dense foods does not promote better health conditions for the population and can worsen emerging health problems. The present study aimed to describe and analyze the effectiveness of educational activities related to nutrition information for enabling healthy food choices, as a tool to promote public health.

METHODS

To describe and analyze the effectiveness of an educational intervention regarding nutrition labeling as a tool to promote healthy food choices, 702 individuals were enrolled in the present quasi-experimental study. The Wilcoxon and McNemar tests were used to compare the pre- and post-intervention data, and a p value <0.05 was considered statistically significant.

RESULTS

Of the 702 participants (mean age, 26.6 years), 17.4 % were male, and 82.6 % were female. The education level was high school for 53.2 % of the participants. The mean income was R$ 1969.54 (about 500 USD). In the pre-test, 55.8 % of the respondents reported consulting the nutrition information provided on packaged foods. At the post-test, 72.0 % of respondents reported consulting this information (p < 0.001; Table 1). However, the change in the response regarding the purchase of packaged products was borderline significant.

CONCLUSIONS

The results indicate that the intervention was feasible and acceptable and improved knowledge regarding the role of nutrition labeling in promoting healthy eating. These results support the importance of an educational intervention to reinforce healthy food choices.

The relationship between return on investment and quality of study methodology in workplace health promotion programs

OBJECTIVE

To determine the relationship between return on investment (ROI) and quality of study methodology in workplace health promotion programs.

DATA SOURCE

Data were obtained through a systematic literature search of National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Database (HTA), Cost Effectiveness Analysis (CEA) Registry, EconLit, PubMed, Embase, Wiley, and Scopus.

STUDY INCLUSION AND EXCLUSION CRITERIA

Included were articles written in English or German reporting cost(s) and benefit(s) and single or multicomponent health promotion programs on working adults. Return-to-work and workplace injury prevention studies were excluded.

DATA EXTRACTION

Methodological quality was graded using British Medical Journal Economic Evaluation Working Party checklist. Economic outcomes were presented as ROI.

DATA SYNTHESIS

ROI was calculated as ROI = (benefits - costs of program)/costs of program. Results were weighted by study size and combined using meta-analysis techniques. Sensitivity analysis was performed using two additional methodological quality checklists. The influences of quality score and important study characteristics on ROI were explored.

RESULTS

Fifty-one studies (61 intervention arms) published between 1984 and 2012 included 261,901 participants and 122,242 controls from nine industry types across 12 countries. Methodological quality scores were highly correlated between checklists (r = .84-.93). Methodological quality improved over time. Overall weighted ROI [mean ± standard deviation (confidence interval)] was 1.38 ± 1.97 (1.38-1.39), which indicated a 138% return on investment. When accounting for methodological quality, an inverse relationship to ROI was found. High-quality studies (n = 18) had a smaller mean ROI, 0.26 ± 1.74 (.23-.30), compared to moderate (n = 16) 0.90 ± 1.25 (.90-.91) and low-quality (n = 27) 2.32 ± 2.14 (2.30-2.33) studies. Randomized control trials (RCTs) (n = 12) exhibited negative ROI, -0.22 ± 2.41(-.27 to -.16). Financial returns become increasingly positive across quasi-experimental, nonexperimental, and modeled studies: 1.12 ± 2.16 (1.11-1.14), 1.61 ± 0.91 (1.56-1.65), and 2.05 ± 0.88 (2.04-2.06), respectively.

CONCLUSION

Overall, mean weighted ROI in workplace health promotion demonstrated a positive ROI. Higher methodological quality studies provided evidence of smaller financial returns. Methodological quality and study design are important determinants.

Process Evaluation of the Nationwide Implementation of a Lifestyle Intervention in the Construction Industry

OBJECTIVE

The aim of this study was to monitor the national scale up of the effective lifestyle intervention Health Under Construction in the Dutch construction industry.

METHODS

Data were collected on seven process indicators, ie, reach, dose delivered, dose received, fidelity, competence, satisfaction, and barriers.

RESULTS

The intervention reached 2.4% of the target group. Thirty-eight percent of the participants received five to seven consultations and 41% discussed all six intervention components. None of the counselors attained motivational interviewing proficiency. Participants perceived their counselor as competent and were satisfied with the intervention. Counselors were moderately satisfied with the intervention and experienced various barriers.

CONCLUSIONS

Even though important conditions for scale up were met, the implementation was characterized by a low reach, a high drop-out rate, and a low quality of the counseling technique.

