Economic analyses of primary studies evaluating interventions promoting mental health and well-being at work
| Bibliographic information . | Intervention (I) and comparator (C) . | Target population and duration of economic analysis . | Study design . | Cost results . | Mental health-related effectiveness results . | Perspective/price year . | Synthesis of costs and effectiveness data . |
|---|---|---|---|---|---|---|---|
| (Loeppke et al., 2008), USA | I: Health-risk assessment, lifestyle management, nurse telephone advice line and telephone nurse-led disease management | 543 employees of company, matched with employees in other companies that were not enrolled in a health promotion programme | Observational study with matched controls | Costs of intervention are not reported | Overall improved health of workforce and significant reduction in overall levels of combined physical and mental health risk (p< 0.001) | Perspective not stated | Paper states that there are net savings after taking account of costs of intervention, but level of net savings not reported |
| C: No intervention | 3 years | Average decrease in 3.5 days per annum in absenteeism in the intervention group. No change in the control group. No significant difference in productivity at work | Majority of employees, where data available, maintained gains over 3 years | Price year not stated | |||
| Compared with control populations significant decrease in prevalence of depression from 17.9 to 10% (p< 0.01), but statistically significant increase for anxiety from 7.9 to 10.2% (p< 0.01) | |||||||
| (McCraty et al., 2009), USA | I: Power to change stress management and health-risk reduction programme. Includes emotion refocusing and restructuring techniques | 75 correctional officers at a youth facility | Quasi-experimental study with waiting list controls | Cost of programme not reported | Intervention associated with improvements in scales measuring productivity (p< 0.01) motivation (p< 0.01), gratitude (p< 0.05), positive outlook (p< 0.05) and reductions in anger (p< 0.05) and fatigue (p< 0.05). In addition there was a significant increase in depression in the control group (p< 0.05) | Health system | 43% of the intervention group had a sufficient reduction in number of risk factors to reduce projected health-care costs compared with just 26% of control group |
| C: Waiting list | 3 months | CCA | Projected average health-care cost per employee in the intervention group based on number of overall risk factors was reduced to $5377 from $6556. This compared with a reduction in from $6381 to $5995 in the control group | 2004 USD | Intervention was associated with an average annual saving of $1179 per employee, compared with a reduction of $386 per employee in the control group (sample size too small for statistical significance on cost differences with controls) | ||
| (Mills et al., 2007), England | I: A multi-component health promotion programme incorporating a health-risk appraisal questionnaire, access to a tailored health improvement web portal, wellness literature, and seminars and workshops focused upon identified wellness issues | 1518 employees at the UK headquarters of a multi-national company | Before and after study | Annual cost of programme per company employee £70 | Overall number of health-risk factors decreases significantly (by 0.48) in the intervention group | Company | Improved work performance and reduced absenteeism led to return of investment (ROI) of 6.19: 1 |
| 12 months | CBA | Significant difference in absenteeism between control and intervention groups largely due to increase in absenteeism in the control group | Work performance also increased significantly by 0.61 points to 7.6 on work performance scale | GBP. Price year not stated | Net benefits of £621 per employee | ||
| No significant changes in these outcomes in control groups | |||||||
| (Munz et al., 2001), USA | I: Comprehensive worksite stress management programme consisting of self-management training and an organizational level stressor reduction process | 79 customer sales representatives in a telecommunications company | Non-randomized controlled trial; other work units were control groups | Costs of intervention not reported | Self-management training group had significantly less stress than control group on the perceived stress scale (2.63 versus 3.11) (p< 0.05). Significantly less likely to experience depression on the Centre for Epidemiological Studies-Depression Scale (CES-D) 11.60 versus 18.90 (p< 0.05). The training group also had significantly better levels of relaxation, positive energy and less tiredness than the control group using the positive and negative affect schedule (p< 0.05) | Not stated | No synthesis of costs and benefits. Significant improvement in emotional well-being in the intervention group compared with the control group; |
| C: No intervention | 3 months | COA | 23% increase in sales revenue per order in the intervention group compared with 17% in the control group. 24% reduction in absenteeism in the intervention group compared with the control group | Individuals also had significantly greater sense of independence and job control in the intervention group (p< 0.05) | Benefits not reported in monetary terms, but at organizational level; 23% increase in sales revenue per order in the intervention group compared with 17% in the control group. Twenty four percent reduction in absenteeism in the intervention group compared with the control group. | ||
