The Best ROI Meta-Analysis Ever: Case Closed?

We’ve known Michael O’Donnell, the publisher and editor in chief of the American Journal of Health Promotion, for 30 years. He is not prone to hyperbole. So he got our attention when he recently wrote that he had just published “the most extensive and well-conceived review conducted to date” on the financial impact of workplace health promotion.

He calls the paper “one of the best reviews ever conducted on any topic in workplace health promotion.” The study by Siyan Baxter and colleagues shows how the quality of the research methodologies used in the 51 interventions examined in their final analysis affected the magnitudes of the ROI’s reported. An archived webinar that summarizes the study findings is available free on this page at the  American Journal of Health Promotion.

Studies vary

There is a time-honored belief among health services researchers that the more rigorous the methodology, the smaller the size of the differences between groups will be. This is precisely what Baxter and colleagues found with respect to return on investment, which they calculated as ROI = (benefits – program costs) / program costs rather than the more typical approach of reporting ROI as the ratio of benefits to costs, i.e., ROI = benefits : costs. Nevertheless, Baxter, who is a PhD candidate in medical research at Australia’s University of Tasmania, found ROIs averaging 0.26 ($1.26 per dollar invested) in the 18 high-quality studies and –0.22 ($0.78 per dollar invested) in 12 studies using the most rigorous methodology, namely, the randomized controlled trial (RCT). For the 43 less rigorous studies of moderate or low quality, Baxter found ROIs averaging 1.79 (i.e., benefits of $2.79 per dollar invested), which is consistent with the oft cited ROI of 3:1 reported in a recent review by Harvard Economist Katherine Baicker and her colleagues.


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