Factors Influencing Implementation of a Workplace Tobacco Cessation Intervention in India: A Qualitative Exploration.

BACKGROUND: Tobacco use is projected to cause more than 8 million deaths annually worldwide by 2030 and is currently linked to 1 million annual deaths in India. Very few workplaces provide tobacco cessation as a part of occupational health in India. In this study, we examined promoters and barriers to implementing an evidence-based tobacco cessation program in a workplace setting in India. METHODS: In-depth interviews were conducted with all facilitators (two program coordinators and four counselors) of a workplace tobacco cessation intervention covering implementation efforts in five organizations, including three manufacturing units and two corporate settings. FINDINGS: The identified promoters for implementation of the program were as follows: (a) workplaces that provided access to many individuals, (b) high prevalence of tobacco use that made the intervention relevant, (c) core components (awareness sessions, face-to-face counseling and 6-months follow-up) that were adaptable, (d) engagement of the management in planning and execution of the intervention, (e) employees' support to each other to quit tobacco, (f) training the medical unit within the workplace to provide limited advice, and (g) efforts to advocate tobacco-free policies within the setting. Barriers centered around (a) lack of ownership from the workplace management, (b) schedules of counselors not matching with employees, (c) nonavailability of employees because of workload, and (d) lack of privacy for counseling. CONCLUSION/IMPLICATIONS FOR PRACTICE: This study provided practical insights into the aspects of planning, engaging, executing and the process of implementation of a tobacco cessation intervention in a workplace setting. It provided guidance for an intervention within occupational health units in similar settings.

Return on Investment of Workplace Wellness: Evidence From a Long-Term Care Company.

BACKGROUND: Workplace wellness programs (WWPs) are increasingly promoted by businesses and governments as an important strategy to improve workers' overall health and well-being and to reduce health care and other organizational costs. Few studies have evaluated WWPs in small businesses to provide evidence on the potential return-on-investment (ROI) that WWPs might yield. This study aimed to fill this gap by presenting a quasi-experimental, ROI analysis of a WWP in a small company. METHODS: This observational quasi-experimental study evaluated economic outcomes of a multicomponent WWP implemented by a small long-term care company. The company provided approximately 2 years of de-identified, individualized data on its employees for 2013-2015. There were 116 WWP participants and 323 nonparticipants. Difference-in-differences models were used to evaluate the program using organizational costs and ROI estimates. FINDINGS: The estimated program cost was $132.692 (95% confidence interval [CI]: [$112.957, $156.101]) per participant and the estimated organizational costs savings were $210.342 (95% CI: [-4354.095, 2002.890]). The WWP achieved an ROI of $0.585 (95% CI: [-$35.095, $14.103]) per participant. Although not statistically significant, the results suggest that the WWP saved $1.585 for every $1 invested. CONCLUSIONS/APPLICATION TO PRACTICE: These results suggest that the evaluated WWP yielded a positive, although nonsignificant, ROI estimate. While ROI is still one of the most common evaluation metrics used in workplace wellness, few studies present ROI estimates of WWPs in small companies. Given policy efforts to promote WWPs in small businesses, there is a need to conduct high-quality ROI analyses for WWPs in smaller companies.

Economic analyses of mental health and substance use interventions in the workplace: a systematic literature review and narrative synthesis.

Mental illness and substance use disorders in the workplace have been increasingly recognised as a problem in most countries; however, evidence is scarce on which solutions provide the highest return on investment. We searched academic and grey literature databases and additional sources for studies that included a workplace intervention for mental health or substance abuse, or both, and that did an economic analysis. We analysed the papers we found to identify the highest yielding and most cost-effective interventions by disorder. On the basis of 56 studies, we found moderate strength of evidence that cognitive behavioural therapy is cost-saving (and in some cases cost-effective) to address depression. We observed strong evidence that regular and active involvement of occupational health professionals is cost-saving and cost-effective in reducing sick leave related to mental health and in encouraging return to work. We identified moderate evidence that coverage for pharmacotherapy and brief counselling for smoking cessation are both cost-saving and cost-effective. Addressing mental health and substance misuse in the workplace improves workers' wellbeing and productivity, and benefits employers' bottom line (ie, profit). Future economic analyses would benefit from the consideration of subgroup analyses, examination of longer follow-ups, inclusion of statistical and sensitivity analyses and discussion around uncertainty, and consideration of potential for bias.