| (Naydeck et al., 2008), USA | I: Comprehensive wellness programme including on-line sessions for nutrition, weight management, stress management, and smoking cessation; on-site classes in stress and weight management. Access to exercise facility and incentives to participate in walking programme | 1892 employees who participated in company wellness programme. Matched controls from non-participants in company and non-participants in other companies | Observational study with matched controls | Total costs per employee per year were $138.74 | No specific health benefits—mental or physical were reported—the study focused on reduction in overall health-care costs only of the wellness programme | Company as payer of health-care premiums for employees | Reduction in health-care costs over 4 years for the programme were $1 335 524, with net savings of $527 121 and a return on investment of $1.65 |
| C: No health promotion programme | 4 years | COA, CBA | 2005 USD | ||||
| (Ozminkowski et al., 2002), USA | I: Multi-component Health and Wellness Programme including health profiles, risk management programmes and access to fitness centres, including financial incentives of up to $500 to participate in programmes | 11 584 US-based employees of multi-national company | Before and after study making use of health claims data | Cost of programme not reported. Impact on health-care utilization reported. On average after 4 years overall reduction in health-care costs per worker of $224.66. This consisted of increase in cost of emergency department visits of $10.87; and decreases in costs of outpatient/doctor visits $45.17; mental health visits $70.69 and inpatient days of $119.67 | Mental health (or other health-related outcomes) not reported. Instead changes in utilization of health-care services reported, including specific use of mental health service visits | Company (as health-care payer) | Investing in wellness programme associated with a large reduction in utilization of health-care services including mental health services over 4 years. On average savings per employee of $225 per year |
| C: No intervention | 60 months | COA | Impact on productivity not considered | 2000 USD | Impacts on productivity not considered | ||
| (Rahe et al., 2002), USA | I: Stress management programme focused on coping with stress through six group sessions and personal feedback | 501 computer industry company and local city government employees | RCT | Cost of intervention $103 per employee | Stress, anxiety and coping levels improved significantly in all three groups after 12 months (p< 0.05), but there was no significant difference between groups with the exception of negative responses to stress for computer industry employees. Full intervention group computer industry employees had a significantly greater improvement in negative response, followed by partial intervention group and waiting list controls (p= 0.012) | Company perspective (as health-care payer) | No ratio reported, as no significant difference in stress, anxiety and coping |
| C: Self-help groups with e-mail personal feedback (partial intervention) and waiting list control | 12 months | CCA | Costs would be lower at $47.50 if delivered by in house medical professionals | There was a nearly significant difference in self-reported days of illness for the intervention group | But significant 34% reduction in health-care utilization by intervention participants compared with the control groups (p= 0.04) | ||
| Concluded that this reduction in costs would more than cover the costs of delivering the intervention if delivered by in-house professionals | |||||||
| (Renaud et al., 2008), Canada | I: Comprehensive health promotion programmes to provide employees with information and support for risk factor reduction, using a personalized approach and involving the organization's management as both programme participants and promoters. Programme includes modules on stress management, healthy eating and physical activity | 270 company employees | Before and after study. No controls. COA | Cost of the intervention not reported Costs avoided not directly reported in monetary terms, but in terms of absenteeism and staff turnover | Significant reduction in stress levels away from work as reported using Global Health Profile Score over 3 years falling from 27 to 17% (p< 0.0001). There was also a reduction in feelings of depression with 54.8% of participants stating that they rarely felt depressed after 3 years compared with 38.5% at baseline (p< 0.0001). There was also a reduction in the number of people experiencing signs of stress (p< 0.0001) | Company perspective | No ratio. Significant reduction in high levels of stress, signs of stress and feelings of depression |
| C: No control | 3 years | Costs not directly reported staff absenteeism decreased by 28% and staff turnover by 54% | |||||
| (van Rhenen et al., 2007), Netherlands | I: Cognitive focused stress management programme | 242 stressed and non-stressed employees of a telecommunications company | RCT | Costs not stated | No significant impact on sickness-related absenteeism between groups overall. Very marginally significant impact of cognitive interventions in delaying time to sickness | Company | Study authors commented costs not affected as overall no difference in impact on absenteeism |
| C: Brief relaxation and physical exercise intervention | 12 months | COA |
