Amid soaring health spending, there is growing interest in workplace disease prevention and wellness programs to improve health and lower costs. In a critical meta-analysis of the literature on costs and savings associated with such programs, we found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent. Although further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes.

Workplace Wellness Programs Can Generate Savings

Background 
Physical inactivity is a key risk factor for chronic disease, but a growing number of people are not achieving the recommended levels of physical activity necessary for good health. Australians are no exception; despite Australia's image as a sporting nation, with success at the elite level, the majority of Australians do not get enough physical activity. There are many options for intervention, from individually tailored advice, such as counselling from a general practitioner, to population-wide approaches, such as mass media campaigns, but the most cost-effective mix of interventions is unknown. In this study we evaluate the cost-effectiveness of interventions to promote physical activity.


Methods and Findings 
From evidence of intervention efficacy in the physical activity literature and evaluation of the health sector costs of intervention and disease treatment, we model the cost impacts and health outcomes of six physical activity interventions, over the lifetime of the Australian population. We then determine cost-effectiveness of each intervention against current practice for physical activity intervention in Australia and derive the optimal pathway for implementation. Based on current evidence of intervention effectiveness, the intervention programs that encourage use of pedometers (Dominant) and mass media-based community campaigns (Dominant) are the most cost-effective strategies to implement and are very likely to be cost-saving. The internet-based intervention program (AUS$3,000/DALY), the GP physical activity prescription program (AUS$12,000/DALY), and the program to encourage more active transport (AUS$20,000/DALY), although less likely to be cost-saving, have a high probability of being under a AUS$50,000 per DALY threshold. GP referral to an exercise physiologist (AUS$79,000/DALY) is the least cost-effective option if high time and travel costs for patients in screening and consulting an exercise physiologist are considered.


Conclusions 
Intervention to promote physical activity is recommended as a public health measure. Despite substantial variability in the quantity and quality of evidence on intervention effectiveness, and uncertainty about the long-term sustainability of behavioural changes, it is highly likely that as a package, all six interventions could lead to substantial improvement in population health at a cost saving to the health sector.



Please see later in the article for Editors' Summary

/pdf/cost-effectiveness-of-interventions-to-promote-physical-uj5rfsd7t2.pdf

Cost-Effectiveness of Interventions to Promote Physical Activity: A Modelling Study

We review the state of the art in work site health promotion (WHP), focusing on factors that influence the health and productivity of workers. We begin by defining WHP, then review the literature that addresses the business rationale for it, as well as the objections and barriers that may prevent sufficient investment in WHP. Despite methodological limitations in many available studies, the results in the literature suggest that, when properly designed, WHP can increase employees' health and productivity. We describe the characteristics of effective programs including their ability to assess the need for services, attract participants, use behavioral theory as a foundation, incorporate multiple ways to reach people, and make efforts to measure program impact. Promising practices are noted including senior management support for and participation in these programs. A very important challenge is widespread dissemination of information regarding success factors because only approximately 7% of employers use all the program components required for successful interventions. The need for more and better science when evaluating program outcomes is highlighted. Federal initiatives that support cost-benefit or cost-effectiveness analyses are stressed, as is the need to invest in healthy work environments, to complement individual based interventions.

https://health.uconn.edu/occupational-environmental/wp-content/uploads/sites/25/2016/03/review_publichealth.pdf

The Health and Cost Benefits of Work Site Health-Promotion Programs

Purpose. The purpose of this review is to summarize the literature on the ability of health promotion programs to reduce employee-related health care expenditures and absenteeism. Search Process. Using key words in a literature-searching program, a comprehensive search was conducted on the following databases: .MEDLINE, Embase, HealthSTAR, SPORTDiscus, PsycINFO, SciSearch, ERIC, and ABI Inform. Study Inclusion and Exclusion Criteria. All data-based studies that appeared in peer reviewed journals in the English language. Theses, dissertations, or presentation abstracts that were not published in peer reviewed journals were excluded. The initial search identified 196 studies, but only 72 met the inclusion criteria and were included in the review. Data Extraction Methods. Summary tables were created that include design classification, subject size, results, and other key information for each study. Data Synthesis. Both the nature of the findings and the overall quality of the literature were evaluat...

Financial Impact of Health Promotion Programs: A Comprehensive Review of the Literature

Review and Analysis of Evaluation Measures Used in Nutrition Education Intervention Research

The initial results of a 12-month controlled trial of a health promotion program in 5686 Bank of America retirees, randomized into full program, questionnaire only, and insurance claims only groups, were analyzed to determine whether the health promotion program was effective. Comparisons were between program and questionnaire only groups for self-reported health habit changes, health risk scores, medical care utilization, and days confined to home, and between all groups for insurance claims data. The intervention, or full program, included health habit questionnaires administered every 6 months, individualized time-oriented health risk appraisals, personal recommendation letters, self-management materials, and a health promotion book. Twelve-month changes in health habits, health status, and economic variables favored the full program group in 31 of 32 comparisons and were statistically significant at the.05 level in two-tailed tests in 19 comparisons and at the.01 level in two-tailed tests in 13 comparisons. Over 12 months, overall computed health risk scores decreased by 4.3% in the full program experimental group and increased by 7.2% in the questionnaire only control group. Total direct and indirect costs decreased by 11% in the experimental group and increased by 6.3% in the questionnaire only control group. Analysis of claims data confirmed these trends. A low-cost health promotion program for retirees was effective in changing health behaviors and has potential to decrease health care utilization. ( Arch Intern Med . 1992;152:1201-1206)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=INTEMED&articleId=616319&pdfFileName=archinte_152_6_010.pdf

Randomized Controlled Study of a Retiree Health Promotion Program The Bank of America Study

Background and Purpose. Health promotion programs are increasingly important components of health care in an era of predominantly chronic illness preceded by identified health risk behaviors. We report a large and relatively long experience with a low-cost intervention delivered through the mail and using sequential time-oriented risk appraisal and personalized recommendations, each six months, together with self-management materials. Methods. We performed a prospective, longitudinal, observational study of 103,937 consecutive program participants observed for at least six months and up to 30 months. The primary study endpoint is overall health risk score, with secondary analysis of individual risk behaviors. A concurrent comparison group utilizes the initial scores of new participants by calendar time over the study period. Results. Strong overall positive effects were observed, with improvement in computed health risk scores over 18 months of 14.7% (p<.0001) in those 65 and over and 18.4% (p< ....

Charles L. Parcell

Papers

Randomized Controlled Study of a Retiree Health Promotion Program The Bank of America Study

Health risk changes with a low-cost individualized health promotion program: effects at up to 30 months.