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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.
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      REFERENCES

      1. Center for Disease Control and Prevention. CDC's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP): chronic diseases in America. Atlanta, GA: Center for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/pdf/infographics/chronic-disease-H.pdf. Published 2019. Accessed May 2020.

        • Hall G
        • Laddu DR
        • Phillips SA
        • Lavie CJ
        • Arena R.
        A tale of 2 pandemics: how will COVID-19 and global trends in physical inactivity and sedentary behavior affect one another?.
        Prog Cardiovasc Dis. 2021; 64: 108-110https://doi.org/10.1016/j.pcad.2020.04.005
        • Peçanha T
        • Goessler KF
        • Roschel H
        • Gualano B.
        Social isolation during the covid-19 pandemic can increase physical inactivity and the global burden of cardiovascular disease.
        Am J Physiol Heart Circ Physiol. 2020; 318: H1441-H1446https://doi.org/10.1152/ajpheart.00268.2020
        • Gerteis J
        • Izrael D
        • Deitz D
        • et al.
        Multiple chronic conditions chartbook: 2010 Medical Expenditure Panel Survey data.
        Agency for Healthcare Research and Quality, HHS, Rockville, MDApril 2014 (Published)
        • Collins SR
        • Bhupal HK
        • Doty MM.
        Health insurance coverage eight years after the ACA: fewer uninsured Americans and shorter coverage gaps, but more underinsured.
        The Commonwealth Fund, New York, NYFebruary 2019 (Published)
        • Fouad AM
        • Waheed A
        • Gamal A
        • Amer SA
        • Abdellah RF
        • Shebl FM.
        Effect of chronic diseases on work productivity: a propensity score analysis.
        J Occup Environ Med. 2017; 59: 480-485https://doi.org/10.1097/JOM.0000000000000981
        • Mattke S
        • Liu H
        • Caloyeras J
        • et al.
        Workplace wellness programs study: Final Report.
        Rand Health Q. 2013; 3: 7https://doi.org/10.7249/rr254
        • Kaiser Family Foundation
        Employer health benefits survey.
        Kaiser Family Foundation, San Francisco, CASeptember 25, 2019 (PublishedAccessed January 2020)
        • Groeneveld IF
        • van Wier MF
        • Proper KI
        • Bosmans JE
        • van Mechelen W
        • van der Beek AJ.
        Cost-effectiveness and cost–benefit of a lifestyle intervention for workers in the construction industry at risk for cardiovascular disease.
        J Occup Environ Med. 2011; 53: 610-617https://doi.org/10.1097/JOM.0b013e31821b9c24
      2. Mattke S, Liu HH, Caloyeras JP, et al. Workplace wellness programs study. Final report. Santa Monica, CA: RAND Corporation, RR-254-DOL, 2013. https://www.rand.org/pubs/research_reports/RR254.html. Accessed April 30, 2021.

        • Fitzgerald S
        • Murphy A
        • Kirby A
        • Geaney F
        • Perry IJ.
        Cost-effectiveness of a complex workplace dietary intervention: an economic evaluation of the Food Choice at Work study.
        BMJ Open. 2018; 8e019182https://doi.org/10.1136/bmjopen-2017-019182
        • Baicker K
        • Cutler D
        • Song Z.
        Workplace wellness programs can generate savings.
        Health Aff (Millwood). 2010; 29: 304-311https://doi.org/10.1377/hlthaff.2009.0626
        • Baxter S
        • Sanderson K
        • Venn AJ
        • Blizzard CL
        • Palmer AJ.
        The relationship between return on investment and quality of study methodology in workplace health promotion programs.
        Am J Health Promot. 2014; 28: 347-363https://doi.org/10.4278/ajhp.130731-LIT-395
        • van Dongen JM
        • Proper KI
        • van Wier MF
        • et al.
        Systematic review on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity.
        Obes Rev. 2011; 12: 1031-1049https://doi.org/10.1111/j.1467-789X.2011.00925.x
        • Osilla KC
        • Van Busum K
        • Schnyer C
        • Larkin JW
        • Eibner C
        • Mattke S.
        Systematic review of the impact of worksite wellness programs.
        Am J Manag Care. 2012; 18 (https://pubmed.ncbi.nlm.nih.gov/22435887/. Accessed April 11, 2021): e68-e81
        • Moher D
        • Liberati A
        • Tetzlaff J
        • Altman DG
        • PRISMA Group
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement.
        PLoS Med. 2009; 6e1000097https://doi.org/10.1371/journal.pmed.1000097
        • Evers S
        • Goossens M
        • De Vet H
        • Van Tulder M
        • Ament A.
        Criteria list for assessment of methodological quality of economic evaluations: consensus on health economic criteria.
        Int J Technol Assess Health Care. 2005; 21: 240-245https://doi.org/10.1017/s0266462305050324
        • Wijnen BF
        • Van Mastrigt G
        • Redekop WK
        • Majoie H
        • De Kinderen R
        • Evers S.