| Bibliographic information . | Intervention (I) and comparator (C) . | Target population and duration of economic analysis . | Study design . | Cost results . | Mental health-related effectiveness results . | Perspective/price year . | Synthesis of costs and effectiveness data . |
|---|---|---|---|---|---|---|---|
| (Loeppke et al., 2008), USA | I: Health-risk assessment, lifestyle management, nurse telephone advice line and telephone nurse-led disease management | 543 employees of company, matched with employees in other companies that were not enrolled in a health promotion programme | Observational study with matched controls | Costs of intervention are not reported | Overall improved health of workforce and significant reduction in overall levels of combined physical and mental health risk (p< 0.001) | Perspective not stated | Paper states that there are net savings after taking account of costs of intervention, but level of net savings not reported |
| C: No intervention | 3 years | Average decrease in 3.5 days per annum in absenteeism in the intervention group. No change in the control group. No significant difference in productivity at work | Majority of employees, where data available, maintained gains over 3 years | Price year not stated | |||
| Compared with control populations significant decrease in prevalence of depression from 17.9 to 10% (p< 0.01), but statistically significant increase for anxiety from 7.9 to 10.2% (p< 0.01) | |||||||
| (McCraty et al., 2009), USA | I: Power to change stress management and health-risk reduction programme. Includes emotion refocusing and restructuring techniques | 75 correctional officers at a youth facility | Quasi-experimental study with waiting list controls | Cost of programme not reported | Intervention associated with improvements in scales measuring productivity (p< 0.01) motivation (p< 0.01), gratitude (p< 0.05), positive outlook (p< 0.05) and reductions in anger (p< 0.05) and fatigue (p< 0.05). In addition there was a significant increase in depression in the control group (p< 0.05) | Health system | 43% of the intervention group had a sufficient reduction in number of risk factors to reduce projected health-care costs compared with just 26% of control group |
| C: Waiting list | 3 months | CCA | Projected average health-care cost per employee in the intervention group based on number of overall risk factors was reduced to $5377 from $6556. This compared with a reduction in from $6381 to $5995 in the control group | 2004 USD | Intervention was associated with an average annual saving of $1179 per employee, compared with a reduction of $386 per employee in the control group (sample size too small for statistical significance on cost differences with controls) | ||
| (Mills et al., 2007), England | I: A multi-component health promotion programme incorporating a health-risk appraisal questionnaire, access to a tailored health improvement web portal, wellness literature, and seminars and workshops focused upon identified wellness issues | 1518 employees at the UK headquarters of a multi-national company | Before and after study | Annual cost of programme per company employee £70 | Overall number of health-risk factors decreases significantly (by 0.48) in the intervention group | Company | Improved work performance and reduced absenteeism led to return of investment (ROI) of 6.19: 1 |
| 12 months | CBA | Significant difference in absenteeism between control and intervention groups largely due to increase in absenteeism in the control group | Work performance also increased significantly by 0.61 points to 7.6 on work performance scale | GBP. Price year not stated | Net benefits of £621 per employee | ||
| No significant changes in these outcomes in control groups | |||||||
| (Munz et al., 2001), USA | I: Comprehensive worksite stress management programme consisting of self-management training and an organizational level stressor reduction process | 79 customer sales representatives in a telecommunications company | Non-randomized controlled trial; other work units were control groups | Costs of intervention not reported | Self-management training group had significantly less stress than control group on the perceived stress scale (2.63 versus 3.11) (p< 0.05). Significantly less likely to experience depression on the Centre for Epidemiological Studies-Depression Scale (CES-D) 11.60 versus 18.90 (p< 0.05). The training group also had significantly better levels of relaxation, positive energy and less tiredness than the control group using the positive and negative affect schedule (p< 0.05) | Not stated | No synthesis of costs and benefits. Significant improvement in emotional well-being in the intervention group compared with the control group; |
| C: No intervention | 3 months | COA | 23% increase in sales revenue per order in the intervention group compared with 17% in the control group. 24% reduction in absenteeism in the intervention group compared with the control group | Individuals also had significantly greater sense of independence and job control in the intervention group (p< 0.05) | Benefits not reported in monetary terms, but at organizational level; 23% increase in sales revenue per order in the intervention group compared with 17% in the control group. Twenty four percent reduction in absenteeism in the intervention group compared with the control group. | ||