Cost and cost-effectiveness analysis of a bundled intervention to enhance outcomes after stroke in Nigeria: Rationale and design

The economic and social costs of stroke to the society can be enormous. These costs can cause serious economic damage to both the individual and the nation. It is thus important to conduct a cost effectiveness analysis to indicate whether an intervention provides high value where its health benefits justify its costs. This study will provide evidence based on the costs of stroke with a view of improving intervention and treatments of stoke survivors in Nigeria. This study utilizes two types of economic evaluation methods - cost-effectiveness analysis and cost-benefit analysis - to determine the economic impact of Tailored Hospital-based Risk Reduction to Impede Vascular Events after Stroke (THRIVES) intervention. The study is conducted in four Nigerian hospitals where 400 patients are recruited to participate in the study. The cost-effectiveness of THRIVES post-discharge intervention is compared with the control Intervention scenario, which is the usual and customary care delivered at each health facility in terms of cost per quality adjusted life years (QALYs). It is expected that successful implementation of the project would serve as a model of cost-effective quality stroke care for implementation.

Economic impact of corporate wellness programs in Europe: A literature review

OBJECTIVES

The purpose of this review is to summarize the current evidence on the economic impact of corporate wellness programs (CWPs) in Europe from the results of randomized controlled trials (RCTs) published up to 2013.

METHODS

A review was undertaken by searching for RCTs with key words in the following databases: PubMed, SPORT-Discus, and Business Source Premier. Only RCTs that evaluated the economic impact of CWPs, and included analyses performed in Europe with results converted into monetary values, were eligible for inclusion. An approach to economic analyses from both an employer's perspective and a societal perspective was also undertaken.

RESULTS

Eleven RCTs were identified, and review of these studies determined that the economic impact of the majority of CWPs analyzed was mostly negative. We discuss a possible explanation for these discrepancies with regard to prior reviews in this area. Despite the fact that the RCT is the "gold standard" for investigating without bias, several limitations to the methodology may have influenced the results of the studies in this review and suggested the use of caution in the interpretation of the results.

CONCLUSIONS

The findings of this review could be a "wake up call" for companies regarding the high probability of bias from non-RCT studies, the majority of which report a positive economic impact of these programs, and the risk of taking inappropriate decisions based on the results of such studies.

Trial-based economic evaluations in occupational health: principles, methods, and recommendations

To allocate available resources as efficiently as possible, decision makers need information on the relative economic merits of occupational health and safety (OHS) interventions. Economic evaluations can provide this information by comparing the costs and consequences of alternatives. Nevertheless, only a few of the studies that consider the effectiveness of OHS interventions take the extra step of considering their resource implications. Moreover, the methodological quality of those that do is generally poor. Therefore, this study aims to help occupational health researchers conduct high-quality trial-based economic evaluations by discussing the theory and methodology that underlie them, and by providing recommendations for good practice regarding their design, analysis, and reporting. This study also helps consumers of this literature with understanding and critically appraising trial-based economic evaluations of OHS interventions.

A qualitative study of the anticipated barriers and facilitators to the implementation of a lifestyle intervention in the Dutch construction industry

Background

Lifestyle interventions have proven effective for lowering a cardiovascular risk profile by improving lifestyle behaviors, blood glucose and blood cholesterol levels. However, implementation of lifestyle interventions is often met with barriers. This qualitative study sought to determine anticipated barriers and facilitators to the nationwide implementation of an effective lifestyle intervention in the construction industry in the Netherlands.

Methods

Prior to implementation, focus groups were held with 8 lifestyle counselors and semi-structured interviews with 20 employees of the construction industry, 4 occupational physicians, 4 medical assistants, and 1 manager of an occupational health service. The transcripts were coded by two coders and analyzed by constant comparison.

Results

Hypothetical employee willingness to sign up for the intervention was facilitated by a high level of perceived risk, perceived added value of the intervention, and perceived social support. It was hampered by a preference for independence and perceived interference with their work. All professionals named a lack of time as an anticipated barrier to implementation. Lifestyle counselors suggested several strategies to improve the proficiency of their counseling technique, such as training in small groups and a continuous stream of employee referrals. Occupational physicians thought they would be hampered in screening employees and referring them to a lifestyle counselor by the perception that addressing employee lifestyles was not their task, and by a counter-productive relationship with other stakeholders. The manager addressed financial incentives and a good intervention fit with the current approach of the OHS.

Conclusion

The findings suggest that employees can be motivated to sign up for a lifestyle intervention by tailoring the implementation strategy to various subgroups within the target group. Occupational physicians can be motivated to refer employees for the intervention by making a referral personally and professionally rewarding.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-1317) contains supplementary material, which is available to authorized users.

Advantages of the net benefit regression framework for economic evaluations of interventions in the workplace: a case study of the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders

OBJECTIVE

Economic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not well known.

METHODS

To illustrate regression-based economic evaluation, we present a case study investigating the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders. We implement net benefit regression to illustrate its strengths and limitations.

RESULTS

Net benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges.

