University of Tasmania
Baxter_whole_thesis_ex_pub_mat.pdf (5.71 MB)

Healthy, wealthy and wise : investigating the application of health economics in workplace health promotion : the economic evaluation of Healthy@Work

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posted on 2023-05-27, 10:03 authored by Siyan BaxterSiyan Baxter
Workplace health promotion (WHP) describes any initiative carried out in the workplace to support and ultimately improve the health and wellbeing of people at work. Implementation of WHP is often unique to the organisation, and can include individual, social, cultural, environmental and political processes. Funding of WHP may necessitate an economic evaluation. The ideal evaluative method, however, is unclear. This thesis investigated the application of health economics in WHP by considering established guidelines and business needs to conduct an economic evaluation of an organisational approach to WHP in state government, Tasmania, Australia; Healthy@Work (2009-2012). The first chapter is a review of the global WHP evidence. A quality-based systematic literature review identified currently used components of economic evaluations. It found that methodological quality of economic evaluations was generally low to moderate and that benefits were measured predominately by changes in absenteeism and healthcare costs. The review also provided a robust synthesis of return on investment, accounting for quality along with offering recommendations for improving the state of evidence in WHP. From insights gained, a resource was then developed on behalf of a research-policy partnership. The second chapter describes the development of a workplace health savings calculator that is currently a national resource to assist employers at a business case level and is available in a WHP toolkit on the Australian federal government website. Data sourced locally (Healthy@Work) and nationally (Household Income and Labour Dynamics of Australia; HILDA) were used in a further analysis to investigate the validity of health utility in the employee population. It demonstrated construct validity of a measure of health status (SF-6D) derived from health-related quality of life (SF-12v2), and recommended its use in economic evaluations. This finding closes the gap between evaluations in WHP and health economic guidelines. Collectively these works helped identify measure and value what costs and benefits are involved in WHP. The final chapter applied this knowledge. An economic evaluation of Healthy@Work was conducted. Overall costs and impacts from health status, total lost productive time and healthcare utilisation were presented in a cost consequence analysis. There was no health status change found and inherent challenges for WHP when positioned within a public health paradigm were discussed. This thesis presents a range of studies that add to the body of knowledge for conducting economic evaluations in workplace health promotion. It discusses economic forms and analytic methods in the pursuit of best fit for WHP.


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  • Unpublished

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Copyright 2015 the Author Chapter 2 appears to be the equivalent of a post-print version of an article published as: Baxter, S., Sanderson, K., Venn, A. J., Blizzard, C. L., Palmer, A. J., 2014. The Relationship between return on investment and quality of study methodology in workplace health promotion programs, American journal of health promotion, 28(6), 347-363. Chapter 3 has been published as: Baxter, S., Campbell, S., Sanderson, K., Cazaly, C., Venn, A. J., Owen, C., Palmer, A. J., 2015. Development of the workplace health savings calculator: a practical tool to measure economic impact from reduced absenteeism and staff turnover in workplace health promotion, BMC research notes, 8(457), 1-12 Chapter 4 appears to be the equivalent of a post-print version of an article published as: Baxter, S., Sanderson, K., Venn, A. J., Otahal, P., Palmer, A. J., 2015. Construct validity of SF-6D health state utility values in an employed population, Quality of life research, 24(4), 851-870. The final publication is available at Springer via

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