| (Naydeck et al., 2008), USA | I: Comprehensive wellness programme including on-line sessions for nutrition, weight management, stress management, and smoking cessation; on-site classes in stress and weight management. Access to exercise facility and incentives to participate in walking programme | 1892 employees who participated in company wellness programme. Matched controls from non-participants in company and non-participants in other companies | Observational study with matched controls | Total costs per employee per year were $138.74 | No specific health benefits—mental or physical were reported—the study focused on reduction in overall health-care costs only of the wellness programme | Company as payer of health-care premiums for employees | Reduction in health-care costs over 4 years for the programme were $1 335 524, with net savings of $527 121 and a return on investment of $1.65 |
| C: No health promotion programme | 4 years | COA, CBA | 2005 USD | ||||
| (Ozminkowski et al., 2002), USA | I: Multi-component Health and Wellness Programme including health profiles, risk management programmes and access to fitness centres, including financial incentives of up to $500 to participate in programmes | 11 584 US-based employees of multi-national company | Before and after study making use of health claims data | Cost of programme not reported. Impact on health-care utilization reported. On average after 4 years overall reduction in health-care costs per worker of $224.66. This consisted of increase in cost of emergency department visits of $10.87; and decreases in costs of outpatient/doctor visits $45.17; mental health visits $70.69 and inpatient days of $119.67 | Mental health (or other health-related outcomes) not reported. Instead changes in utilization of health-care services reported, including specific use of mental health service visits | Company (as health-care payer) | Investing in wellness programme associated with a large reduction in utilization of health-care services including mental health services over 4 years. On average savings per employee of $225 per year |
| C: No intervention | 60 months | COA | Impact on productivity not considered | 2000 USD | Impacts on productivity not considered | ||
| (Rahe et al., 2002), USA | I: Stress management programme focused on coping with stress through six group sessions and personal feedback | 501 computer industry company and local city government employees | RCT | Cost of intervention $103 per employee | Stress, anxiety and coping levels improved significantly in all three groups after 12 months (p< 0.05), but there was no significant difference between groups with the exception of negative responses to stress for computer industry employees. Full intervention group computer industry employees had a significantly greater improvement in negative response, followed by partial intervention group and waiting list controls (p= 0.012) | Company perspective (as health-care payer) | No ratio reported, as no significant difference in stress, anxiety and coping |
| C: Self-help groups with e-mail personal feedback (partial intervention) and waiting list control | 12 months | CCA | Costs would be lower at $47.50 if delivered by in house medical professionals | There was a nearly significant difference in self-reported days of illness for the intervention group | But significant 34% reduction in health-care utilization by intervention participants compared with the control groups (p= 0.04) | ||
| Concluded that this reduction in costs would more than cover the costs of delivering the intervention if delivered by in-house professionals | |||||||
| (Renaud et al., 2008), Canada | I: Comprehensive health promotion programmes to provide employees with information and support for risk factor reduction, using a personalized approach and involving the organization's management as both programme participants and promoters. Programme includes modules on stress management, healthy eating and physical activity | 270 company employees | Before and after study. No controls. COA | Cost of the intervention not reported Costs avoided not directly reported in monetary terms, but in terms of absenteeism and staff turnover | Significant reduction in stress levels away from work as reported using Global Health Profile Score over 3 years falling from 27 to 17% (p< 0.0001). There was also a reduction in feelings of depression with 54.8% of participants stating that they rarely felt depressed after 3 years compared with 38.5% at baseline (p< 0.0001). There was also a reduction in the number of people experiencing signs of stress (p< 0.0001) | Company perspective | No ratio. Significant reduction in high levels of stress, signs of stress and feelings of depression |
| C: No control | 3 years | Costs not directly reported staff absenteeism decreased by 28% and staff turnover by 54% | |||||
| (van Rhenen et al., 2007), Netherlands | I: Cognitive focused stress management programme | 242 stressed and non-stressed employees of a telecommunications company | RCT | Costs not stated | No significant impact on sickness-related absenteeism between groups overall. Very marginally significant impact of cognitive interventions in delaying time to sickness | Company | Study authors commented costs not affected as overall no difference in impact on absenteeism |
| C: Brief relaxation and physical exercise intervention | 12 months | COA |
RCT, randomized controlled trial; CBA, cost–benefit analysis; CEA, cost-effectiveness analysis; CCA, cost-consequences analysis; CUA, cost–utility analysis; COA, cost-offset analysis.