Cost-Effectiveness of a Problem-Solving Intervention Aimed to Prevent Sickness Absence among Employees with Common Mental Disorders or Occupational Stress.

The cost-benefit and cost-effectiveness of a work-directed intervention implemented by the occupational health service (OHS) for employees with common mental disorders (CMD) or stress related problems at work were investigated. The economic evaluation was conducted in a two-armed clustered RCT. Employees received either a problem-solving based intervention (PSI; n = 41) or care as usual (CAU; n = 59). Both were work-directed interventions. Data regarding sickness absence and production loss at work was gathered during a one-year follow-up. Bootstrap techniques were used to conduct a Cost-Benefit Analysis (CBA) and a Cost-Effectiveness Analysis (CEA) from both an employer and societal perspective. Intervention costs were lower for PSI than CAU. Costs for long-term sickness absence were higher for CAU, whereas costs for short-term sickness absence and production loss at work were higher for PSI. Mainly due to these costs, PSI was not cost-effective from the employer's perspective. However, PSI was cost-beneficial from a societal perspective. CEA showed that a one-day reduction of long-term sickness absence costed on average €101 for PSI, a cost that primarily was borne by the employer. PSI reduced the socio-economic burden compared to CAU and could be recommended to policy makers. However, reduced long-term sickness absence, i.e., increased work attendance, was accompanied by employees perceiving higher levels of production loss at work and thus increased the cost for employers. This partly explains why an effective intervention was not cost-effective from the employer's perspective. Hence, additional adjustments and/or support at the workplace might be needed for reducing the loss of production at work.

Health-Related Quality of Life and Cost-Utility Analysis of Employees With Musculoskeletal Disorders Receiving Vocational Physiotherapy.

Background: The purpose of this project was to evaluate both health-related quality of life (HRQoL) and cost-utility associated with care for employees with musculoskeletal disorders who received vocational physiotherapy at a North London National Health Service (NHS) Foundation Trust in the United Kingdom. Methods: A pre- and post-physiotherapy EuroQol 5 Dimension (EQ-5D) questionnaire was administered to employees presenting to the vocational physiotherapy service (VPS) with musculoskeletal disorders. The cost-utility analysis of the physiotherapy service was calculated using cost data provided by VPS billing information and benefits measured using Quality-Adjusted Life Years (QALYs). Findings: Overall, there was a significant improvement in the EQ-5D index from baseline to discharge in all HRQoL domains. The visual analog scale (VAS) improved from a mean of 31.5 (SD = 18.3) at baseline to 73.2 (SD = 18.5) at discharge. A cost-utility analysis indicated that the VPS would continue to be cost-effective until the cost per employee increased by 82.5%. Conclusion/Application to Practice: The project supports integration of vocational physiotherapy services into an occupational health department.

High cost or frequent attender - both spend resources, but are they linked to work disability? A cohort study from occupational health primary care in Finland.

