Abstract / Summary
Background: Workplace health programmes increasingly include blood-based laboratory screening, promoted to lower costs and improve productivity, yet the economic case is contested and previous reviews have not isolated programmes with a blood-based screening component. We systematically reviewed the economic and productivity outcomes of such programmes.
Methods: Following PRISMA 2020 and a prospectively registered protocol, we searched PubMed, Scopus, Web of Science, EconLit, the Cochrane Library, and grey literature (WHO, ILO) from January 2000 to May 2026. Eligible studies evaluated workplace programmes incorporating blood-based laboratory or biomarker screening in working adults and reported at least one economic or productivity outcome. Selection, extraction, and quality appraisal, using design-appropriate tools (RoB 2, Newcastle-Ottawa Scale, NIH before-after tool, CHEC list), were performed in duplicate with adjudication. Because outcome metrics were too heterogeneous to pool, findings were synthesised narratively by direction of effect across six domains, with sensitivity and subgroup analyses.
Results: Fifty-six studies were included, mostly US observational or single-arm designs; six were randomised trials, none at low risk of bias. Healthcare-cost outcomes (29 studies) were predominantly favourable (21 studies) and remained so among higher-quality studies. Return on investment (20 studies) was uniformly favourable, with no attenuation in the direction of effect across study quality. Absenteeism (23 studies) was inconsistent, and presenteeism (7) and staff turnover (1) were rarely measured, reflecting reliance on administrative rather than validated measures. Patterns were robust in sensitivity analyses.
Conclusions: Workplace programmes incorporating blood-based screening were associated with favourable healthcare-cost and return-on-investment results in most studies, but the return-on-investment signal showed no attenuation with study quality and is hard to separate from reporting and selection bias; absenteeism was inconsistent and productivity rarely assessed. Favourable economics appeared almost exclusively where screening was coupled to a structured, coordinator- or physician-led pathway, not offered alone-a contrast to read cautiously, since screening-only programmes were seldom evaluated economically. The evidence does not support blood-based screening as a stand-alone cost-saving measure and suggests, as a hypothesis, that its value lies less in testing than in support that turns detection into sustained behaviour or treatment change. Rigorous, controlled, non-US studies with validated productivity measures are needed.