Economic analyses of primary studies evaluating interventions promoting mental health and well-being at work
| Bibliographic information . | Intervention (I) and comparator (C) . | Target population and duration of economic analysis . | Study design . | Cost results . | Mental health-related effectiveness results . | Perspective/price year . | Synthesis of costs and effectiveness data . |
|---|---|---|---|---|---|---|---|
| (Loeppke et al., 2008), USA | I: Health-risk assessment, lifestyle management, nurse telephone advice line and telephone nurse-led disease management | 543 employees of company, matched with employees in other companies that were not enrolled in a health promotion programme | Observational study with matched controls | Costs of intervention are not reported | Overall improved health of workforce and significant reduction in overall levels of combined physical and mental health risk (p< 0.001) | Perspective not stated | Paper states that there are net savings after taking account of costs of intervention, but level of net savings not reported |
| C: No intervention | 3 years | Average decrease in 3.5 days per annum in absenteeism in the intervention group. No change in the control group. No significant difference in productivity at work | Majority of employees, where data available, maintained gains over 3 years | Price year not stated | |||
| Compared with control populations significant decrease in prevalence of depression from 17.9 to 10% (p< 0.01), but statistically significant increase for anxiety from 7.9 to 10.2% (p< 0.01) | |||||||
| (McCraty et al., 2009), USA | I: Power to change stress management and health-risk reduction programme. Includes emotion refocusing and restructuring techniques | 75 correctional officers at a youth facility | Quasi-experimental study with waiting list controls | Cost of programme not reported | Intervention associated with improvements in scales measuring productivity (p< 0.01) motivation (p< 0.01), gratitude (p< 0.05), positive outlook (p< 0.05) and reductions in anger (p< 0.05) and fatigue (p< 0.05). In addition there was a significant increase in depression in the control group (p< 0.05) | Health system | 43% of the intervention group had a sufficient reduction in number of risk factors to reduce projected health-care costs compared with just 26% of control group |
| C: Waiting list | 3 months | CCA | Projected average health-care cost per employee in the intervention group based on number of overall risk factors was reduced to $5377 from $6556. This compared with a reduction in from $6381 to $5995 in the control group | 2004 USD | Intervention was associated with an average annual saving of $1179 per employee, compared with a reduction of $386 per employee in the control group (sample size too small for statistical significance on cost differences with controls) | ||
| (Mills et al., 2007), England | I: A multi-component health promotion programme incorporating a health-risk appraisal questionnaire, access to a tailored health improvement web portal, wellness literature, and seminars and workshops focused upon identified wellness issues | 1518 employees at the UK headquarters of a multi-national company | Before and after study | Annual cost of programme per company employee £70 | Overall number of health-risk factors decreases significantly (by 0.48) in the intervention group | Company | Improved work performance and reduced absenteeism led to return of investment (ROI) of 6.19: 1 |
| 12 months | CBA | Significant difference in absenteeism between control and intervention groups largely due to increase in absenteeism in the control group | Work performance also increased significantly by 0.61 points to 7.6 on work performance scale | GBP. Price year not stated | Net benefits of £621 per employee | ||
| No significant changes in these outcomes in control groups | |||||||
| (Munz et al., 2001), USA | I: Comprehensive worksite stress management programme consisting of self-management training and an organizational level stressor reduction process | 79 customer sales representatives in a telecommunications company | Non-randomized controlled trial; other work units were control groups | Costs of intervention not reported | Self-management training group had significantly less stress than control group on the perceived stress scale (2.63 versus 3.11) (p< 0.05). Significantly less likely to experience depression on the Centre for Epidemiological Studies-Depression Scale (CES-D) 11.60 versus 18.90 (p< 0.05). The training group also had significantly better levels of relaxation, positive energy and less tiredness than the control group using the positive and negative affect schedule (p< 0.05) | Not stated | No synthesis of costs and benefits. Significant improvement in emotional well-being in the intervention group compared with the control group; |
| C: No intervention | 3 months | COA | 23% increase in sales revenue per order in the intervention group compared with 17% in the control group. 24% reduction in absenteeism in the intervention group compared with the control group | Individuals also had significantly greater sense of independence and job control in the intervention group (p< 0.05) | Benefits not reported in monetary terms, but at organizational level; 23% increase in sales revenue per order in the intervention group compared with 17% in the control group. Twenty four percent reduction in absenteeism in the intervention group compared with the control group. | ||
