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

Abstract

Background

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.Objective

To synthesize evidence on the return on investment (ROI) of workplace health prevention and promotion interventions across diverse settings and intervention types (2003-2024).Methods

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.Results

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).Conclusions

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.Clinical trial number

not applicable.

Do investments in sport pay off: a systematic review and exploratory quasi meta-analysis of social return on investment in sport and physical activity
Ágoston Koch, Erika Kendelényi-Gulyás, Tamás Sterbenz +1
International Journal of Behavioral Nutrition and Physical Activity1 Jul 2026Peer-reviewedCC BYFull textEndocrinology & metabolism Epidemiology & public healthDOAJ
Verbal de-escalation techniques for the prevention and management of workplace violence in healthcare: a systematic review
Hajar Seiyad, Joseph Nimako, Brendan Singh +10
Frontiers in Psychiatry14 Oct 2026Peer-reviewedCC BY 4.0Full textPsychiatry & mental healthCrossrefEurope PMCPMC
Research trends of workplace health promotion in Japan: a scoping review
Kaname Sakurai, Masashi Tachikawa
BMC Public Health31 Oct 2026Peer-reviewedCC BY 4.0Epidemiology & public healthCrossref
Health prevention research in France: Increasing investment is a priority, rethinking targets is equally crucial
Louise Potvin, Chloé Hamant, Zoé Rollin
Canadian Journal of Public Health15 Sep 2026Peer-reviewedLicence not statedFull textGeneral biology Epidemiology & public healthHAL
Social Return on Investment evaluation of the ‘Art of Life’ project
M Lynch, S Yang
The European Journal of Public Health1 Oct 2026Peer-reviewedCC BY-NC 4.0Full textEpidemiology & public healthPMCEurope PMC

Cite

BibTeX RIS

BibTeX

@article{llamas2026return,
  title = {{Return on investment in workplace health prevention and promotion: a systematic review (2003-2024).}},
  author = {Pablo Llamas and María Isabel Martín Estévez},
  journal = {BMC public health},
  year = {2026},
  month = aug,
  doi = {10.1186/s12889-026-28454-2},
  url = {https://europepmc.org/article/MED/43009872},
  note = {CC BY-NC-ND},
}

RIS

TY  - JOUR
TI  - Return on investment in workplace health prevention and promotion: a systematic review (2003-2024).
AU  - Pablo Llamas
AU  - María Isabel Martín Estévez
PY  - 2026
DA  - 2026/08/04
JO  - BMC public health
DO  - 10.1186/s12889-026-28454-2
UR  - https://europepmc.org/article/MED/43009872
AB  - Background  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.Objective  To synthesize evidence on the return on investment (ROI) of workplace health prevention and promotion interventions across diverse settings and intervention types (2003-2024).Methods  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.Results  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).Conclusions  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.Clinical trial number  not applicable.
SN  - 1471-2458
ER  -

Abstract

Related

Cite