title: A systematic review of the cost-effectiveness of worksite physical activity and/or nutrition         programs.
abstract: OBJECTIVE
  The aim of this study was to appraise and summarize the evidence on the cost-effectiveness of         worksite physical activity and/or nutrition programs.
  
  
  METHODS
  We searched EMBASE, MEDLINE, SportDiscus, PsycInfo,         NIOSHTIC-2, NHSEED, HTA, and Econlit for studies published up to 14 January 2011. Additionally, we searched for         articles by reviewing references, searching authors' databases, and contacting authors of included studies. Two         researchers independently selected articles. Articles had to include a cost-effectiveness and/or cost-utility analysis         comparing a worksite physical activity and/or nutrition program to usual care or an abridged version of the program.         Data were extracted on study characteristics and results. Two researchers independently assessed the risk of bias using         the Consensus on Health Economic Criteria list (CHEC-list).
  
  
  RESULTS
  Ten studies (18 programs) were included. More than         50% of the studies fulfilled 11 (58%) of the 19 CHEC-list items. From various perspectives, worksite nutrition and         worksite physical activity and nutrition programs (N=6) were more costly and more effective in reducing body weight         than usual care. When only intervention costs were considered, most worksite nutrition (N=4/5) and worksite physical         activity and nutrition programs (N=5/6) were more costly and more effective in reducing cholesterol level and         cardiovascular disease risks, respectively.
  
  
  CONCLUSIONS
  The cost-effectiveness of more costly and more effective         programs depends on the "willingness to pay" for their effects. It is unknown how much decision-makers are         willing to pay for reductions in body weight, cholesterol level, and cardiovascular disease risks. Therefore,         conclusions about the cost-effectiveness of worksite physical activity and/or nutrition programs cannot be made. There         is substantial need for improvement of the methodological quality of studies and particular emphasis should be placed         on the handling of uncertainty.
authors.affiliation: Faculty of Earth and Life Sciences, Department of Health Sciences, Unit Health Economics and Health Technology Assessment, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands. j.m.van.dongen@vu.nl
authors.forename: Johanna M
authors.initials: JM
authors.lastname: van Dongen
authors.forename: Karin I
authors.initials: KI
authors.lastname: Proper
authors.forename: Marieke F
authors.initials: MF
authors.lastname: van Wier
authors.forename: Allard J
authors.initials: AJ
authors.lastname: van der Beek
authors.forename: Paulien M
authors.initials: PM
authors.lastname: Bongers
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
mesh_terms: D003362:Cost-Benefit Analysis; D004032:Diet; D006801:Humans; D009043:Motor Activity; D015588:Observer Variation; D009790:Occupations