| (Naydeck et al., 2008), USA | I: Comprehensive wellness programme including on-line sessions for nutrition, weight management, stress management, and smoking cessation; on-site classes in stress and weight management. Access to exercise facility and incentives to participate in walking programme | 1892 employees who participated in company wellness programme. Matched controls from non-participants in company and non-participants in other companies | Observational study with matched controls | Total costs per employee per year were $138.74 | No specific health benefits—mental or physical were reported—the study focused on reduction in overall health-care costs only of the wellness programme | Company as payer of health-care premiums for employees | Reduction in health-care costs over 4 years for the programme were $1 335 524, with net savings of $527 121 and a return on investment of $1.65 |
| C: No health promotion programme | 4 years | COA, CBA | 2005 USD | ||||
| (Ozminkowski et al., 2002), USA | I: Multi-component Health and Wellness Programme including health profiles, risk management programmes and access to fitness centres, including financial incentives of up to $500 to participate in programmes | 11 584 US-based employees of multi-national company | Before and after study making use of health claims data | Cost of programme not reported. Impact on health-care utilization reported. On average after 4 years overall reduction in health-care costs per worker of $224.66. This consisted of increase in cost of emergency department visits of $10.87; and decreases in costs of outpatient/doctor visits $45.17; mental health visits $70.69 and inpatient days of $119.67 | Mental health (or other health-related outcomes) not reported. Instead changes in utilization of health-care services reported, including specific use of mental health service visits | Company (as health-care payer) | Investing in wellness programme associated with a large reduction in utilization of health-care services including mental health services over 4 years. On average savings per employee of $225 per year |
| C: No intervention | 60 months | COA | Impact on productivity not considered | 2000 USD | Impacts on productivity not considered | ||
| (Rahe et al., 2002), USA | I: Stress management programme focused on coping with stress through six group sessions and personal feedback | 501 computer industry company and local city government employees | RCT | Cost of intervention $103 per employee | Stress, anxiety and coping levels improved significantly in all three groups after 12 months (p< 0.05), but there was no significant difference between groups with the exception of negative responses to stress for computer industry employees. Full intervention group computer industry employees had a significantly greater improvement in negative response, followed by partial intervention group and waiting list controls (p= 0.012) | Company perspective (as health-care payer) | No ratio reported, as no significant difference in stress, anxiety and coping |
| C: Self-help groups with e-mail personal feedback (partial intervention) and waiting list control | 12 months | CCA | Costs would be lower at $47.50 if delivered by in house medical professionals | There was a nearly significant difference in self-reported days of illness for the intervention group | But significant 34% reduction in health-care utilization by intervention participants compared with the control groups (p= 0.04) | ||
| Concluded that this reduction in costs would more than cover the costs of delivering the intervention if delivered by in-house professionals | |||||||
| (Renaud et al., 2008), Canada | I: Comprehensive health promotion programmes to provide employees with information and support for risk factor reduction, using a personalized approach and involving the organization's management as both programme participants and promoters. Programme includes modules on stress management, healthy eating and physical activity | 270 company employees | Before and after study. No controls. COA | Cost of the intervention not reported Costs avoided not directly reported in monetary terms, but in terms of absenteeism and staff turnover | Significant reduction in stress levels away from work as reported using Global Health Profile Score over 3 years falling from 27 to 17% (p< 0.0001). There was also a reduction in feelings of depression with 54.8% of participants stating that they rarely felt depressed after 3 years compared with 38.5% at baseline (p< 0.0001). There was also a reduction in the number of people experiencing signs of stress (p< 0.0001) | Company perspective | No ratio. Significant reduction in high levels of stress, signs of stress and feelings of depression |
| C: No control | 3 years | Costs not directly reported staff absenteeism decreased by 28% and staff turnover by 54% | |||||
| (van Rhenen et al., 2007), Netherlands | I: Cognitive focused stress management programme | 242 stressed and non-stressed employees of a telecommunications company | RCT | Costs not stated | No significant impact on sickness-related absenteeism between groups overall. Very marginally significant impact of cognitive interventions in delaying time to sickness | Company | Study authors commented costs not affected as overall no difference in impact on absenteeism |
| C: Brief relaxation and physical exercise intervention | 12 months | COA |
