Is Positive Return on Investment (ROI) Too Good to Be True? A Review of the Quality of Study Methodology in Behavioral Chronic Disease Interventions Claiming Positive ROI

Objective: To examine the quality of articles that claim cost savings resulting from chronic disease interventions. The interventions are limited to behavioral interventions, including worksite wellness programs, weight and disease management programs, and community-based programs. Methods: Published articles were identified from a database search. Included articles were published between January 1990 and December 2016, described a positive return on investment of behavioral interventions for chronic disease. A single reviewer, following specific criteria, assessed research quality using the Quality of Health Economic Studies (QHES) instrument. Results: Of 1990 retrieved articles, 19 met study inclusion criteria. No study we reviewed has sufficient quality to be considered evidentiary. Conclusions: Economic evaluations yield positive ROI on chronic disease behavioral interventions have limited methodological quality and their results should be interpreted with caution.