        How to prepare a systematic review of economic evaluations for informing evidence-based healthcare decisions: data extraction, risk of bias, and transferability (part 3/3).
        Expert Rev Pharmacoecon Outcomes Res. 2016; 16: 723-732https://doi.org/10.1080/14737167.2016.1246961
        • Oster E.
        Health recommendations and selection in health behaviors.
        Am Econ Rev Insights. 2020; 2: 143-160https://doi.org/10.1257/aeri.20190355
        • Jones D
        • Molitor D
        • Reif J.
        What do workplace wellness programs do? Evidence from the Illinois workplace wellness study.
        Q J Econ. 2019; 134: 1747-1791https://doi.org/10.1093/qje/qjz023
        • Pan W
        • Bai H.
        Propensity score methods for causal inference: an overview.
        Behaviormetrika. 2018; 45: 317-334https://doi.org/10.1007/s41237-018-0058-8
        • King G
        • Nielsen RA.
        Why propensity scores should not be used for matching.
        Polit Anal. 2019; 27: 435-454https://doi.org/10.1017/pan.2019.11
        • Angrist JD
        • Pischke JS.
        Mostly Harmless Econometrics: An Empiricist's Companion.
        Princeton University Press, Princeton, NJ2008https://doi.org/10.2307/j.ctvcm4j72
        • Caloyeras JP
        • Liu H
        • Exum E
        • Broderick M
        • Mattke S.
        Managing manifest diseases, but not health risks, saved PepsiCo money over seven years.
        Health Aff (Millwood). 2014; 33: 124-131https://doi.org/10.1377/hlthaff.2013.0625
        • Michaud TL
        • Nyman JA
        • Jutkowitz E
        • Su D
        • Dowd B
        • Abraham JM.
        Effect of workplace weight management on health care expenditures and quality of life.
        J Occup Environ Med. 2016; 58: 1073-1078https://doi.org/10.1097/JOM.0000000000000864
        • Musich S
        • McCalister T
        • Wang S
        • Hawkins K.
        An evaluation of the Well at Dell health management program: health risk change and financial return on investment.
        Am J Health Promot. 2015; 29: 147-157https://doi.org/10.4278/ajhp.131115-QUAN-582
        • Dement JM
        • Epling C
        • Joyner J
        • Cavanaugh K.
        Impacts of workplace health promotion and wellness programs on health care utilization and costs: results from an academic workplace.
        J Occup Environ Med. 2015; 57: 1159-1169https://doi.org/10.1097/JOM.0000000000000555
        • Nyman JA
        • Jeffery MM
        • Abraham JM
        • Jutkowitz E
        • Dowd BE.
        The 3-year disease management effect: understanding the positive return on investment.
        J Occup Environ Med. 2013; 55: 1356-1364https://doi.org/10.1097/JOM.0b013e3182a4fffe
        • Merrill RM
        • Hyatt B
        • Aldana SG
        • Kinnersley D.
        Lowering employee health care costs through the healthy lifestyle incentive program.
        J Public Health Manag Pract. 2011; 17: 225-232https://doi.org/10.1097/PHH.0b013e3181f54128
        • Meenan RT
        • Vogt TM
        • Williams AE
        • Stevens VJ
        • Albright CL
        • Nigg C.
        Economic evaluation of a worksite obesity prevention and intervention trial among hotel workers in Hawaii.
        J Occup Environ Med. 2010; 52: S8-S13https://doi.org/10.1097/JOM.0b013e3181c81af9
        • Henke RM
        • Goetzel RZ
        • McHugh J
        • Isaac F.
        Recent experience in health promotion at Johnson & Johnson: lower health spending, strong return on investment.
        Health Aff (Millwood). 2011; 30: 490-499https://doi.org/10.1377/hlthaff.2010.0806
        • Grossmeier J
        • Seaverson EL
        • Mangen DJ
        • et al.
        Impact of a comprehensive population health management program on health care costs.
        J Occup Environ Med. 2013; 55: 634-643https://doi.org/10.1097/JOM.0b013e318297306f
        • Yen L
        • Schultz AB
        • Schaefer C
        • Bloomberg S
        • Edington DW.
        Long-term return on investment of an employee health enhancement program at a Midwest utility company from 1999 to 2007.
        Int J Workplace Health Manag. 2010; 3: 79-96https://doi.org/10.1108/17538351011054998
        • Aldana SG
        • Jacobson BH
        • Harris CJ
        • Kelley PL
        • Stone WJ.
        Influence of a mobile worksite health promotion program on health care costs.
        Am J Prev Med. 1993; 9: 378-383https://doi.org/10.1016/s0749-3797(18)30691-3
        • Aldana SG
        • Merrill RM
        • Price K
        • Hardy A
        • Hager R.
        Financial impact of a comprehensive multisite workplace health promotion program.