| Bibliographic information . | Intervention (I) and comparator (C) . | Target population and duration of economic analysis . | Study design . | Cost results . | Mental health-related effectiveness results . | Perspective/price year . | Synthesis of costs and effectiveness data . |
|---|---|---|---|---|---|---|---|
| (Loeppke et al., 2008), USA | I: Health-risk assessment, lifestyle management, nurse telephone advice line and telephone nurse-led disease management | 543 employees of company, matched with employees in other companies that were not enrolled in a health promotion programme | Observational study with matched controls | Costs of intervention are not reported | Overall improved health of workforce and significant reduction in overall levels of combined physical and mental health risk (p< 0.001) | Perspective not stated | Paper states that there are net savings after taking account of costs of intervention, but level of net savings not reported |
| C: No intervention | 3 years | Average decrease in 3.5 days per annum in absenteeism in the intervention group. No change in the control group. No significant difference in productivity at work | Majority of employees, where data available, maintained gains over 3 years | Price year not stated | |||
| Compared with control populations significant decrease in prevalence of depression from 17.9 to 10% (p< 0.01), but statistically significant increase for anxiety from 7.9 to 10.2% (p< 0.01) | |||||||
| (McCraty et al., 2009), USA | I: Power to change stress management and health-risk reduction programme. Includes emotion refocusing and restructuring techniques | 75 correctional officers at a youth facility | Quasi-experimental study with waiting list controls | Cost of programme not reported | Intervention associated with improvements in scales measuring productivity (p< 0.01) motivation (p< 0.01), gratitude (p< 0.05), positive outlook (p< 0.05) and reductions in anger (p< 0.05) and fatigue (p< 0.05). In addition there was a significant increase in depression in the control group (p< 0.05) | Health system | 43% of the intervention group had a sufficient reduction in number of risk factors to reduce projected health-care costs compared with just 26% of control group |
| C: Waiting list | 3 months | CCA | Projected average health-care cost per employee in the intervention group based on number of overall risk factors was reduced to $5377 from $6556. This compared with a reduction in from $6381 to $5995 in the control group | 2004 USD | Intervention was associated with an average annual saving of $1179 per employee, compared with a reduction of $386 per employee in the control group (sample size too small for statistical significance on cost differences with controls) | ||
| (Mills et al., 2007), England | I: A multi-component health promotion programme incorporating a health-risk appraisal questionnaire, access to a tailored health improvement web portal, wellness literature, and seminars and workshops focused upon identified wellness issues | 1518 employees at the UK headquarters of a multi-national company | Before and after study | Annual cost of programme per company employee £70 | Overall number of health-risk factors decreases significantly (by 0.48) in the intervention group | Company | Improved work performance and reduced absenteeism led to return of investment (ROI) of 6.19: 1 |
| 12 months | CBA | Significant difference in absenteeism between control and intervention groups largely due to increase in absenteeism in the control group | Work performance also increased significantly by 0.61 points to 7.6 on work performance scale | GBP. Price year not stated | Net benefits of £621 per employee | ||
| No significant changes in these outcomes in control groups | |||||||
| (Munz et al., 2001), USA | I: Comprehensive worksite stress management programme consisting of self-management training and an organizational level stressor reduction process | 79 customer sales representatives in a telecommunications company | Non-randomized controlled trial; other work units were control groups | Costs of intervention not reported | Self-management training group had significantly less stress than control group on the perceived stress scale (2.63 versus 3.11) (p< 0.05). Significantly less likely to experience depression on the Centre for Epidemiological Studies-Depression Scale (CES-D) 11.60 versus 18.90 (p< 0.05). The training group also had significantly better levels of relaxation, positive energy and less tiredness than the control group using the positive and negative affect schedule (p< 0.05) | Not stated | No synthesis of costs and benefits. Significant improvement in emotional well-being in the intervention group compared with the control group; |
| C: No intervention | 3 months | COA | 23% increase in sales revenue per order in the intervention group compared with 17% in the control group. 24% reduction in absenteeism in the intervention group compared with the control group | Individuals also had significantly greater sense of independence and job control in the intervention group (p< 0.05) | Benefits not reported in monetary terms, but at organizational level; 23% increase in sales revenue per order in the intervention group compared with 17% in the control group. Twenty four percent reduction in absenteeism in the intervention group compared with the control group. | ||