CONCLUSIONS

Economic evaluations of person-level data (eg, from a clinical trial) should use net benefit regression to facilitate analysis and enhance results.

Promoting physical activity and healthy dietary behavior: the role of the occupational health services: a scoping review

OBJECTIVE

Conduct a scoping review to identify and map the literature that has evaluated the effects of health promotion interventions aimed at physical activity and/or dietary behavior, implemented by the occupational health services.

METHODS

A search for peer-reviewed articles was conducted (up to February 2013) through electronic databases, hand searching of key journals, and reference lists. A methodological quality assessment was performed.

RESULTS

Fourteen studies were included, describing 10 interventions. The main component was counseling of individuals with known cardiovascular disease risk factors. Intervention effects were reported for dietary behavior, physical activity, sedentary behavior, and biological risk factors.

CONCLUSIONS

Results are promising, especially with regard to interventions containing counseling targeting individuals at risk. High-quality studies using objective measures to assess behavioral outcomes and the (cost)-effectiveness of interventions containing counseling, PA on prescription, and multilevel interventions are needed.

Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults

BACKGROUND

Obesity is a global public health threat. The transtheoretical stages of change (TTM SOC) model has long been considered a useful interventional approach in lifestyle modification programmes, but its effectiveness in producing sustainable weight loss in overweight and obese individuals has been found to vary considerably. 

OBJECTIVES

To assess the effectiveness of dietary intervention or physical activity interventions, or both, and other interventions based on the transtheoretical model (TTM) stages of change (SOC) to produce sustainable (one year and longer) weight loss in overweight and obese adults.

SEARCH METHODS

Studies were obtained from searches of multiple electronic bibliographic databases. We searched The Cochrane Library, MEDLINE, EMBASE and PsycINFO. The date of the last search, for all databases, was 17 December 2013.

SELECTION CRITERIA

Trials were included if they fulfilled the criteria of randomised controlled clinical trials (RCTs) using the TTM SOC as a model, that is a theoretical framework or guideline in designing lifestyle modification strategies, mainly dietary and physical activity interventions, versus a comparison intervention of usual care; one of the outcome measures of the study was weight loss, measured as change in weight or body mass index (BMI); participants were overweight or obese adults only; and the intervention was delivered by healthcare professionals or trained lay people at the hospital and community level, including at home.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted the data, assessed studies for risk of bias and evaluated overall study quality according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). We resolved disagreements by discussion or consultation with a third party. A narrative, descriptive analysis was conducted for the systematic review.

MAIN RESULTS

A total of three studies met the inclusion criteria, allocating 2971 participants to the intervention and control groups. The total number of participants randomised to the intervention groups was 1467, whilst 1504 were randomised to the control groups. The length of intervention was 9, 12 and 24 months in the different trials. The use of TTM SOC in combination with diet or physical activity, or both, and other interventions in the included studies produced inconclusive evidence that TTM SOC interventions led to sustained weight loss (the mean difference between intervention and control groups varied from 2.1 kg to 0.2 kg at 24 months; 2971 participants; 3 trials; low quality evidence). Following application of TTM SOC there were improvements in physical activity and dietary habits, such as increased exercise duration and frequency, reduced dietary fat intake and increased fruit and vegetable consumption (very low quality evidence). Weight gain was reported as an adverse event in one of the included trials. None of the trials reported health-related quality of life, morbidity, or economic costs as outcomes. The small number of studies and their variable methodological quality limit the applicability of the findings to clinical practice. The main limitations include inadequate reporting of outcomes and the methods for allocation, randomisation and blinding; extensive use of self-reported measures to estimate the effects of interventions on a number of outcomes, including weight loss, dietary consumption and physical activity levels; and insufficient assessment of sustainability due to lack of post-intervention assessments.

AUTHORS' CONCLUSIONS

The evidence to support the use of TTM SOC in weight loss interventions is limited by risk of bias and imprecision, not allowing firm conclusions to be drawn. When combined with diet or physical activity, or both, and other interventions we found very low quality evidence that it might lead to better dietary and physical activity habits. This systematic review highlights the need for well-designed RCTs that apply the principles of the TTM SOC appropriately to produce conclusive evidence about the effect of TTM SOC lifestyle interventions on weight loss and other health outcomes.

Prevention program at construction worksites aimed at improving health and work ability is cost-saving to the employer: results from an RCT

BACKGROUND

To prolong sustainable healthy working lives of construction workers, a prevention program was developed which aimed to improve the health and work ability of construction workers. The objective of this study was to analyze the cost-effectiveness and financial return from the employers' perspective of this program.

METHODS

A total of 293 workers in 15 departments were randomized to the intervention (n = 8 departments) or control group (n = 7). Data on work ability and health were collected using questionnaires. Sick leave data were obtained from the companies. Both the cost-effectiveness analyses and return on investment analyses were performed.