        Prev Med. 2005; 40: 131-137https://doi.org/10.1016/j.ypmed.2004.05.008
        • Davis L
        • Loyo K
        • Glowka A
        • et al.
        A comprehensive worksite wellness program in Austin, Texas: partnership between Steps to a Healthier Austin and Capital Metropolitan Transportation Authority.
        Prev Chronic Dis. 2009; 6 (https://stacks.cdc.gov/view/cdc/20348. Accessed April 11, 2021): A60
        • Bertera RL.
        The effects of workplace health promotion on absenteeism and employment costs in a large industrial population.
        Am J Public Health. 1990; 80: 1101-1105https://doi.org/10.2105/ajph.80.9.1101
        • Naydeck BL
        • Pearson JA
        • Ozminkowski RJ
        • Day BT
        • Goetzel RZ.
        The impact of the highmark employee wellness programs on 4-year healthcare costs.
        J Occup Environ Med. 2008; 50: 146-156https://doi.org/10.1097/JOM.0b013e3181617855
        • Ozminkowski RJ
        • Dunn RL
        • Goetzel RZ
        • Cantor RI
        • Murnane J
        • Harrison M.
        A return on investment evaluation of the Citibank, N.A., Health Management Program.
        Am J Health Promot. 1999; 14: 31-43https://doi.org/10.4278/0890-1171-14.1.31
        • Shi L
        Health promotion. medical care use, and costs in a sample of work-site employees.
        Eval Rev. 1993; 17: 475-487https://doi.org/10.1177/0193841X9301700501
        • Gowrisankaran G
        • Norberg K
        • Kymes S
        • et al.
        A hospital system's wellness program linked to health plan enrollment cut hospitalizations but not overall costs.
        Health Aff (Millwood). 2013; 32: 477-485https://doi.org/10.1377/hlthaff.2012.0090
        • Touger GN
        • Butts JK.
        The workplace: an innovative and cost-effective practice site.
        Nurse Pract. 1989; 14: 35-42https://doi.org/10.1097/00006205-198901000-00014
        • White ND
        • Lenz TL
        • Skrabal MZ
        • Skradski JJ
        • Lipari L.
        Long-term outcomes of a cardiovascular and diabetes risk-reduction program initiated by a self-insured employer.
        Am Health Drug Benefits. 2018; 11 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207306/. Accessed April 11, 2021): 177-183
        • Lahiri S
        • Faghri PD.
        Cost-effectiveness of a workplace-based incentivized weight loss program.
        J Occup Environ Med. 2012; 54: 371-377https://doi.org/10.1097/JOM.0b013e318247a394
        • Ringen K
        • Anderson N
        • McAfee T
        • Zbikowski SM
        • Fales D.
        Smoking cessation in a blue-collar population: results from an evidence-based pilot program.
        Am J Ind Med. 2002; 42: 367-377https://doi.org/10.1002/ajim.10129
        • Gubler T
        • Larkin I
        • Pierce L.
        Doing well by making well: the impact of corporate wellness programs on employee productivity.
        Manag Sci. 2018; 64: 4967-4987https://doi.org/10.1287/mnsc.2017.2883
        • Milani RV
        • Lavie CJ.
        Impact of worksite wellness intervention on cardiac risk factors and one-year health care costs.
        Am J Cardiol. 2009; 104: 1389-1392https://doi.org/10.1016/j.amjcard.2009.07.007
        • Sanders GD
        • Neumann PJ
        • Basu A
        • et al.
        Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine.
        JAMA. 2016; 316: 1093-1103https://doi.org/10.1001/jama.2016.12195
        • Song Z
        • Baicker K.
        Effect of a workplace wellness program on employee health and economic outcomes: a randomized clinical trial.
        JAMA. 2019; 321: 1491-1501https://doi.org/10.1001/jama.2019.3307
        • Bilger M
        • Finkelstein EA
        • Kruger E
        • Tate DF
        • Linnan LA.
        The effect of weight loss on health, productivity, and medical expenditures among overweight employees.
        Med Care. 2013; 51: 471-477https://doi.org/10.1097/MLR.0b013e318286e437
        • Deaton A
        • Cartwright N.
        Understanding and misunderstanding randomized controlled trials.
        Soc Sci Med. 2018; 210: 2-21https://doi.org/10.1016/j.socscimed.2017.12.005
        • McCleary K
        • Goetzel RZ
        • Roemer EC
        • Berko J
        • Kent K
        • Torre HDL.
        Employer and employee opinions about workplace health promotion (wellness) programs: results of the 2015 Harris Poll Nielsen Survey.
        J Occup Environ Med. 2017; 59: 256-263https://doi.org/10.1097/JOM.0000000000000946
        • Linnan LA
        • Sorensen G
        • Colditz G
        • Klar DN
        • Emmons KM.
        Using theory to understand the multiple determinants of low participation in worksite health promotion programs.
        Health Educ Behav. 2001; 28: 591-607https://doi.org/10.1177/109019810102800506