BACKGROUND: High use of services is associated with ill health and a number of health problems, but more information is needed on whether high use of services presents a risk for future pensions or disability. We aimed to investigate if defining patients as high cost (HC) or frequent attenders (FA) was more useful in occupational health services (OHS) as a predictor of future disability pension (DP). METHODS: This cohort study used medical record data from a large OHS provider and combined it with register data from the Finnish Centre for Pensions including disability pension decisions. A total of 31,960 patients were included and odds ratios for DP were calculated. Frequent attenders (FA10) were defined as the top decile of visitors according to attendance and high cost (HC10) as the top decile according to costs accrued from service use in 2015. Those patients that were not categorized as FA nor HC, but were eligible for the study were used as the control group (non-FAHC). The outcome measure (disability pensions) was analysed for years 2016-2017. RESULTS: FA and HC did not significantly differ in their risk for disability pension. Both groups' risk was higher than average users' risk (adjusted OR 3.47 for FA10, OR 2.49 for HC10 and OR 0.33 for controls). Both HC10 and FA10 received half of their disability pensions based on musculoskeletal disorders, while for non-FAHC only 28% of pensions were granted based on these disorders. The groups overlapped by 68%. CONCLUSIONS: High utilizers (both FA10 and HC10) have an increased likelihood of receiving a future disability pension. The chosen definition is less important than identifying these patients and directing them towards necessary rehabilitation.

Assessing Workplace Clinic Utilization and Performance: Lessons and Implications for Care Delivery.

: Many large employers utilize on-site medical clinics as a major component of their long-term healthcare cost management strategy. This study aims to quantify on-site clinic return on investment (ROI) associated with the avoidance of direct healthcare expenditures for preventive, urgent care and occupational medical services at an international beverage company. A multivariable linear regression model indicated there was a significant association between the ROI and increasing penetration rates, number of employees, and clinic age (P < 0.0001). Over a 10-year period, while the types of services delivered changed, onsite clinics continued to demonstrate significant and increasing cost savings for this employer.

Effects of a Workplace Wellness Program on Employee Health, Health Beliefs, and Medical Use: A Randomized Clinical Trial.

Importance: Many employers use workplace wellness programs to improve employee health and reduce medical costs, but randomized evaluations of their efficacy are rare. Objective: To evaluate the effect of a comprehensive workplace wellness program on employee health, health beliefs, and medical use after 12 and 24 months. Design, Setting, and Participants: This randomized clinical trial of 4834 employees of the University of Illinois at Urbana-Champaign was conducted from August 9, 2016, to April 26, 2018. Members of the treatment group (n = 3300) received incentives to participate in the workplace wellness program. Members of the control group (n = 1534) did not participate in the wellness program. Statistical analysis was performed on April 9, 2020. Interventions: The 2-year workplace wellness program included financial incentives and paid time off for annual on-site biometric screenings, annual health risk assessments, and ongoing wellness activities (eg, physical activity, smoking cessation, and disease management). Main Outcomes and Measures: Measures taken at 12 and 24 months included clinician-collected biometrics (16 outcomes), administrative claims related to medical diagnoses (diabetes, hypertension, and hyperlipidemia) and medical use (office visits, inpatient visits, and emergency department visits), and self-reported health behaviors and health beliefs (14 outcomes). Results: Among the 4834 participants (2770 women; mean [SD] age, 43.9 [11.3] years), no significant effects of the program on biometrics, medical diagnoses, or medical use were seen after 12 or 24 months. A significantly higher proportion of employees in the treatment group than in the control group reported having a primary care physician after 24 months (1106 of 1200 [92.2%] vs 477 of 554 [86.1%]; adjusted P = .002). The intervention significantly improved a set of employee health beliefs on average: participant beliefs about their chance of having a body mass index greater than 30, high cholesterol, high blood pressure, and impaired glucose level jointly decreased by 0.07 SDs (95% CI, -0.12 to -0.01 SDs; P = .02); however, effects on individual belief measures were not significant. Conclusions and Relevance: This randomized clinical trial showed that a comprehensive workplace wellness program had no significant effects on measured physical health outcomes, rates of medical diagnoses, or the use of health care services after 24 months, but it increased the proportion of employees reporting that they have a primary care physician and improved employee beliefs about their own health. Trial Registration: American Economic Association Randomized Controlled Trial Registry number: AEARCTR-0001368.

The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures.

