Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
Department of Political Science, Swarthmore College, Swarthmore, Pennsylvania.
Am J Prev Med. 2021 Aug;61(2):256-266. doi: 10.1016/j.amepre.2021.02.002. Epub 2021 May 5.
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.
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.
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.
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.
患有非传染性疾病的个体在医疗支出、旷工和出勤方面的占比不成比例。因此，雇主越来越多地将工作场所健康计划视为一种成本控制策略。之前审查工作场所健康计划是否能带来积极的投资回报的研究结果喜忧参半，这可能是因为更乐观的研究结果来自于方法学质量较差的研究。本系统综述的目的是批判性地重新审视和更新这一文献，以探讨这一假设。
总共系统地搜索了 4 个数据库，以查找 2019 年 6 月之前发表的研究。纳入的研究是在美国进行的工作场所健康计划的经济评估，持续时间至少为 4 周，并且至少有 1 个行为改变组件针对 4 种主要可改变的慢性病行为之一：身体活动、健康饮食、吸烟和有害饮酒。使用共识健康经济标准指南和与研究设计相关的选择偏倚风险评估方法学质量。（2019 年 9 月至 2020 年 2 月）进行数据提取后，对工作场所健康计划的特征和投资回报估计进行了叙述性综合。
共确定了 25 项相关研究。在进行质量和偏差评估后，只有 25 项研究中的 2 项被认为具有较高的方法学严谨性和较低的选择偏差风险。这些研究在短期内没有发现工作场所健康计划能带来积极投资回报的证据。
最高质量的研究不支持工作场所健康计划在启动后的头几年内能带来积极投资回报的假设。
