A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace

Abstract

BackgroundRecently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer’s perspective.MethodsEmployees used a 'loyalty card’ to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates.ResultsThe Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds.ConclusionsThe Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer’s perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable “business model” which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings. This comes at a time when both UK and US governments are encouraging business involvement in tackling public health challenges.

Physical activity and sedentary behaviour in a flexible office‐based workplace: Employee perceptions and priorities for change

“…Physical activity may be a focus of WHPP, as it is associated with significant benefits for both the employee and the employer. Physically active workers can deliver tangible benefits to the organisation, such as reduced costs associated with absenteeism, reduction in employee turnover and improved productivity . There are also intangible benefits, including improved employee morale, employee engagement and a positive attitude towards the “caring” organisation .…”

“…Physically active workers can deliver tangible benefits to the organisation, such as reduced costs associated with absenteeism, reduction in employee turnover and improved productivity. 6,7 There are also intangible benefits, including improved employee morale, employee engagement and a positive attitude towards the "caring" organisation. 8,9 Many organisations have therefore come to view physical activity promotion as a benefit in terms of attracting and retaining staff.…”

Productivity estimation in economic evaluations of occupational health and safety interventions: a systematic review

“…Measure for reduced productivity at work/ while working 31 (39, 41-44, 56, 60-65, 69, 70, 72, 77, 82, 87, 89, 94, 95, 98, 103, 104, 114, 115, 118, 119, 123, 124, 128) Source presenteeism Employee survey 18 (41, 44,56,62,64,69,72,82,87,89,94,95,98,104,115,118,119, 123) Simulated / assumptions 7 (39, 43, 44,103,114,124, 128) Previous studies 6 (42,60,61,63,65,70) Firm data 1 (115) Employer survey 1 (77) Survey/instrument presenteeism 56,62,69,82,94,95,118,119,123) Days (unspecified) 49 (39, 40, 42, 46,49,(51)(52)(53)(54)58,60,62,64,66,71,72,74,75,(77)(78)…”

“…Steel et al 39-42, 45-49, 51-54, 56-58, 60-75, 77-91, 93-128) Source absenteeism Firm data 26 (45, 46, 54, 57, 67-69, 71, 85, 86, 88, 91, 95, 96, 100, 101, 105, 107, 110, 114-116, 119, 125-127 (39, 42,49,51,56,57,62,64,66,72,78,79,81,82,87,89,94,102,104,109,113,117,118,(121)(122)(123)) Previous studies 10 (52, 53, 60, 61, 63, 83, 84, 99, 111, 120) Insurance data 9 (47, 48, 58, 60, 74, 75, 80, 112, 124 39, 42,49,56,72,79,81,82,102,104,109,117 11 (41, 56, 62, 93, 100, 107, 118, 119, 121-123) Estimated by the author 1 (88) The Chartered Institute of Personnel and Development 1 (108)…”

Slowing Down the Progression of Type 2 Diabetes: We Need Fair, Innovative, and Disruptive Action on Environmental and Policy Levels!

“…An increasing number of publications (43)(44)(45)(46)(47)(48) analyze various kinds of incentives to encourage people to have a healthy lifestyle. In the business sector, literature addresses the development of regional or targeted currencies (bitcoin and community-based currencies) (43,49).…”