| (Naydeck et al., 2008), USA | I: Comprehensive wellness programme including on-line sessions for nutrition, weight management, stress management, and smoking cessation; on-site classes in stress and weight management. Access to exercise facility and incentives to participate in walking programme | 1892 employees who participated in company wellness programme. Matched controls from non-participants in company and non-participants in other companies | Observational study with matched controls | Total costs per employee per year were $138.74 | No specific health benefits—mental or physical were reported—the study focused on reduction in overall health-care costs only of the wellness programme | Company as payer of health-care premiums for employees | Reduction in health-care costs over 4 years for the programme were $1 335 524, with net savings of $527 121 and a return on investment of $1.65 |
| C: No health promotion programme | 4 years | COA, CBA | 2005 USD | ||||
| (Ozminkowski et al., 2002), USA | I: Multi-component Health and Wellness Programme including health profiles, risk management programmes and access to fitness centres, including financial incentives of up to $500 to participate in programmes | 11 584 US-based employees of multi-national company | Before and after study making use of health claims data | Cost of programme not reported. Impact on health-care utilization reported. On average after 4 years overall reduction in health-care costs per worker of $224.66. This consisted of increase in cost of emergency department visits of $10.87; and decreases in costs of outpatient/doctor visits $45.17; mental health visits $70.69 and inpatient days of $119.67 | Mental health (or other health-related outcomes) not reported. Instead changes in utilization of health-care services reported, including specific use of mental health service visits | Company (as health-care payer) | Investing in wellness programme associated with a large reduction in utilization of health-care services including mental health services over 4 years. On average savings per employee of $225 per year |
| C: No intervention | 60 months | COA | Impact on productivity not considered | 2000 USD | Impacts on productivity not considered | ||
| (Rahe et al., 2002), USA | I: Stress management programme focused on coping with stress through six group sessions and personal feedback | 501 computer industry company and local city government employees | RCT | Cost of intervention $103 per employee | Stress, anxiety and coping levels improved significantly in all three groups after 12 months (p< 0.05), but there was no significant difference between groups with the exception of negative responses to stress for computer industry employees. Full intervention group computer industry employees had a significantly greater improvement in negative response, followed by partial intervention group and waiting list controls (p= 0.012) | Company perspective (as health-care payer) | No ratio reported, as no significant difference in stress, anxiety and coping |
| C: Self-help groups with e-mail personal feedback (partial intervention) and waiting list control | 12 months | CCA | Costs would be lower at $47.50 if delivered by in house medical professionals | There was a nearly significant difference in self-reported days of illness for the intervention group | But significant 34% reduction in health-care utilization by intervention participants compared with the control groups (p= 0.04) | ||
| Concluded that this reduction in costs would more than cover the costs of delivering the intervention if delivered by in-house professionals | |||||||
| (Renaud et al., 2008), Canada | I: Comprehensive health promotion programmes to provide employees with information and support for risk factor reduction, using a personalized approach and involving the organization's management as both programme participants and promoters. Programme includes modules on stress management, healthy eating and physical activity | 270 company employees | Before and after study. No controls. COA | Cost of the intervention not reported Costs avoided not directly reported in monetary terms, but in terms of absenteeism and staff turnover | Significant reduction in stress levels away from work as reported using Global Health Profile Score over 3 years falling from 27 to 17% (p< 0.0001). There was also a reduction in feelings of depression with 54.8% of participants stating that they rarely felt depressed after 3 years compared with 38.5% at baseline (p< 0.0001). There was also a reduction in the number of people experiencing signs of stress (p< 0.0001) | Company perspective | No ratio. Significant reduction in high levels of stress, signs of stress and feelings of depression |
| C: No control | 3 years | Costs not directly reported staff absenteeism decreased by 28% and staff turnover by 54% | |||||
| (van Rhenen et al., 2007), Netherlands | I: Cognitive focused stress management programme | 242 stressed and non-stressed employees of a telecommunications company | RCT | Costs not stated | No significant impact on sickness-related absenteeism between groups overall. Very marginally significant impact of cognitive interventions in delaying time to sickness | Company | Study authors commented costs not affected as overall no difference in impact on absenteeism |
| C: Brief relaxation and physical exercise intervention | 12 months | COA |
RCT, randomized controlled trial; CBA, cost–benefit analysis; CEA, cost-effectiveness analysis; CCA, cost-consequences analysis; CUA, cost–utility analysis; COA, cost-offset analysis.
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