INTRODUCTION: The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health-care expenditures. METHODS: We evaluated test quality among 338 adults with workers' compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12-item Short Form Health Survey version 2), actual receipt of surgery, and expenditures. RESULTS: In simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (-0.50 point; 95% confidence interval [CI], -0.89 to -0.12) and functional impairment (-0.42 point; 95% CI, -0.78 to -0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures. DISCUSSION: Test quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.

Risk versus benefit: Should not audiologists assess this in the context of occupational noise-induced hearing loss in the mining industry?

BACKGROUND: Hearing conservation programmes (HCPs) are an important aspect of occupational health efforts to prevent occupational noise-induced hearing loss (ONIHL). In low- and middle income (LAMI) countries, where the incidence of ONIHL is significant, it is important to deliberate on the risk or benefit of HCPs. OBJECTIVES: This article is an attempt at highlighting important strategic indicators as well as important variables that the occupational health and audiology community need to consider to plan efficacious HCPs within the South African mining context. METHOD: The current arguments are presented in the form of a viewpoint publication. RESULTS: Occupational audiology vigilance in the form of engagement with HCPs in the mining industry has been limited within the South African research and clinical communities. When occupational audiology occurs, it is conducted by mid-level workers and paraprofessionals; and it is non-systematic, non-comprehensive and non-strategic. This is compounded by the current, unclear externally enforced accountability by several bodies, including the mining industry regulating body, with silent and/or peripheral regulation by the Health Professions Council of South Africa and the Department of Health. The lack of involvement of audiologists in the risk or benefit evaluation of HCPs during their development and monitoring process, as well as their limited involvement in the development of policies and regulations concerning ear health and safety within this population are probable reasons for this. CONCLUSIONS: Increased functioning of the regulatory body towards making the employers accountable for the elimination of ONIHL, and a more central and prominent role for audiologists in HCPs, are strongly argued for.

Inequities in occupational diseases recognition in France.

BACKGROUND: In France, complex cases of occupational disease (OD) are submitted to regional committees who are in charge of accepting, or rejecting, the claim. Their mean annual acceptance rate varies from one region to another, which may reflect differences in the cases, or discrepancies between committees. The objective of this study was to assess the comparability of the decisions of the committees on the basis of standardized cases. METHODS: Three experienced occupational physicians specialized in OD were asked to develop 28 clinical cases representative of claims for compensation usually seen in these committees. The cases, in the form of short vignettes, were submitted to the 18 French regional committees, asking if they would recognise each case as an OD. RESULTS: All committees participated. The acceptance rate (recognition of the case as an OD) varied, ranging from 18% to 70%. All the committees took the same decision for only 7 out of the 28 cases, but half accepted and half refused for 3 cases. For 10 cases, one quarter of the committees gave a decision different than the other 75%. The highest discordance rates were observed for the cases concerning musculoskeletal disorders and asbestos related diseases. CONCLUSION: The committees take very different decisions in terms of recognition of OD, especially for the most frequently compensated OD in France, i.e. musculoskeletal disorders and asbestos related diseases. This is a major source of injustice for the employees who seek compensation and there is a need to develop methods to harmonize decisions between committees.

The cost impact of a quality-assured mechanical assessment in primary low back pain care.

