Return on investment in workplace health prevention and promotion: a systematic review (2003–2024)

Abstract

Workplace health prevention and promotion (WHP) programs represent a strategic investment in human capital. Despite a growing body of evidence, synthesized economic evidence remains fragmented. This systematic review addresses identified gaps in the literature by synthesizing economic outcomes from diverse WHP interventions globally. To synthesize evidence on the return on investment (ROI) of workplace health prevention and promotion interventions across diverse settings and intervention types (2003–2024). Systematic search across four databases (PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library) covering January 2003 to November 2024, following PRISMA 2020 guidelines. A total of 1,247 records were identified; after removing 26 duplicates, 1,221 records were screened. Following full-text assessment, 112 studies met the inclusion criteria. Study reporting quality was assessed using the CHEERS 2022 checklist as a reporting quality tool. Economic outcomes included cost-benefit ratios, ROI, cost-effectiveness, absenteeism, and presenteeism. Of 112 included studies, 89% reported positive cost-benefit ratios (> 1:1). The median ROI across all intervention types was 1:3.1 (95% CI: 1:2.7–1:3.6). Ergonomic interventions showed the highest benefit-cost ratios (median 5.2:1), followed by smoking cessation (median 5.1:1). ROI increased with program duration (R²=0.67, p < 0.001). Workplace health investments generate consistent positive economic returns. However, results should be interpreted with caution given the substantial methodological heterogeneity, geographic concentration in high-income countries, and the predominance of employer-perspective analyses. not applicable.