Systematic review links workplace blood screening economics to structured follow-up, with limited evidence on productivity

A systematic review of workplace health programmes that included blood-based laboratory or biomarker screening found generally favourable reported associations with healthcare costs and return on investment, but inconsistent effects on absenteeism and little evidence on presenteeism or staff turnover. The review included 56 studies of programmes involving working adults, most conducted in the United States, and found that favourable economic results were concentrated among programmes combining screening with coordinator- or physician-led follow-up rather than screening alone.

The researchers followed a prospectively registered protocol and reported the work under PRISMA 2020, using the Synthesis Without Meta-analysis guideline because differences in outcome metrics, analytic perspectives and time horizons prevented quantitative pooling. They searched PubMed, Scopus, Web of Science, EconLit, the Cochrane Library, and World Health Organization and International Labour Organization sources for English-language studies published from 2000 through 2026. Study selection, data extraction and quality appraisal were conducted in duplicate, with disagreements adjudicated by a third reviewer.

The evidence base included 19 retrospective cohort studies, 13 single-arm before-after studies, six randomised trials, six quasi-experimental or controlled before-after studies, five cross-sectional studies, four prospective cohorts and three modelling studies. Thirty-five studies were conducted in the United States, while 21 covered 12 other countries. Among 52 empirical studies reporting follow-up, the median was 24 months. None of the six randomised trials was rated at low risk of bias, and no single-arm before-after study was rated good on the National Institutes of Health quality tool.

Healthcare costs were the most frequently assessed economic domain, with 29 studies reporting this outcome. Twenty-one reported a favourable association, five reported no effect, two reported an unfavourable effect and one reported mixed results. The proportion of reporting studies with a favourable result was 72% (95% Wilson confidence interval, 54%–85%), and 12 of 13 higher-quality studies reporting healthcare costs had favourable results. However, these were heterogeneous observational associations rather than pooled causal estimates, and only a small number of randomised studies contributed to the domain.

Return on investment was reported in 20 studies, all of which classified the result as favourable. Among studies expressing return on investment as a benefit-to-cost ratio, values ranged from approximately break-even, or 1:1, to nearly 16:1, with most between about 1.5:1 and 4:1. The favourable direction was observed across low-, moderate- and high-quality studies and did not attenuate as study quality increased. The authors said this pattern is difficult to separate from reporting and selection bias, particularly because the evidence was heterogeneous and frequently based on single-arm designs.

Absenteeism results were mixed across 23 studies: 14 were classified as favourable, six as showing no effect, two as mixed and one as unfavourable. The favourable proportion was 61% (95% Wilson confidence interval, 41%–78%), and higher-quality studies were divided between favourable and null findings. Presenteeism was assessed in only seven studies, with four favourable and three showing no effect, while a single study assessed staff turnover and found no effect. Only five of the 56 studies used a validated productivity instrument, while 44 relied on administrative records and seven modelled outcomes.

Programme design was the clearest pattern in the synthesis. All 20 studies reporting return on investment and 19 of the 21 studies reporting favourable healthcare costs used a coordinator-led or physician-led pathway. Fourteen studies evaluated screening without structured follow-up; one reported healthcare costs and none reported return on investment. This comparison was indirect because screening-only programmes were rarely evaluated economically. The authors described the concentration of favourable results in structured programmes as an association and advanced the proposition that programme value may depend on support that acts on screening results as a hypothesis requiring prospective evaluation.

Sensitivity analyses produced broadly similar patterns. After excluding the three modelling studies, 19 of 27 studies reporting healthcare costs and all 19 reporting return on investment remained favourable. Restricting the synthesis to moderate- and high-quality studies left healthcare costs predominantly favourable, return on investment favourable in all 13 reporting studies, and absenteeism inconsistent. The authors could not make meaningful subgroup comparisons for screening type or productivity-measurement method because the relevant groups were too small.

The findings are limited by the predominantly observational evidence, the absence of pooled effect estimates, limited measurement of productivity and the concentration of studies in employer-funded US settings. Most studies adopted an employer perspective and reported costs in US dollars, which may constrain transfer to systems in which employers bear a smaller share of healthcare expenditure. The review also excluded non-English publications and research published before 2000. On the available evidence, blood-based workplace screening was not supported as a stand-alone cost-saving measure, and rigorous controlled studies outside the United States using validated productivity measures were identified as priorities for future research.

Subject of Research: Systematic review of economic and productivity outcomes of workplace programmes incorporating blood-based screening in working adults

Article Title: Economic and productivity outcomes of workplace health programmes incorporating blood-based laboratory screening: a systematic review

Article References: Swadźba, D., Makuch, S., & Agrawal, S. (2026). Economic and productivity outcomes of workplace health programmes incorporating blood-based laboratory screening: a systematic review. BMC Health Services Research, 26(1), Article 1336. https://doi.org/10.1186/s12913-026-15428-8

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15428-8

Keywords: workplace health programmes, blood-based screening, biomarker screening, healthcare costs, return on investment, absenteeism, presenteeism, productivity, systematic review, economic evaluation, Economic, outcomes