RESULTS

After 12 months, the absenteeism costs were significantly lower in the intervention group than in the control group. At 12-month follow-up, no significant differences were found with respect to the primary outcomes (work ability, mental and physical health status) and secondary outcomes (musculoskeletal symptoms), meaning that the intervention was not cost-effective in comparison with the control group. The net-benefit was €641 per worker, and the intervention generated a positive financial return to the employer.

CONCLUSION

The intervention in the present study was cost-saving to the employer due to reduced sickness absenteeism costs in the intervention group compared with the control group. However, the intervention cannot be regarded as cost-effective as no significant effects were found for work ability and health.

A cost-effectiveness and return-on-investment analysis of a worksite vitality intervention among older hospital workers: results of a randomized controlled trial

OBJECTIVE

To conduct a cost-effectiveness and return-on-investment analysis comparing a worksite vitality intervention with usual care.

METHODS

A total of 730 older hospital workers were randomized to the intervention or control group. The 6-month intervention consisted of yoga and aerobic exercising, coaching, and fruit. At baseline, and 6 and 12 months, general vitality, work-related vitality, and need for recovery were determined. Cost data were collected on a 3-monthly basis. The cost-effectiveness analysis was performed from the societal perspective and the return-on-investment analysis from the employer's perspective using bootstrapping techniques.

RESULTS

No significant differences in costs and effects were observed. Incremental cost-effectiveness ratios in terms of general vitality (range, 0 to 100), work-related vitality (range, 0 to 6), and need for recovery (range, 0 to 100) were, respectively, €280, €7506, and €258 per point improvement. Per euro invested, €2.21 was lost.

CONCLUSIONS

The intervention was neither cost-effective nor cost-saving.

Workplace health promotion: a meta-analysis of effectiveness

CONTEXT

An unhealthy lifestyle may contribute to ill health, absence due to sickness, productivity loss at work, and reduced ability to work. Workplace health promotion programs (WHPPs) aim to improve lifestyle and consequently improve health, work ability, and work productivity. However, systematic reviews on intervention studies have reported small effects, and the overall evaluation of effectiveness of WHPPs is hampered by a large heterogeneity in interventions and study populations. This systematic review aims to investigate the influence of population, study and intervention characteristics, and study quality on the effectiveness of workplace health promotion programs.

EVIDENCE ACQUISITION

A systematic literature search was conducted identifying RCTs, published before June 2012, evaluating the effect of a WHPP aimed at smoking cessation, physical activity, healthy nutrition, and/or obesity on self-perceived health, work absence due to sickness, work productivity, or work ability. Studies were included in the meta-analyses if quantitative information was present to calculate an effect size (ES). A meta-analysis, stratified meta-analyses, and meta-regression analyses were performed in Spring 2012 using Comprehensive Meta-analysis software 2.0 and PAWS 17.0.2.

EVIDENCE SYNTHESIS

In 18 studies describing 21 interventions, the overall effect of a WHPP was small (ES=0.24, 95% CI=0.14, 0.34). The effectiveness of a WHPP was larger in younger populations, in interventions with weekly contacts, and in studies in which the control group received no health promotion. A 2.6-fold lower effectiveness was observed for studies performing an intention-to-treat analysis and a 1.7-fold lower effectiveness for studies controlling for confounders. Studies of poor methodologic quality reported a 2.9-fold higher effect size of the WHPP.

CONCLUSIONS

The effectiveness of a WHPP is partly determined by intervention characteristics and statistical analysis. High-quality RCTs reported lower effect sizes. It is important to determine the effectiveness of WHPPs in RCTs of high quality.

Systematic review on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity

This systematic review summarizes the current evidence on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Data on study characteristics and results were extracted from 18 studies published up to 14 January 2011. Two reviewers independently assessed the risk of bias of included studies. Three metrics were (re-)calculated per study: the net benefits, benefit cost ratio (BCR) and return on investment (ROI). Metrics were averaged, and a post hoc subgroup analysis was performed to compare financial return estimates between study designs. Four randomized controlled trials (RCTs), 13 non-randomized studies (NRSs) and one modelling study were included. Average financial return estimates in terms of absenteeism benefits (NRS: ROI 325%, BCR 4.25; RCT: ROI -49%, BCR 0.51), medical benefits (NRS: ROI 95%, BCR 1.95; RCT: ROI -112%, BCR -0.12) or both (NRS: ROI 387%, BCR 4.87; RCT: ROI -92%, BCR 0.08) were positive in NRSs, but negative in RCTs. Worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity generate financial savings in terms of reduced absenteeism costs, medical costs or both according to NRSs, whereas they do not according to RCTs. Since these programmes are associated with additional types of benefits, conclusions about their overall profitability cannot be made.