Objectives: The escalating cost of low back pain (LBP) care has not improved outcomes. Our purpose: to compare costs between LBP care guided by a quality-assured mechanical assessment (MC) and usual community care (CC).Study Design: Administrative claims data analysis.Methods: Employees and dependents of a large self-insured manufacturer seeking care for LBP in 2013 chose between the company's primary care clinic (where MC was delivered) and community care.The claims of 5,036 were analyzed for one year following subjects' initial evaluation excluding only those with diagnostic codes for fractures, dislocations, or infections. MC included an advanced form of Mechanical Diagnosis & Therapy (MDT). CC varied based on each subjects' selection of providers. Primary outcome measure: one-year cost of each subject's care. Secondary: number of MRIs, spinal injections, and lumbar surgeries undertaken. The payer's proprietary risk-adjustment algorithm was utilized.Results: After risk adjustment, the average cost per MC subject was 51.48% lower than the CC average cost (p < .0279). The utilization of MRIs, injections, and surgeries was lower with MC by 49.75%, 39.44%, 78.38% with relative risks of 1.99, 1.64, and 4.73, respectively.Conclusions: This 51.5% cost-savings reflects the substantial reduction in downstream care-seeking with MC, including lower utilization of MRIs, injections, surgeries, and downstream care after six months from the initial visit. It is well documented that the MDT clinical examination typically elicit patterns of pain response that in turn identify how most can rapidly recover with self-care with no need for other intervention.Level of Evidence: 1b.

Health Risk Calculator: An Online, Interactive Tool to Estimate how Health Impacts Workers' Compensation Claim Incidence and Cost.

OBJECTIVE: The purpose of this paper is to describe and evaluate a web-based, educational Health Risk Calculator that communicates the value of investing in employee health and well-being for the prevention of work-related injuries, illnesses, and fatalities. METHODS: We developed and evaluated the calculator following the RE-AIM framework. We assessed effectiveness via focus groups (n = 15) and a post-use survey (n = 33) and reach via website analytics. RESULTS: We observed evidence for the calculator's usability, educational benefit, and encouragement of action to improve worker health and safety. Website analytics data demonstrated that we reached over 300 users equally in urban and rural areas within 3 months after launch. CONCLUSION: We urge researchers to consider the ways in which they can communicate their empirical research findings to their key stakeholders and to evaluate their communication efforts.

Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes: A Randomized Clinical Trial.

Importance: Employers have increasingly invested in workplace wellness programs to improve employee health and decrease health care costs. However, there is little experimental evidence on the effects of these programs. Objective: To evaluate a multicomponent workplace wellness program resembling programs offered by US employers. Design, Setting, and Participants: This clustered randomized trial was implemented at 160 worksites from January 2015 through June 2016. Administrative claims and employment data were gathered continuously through June 30, 2016; data from surveys and biometrics were collected from July 1, 2016, through August 31, 2016. Interventions: There were 20 randomly selected treatment worksites (4037 employees) and 140 randomly selected control worksites (28 937 employees, including 20 primary control worksites [4106 employees]). Control worksites received no wellness programming. The program comprised 8 modules focused on nutrition, physical activity, stress reduction, and related topics implemented by registered dietitians at the treatment worksites. Main Outcomes and Measures: Four outcome domains were assessed. Self-reported health and behaviors via surveys (29 outcomes) and clinical measures of health via screenings (10 outcomes) were compared among 20 intervention and 20 primary control sites; health care spending and utilization (38 outcomes) and employment outcomes (3 outcomes) from administrative data were compared among 20 intervention and 140 control sites. Results: Among 32 974 employees (mean [SD] age, 38.6 [15.2] years; 15 272 [45.9%] women), the mean participation rate in surveys and screenings at intervention sites was 36.2% to 44.6% (n = 4037 employees) and at primary control sites was 34.4% to 43.0% (n = 4106 employees) (mean of 1.3 program modules completed). After 18 months, the rates for 2 self-reported outcomes were higher in the intervention group than in the control group: for engaging in regular exercise (69.8% vs 61.9%; adjusted difference, 8.3 percentage points [95% CI, 3.9-12.8]; adjusted P = .03) and for actively managing weight (69.2% vs 54.7%; adjusted difference, 13.6 percentage points [95% CI, 7.1-20.2]; adjusted P = .02). The program had no significant effects on other prespecified outcomes: 27 self-reported health outcomes and behaviors (including self-reported health, sleep quality, and food choices), 10 clinical markers of health (including cholesterol, blood pressure, and body mass index), 38 medical and pharmaceutical spending and utilization measures, and 3 employment outcomes (absenteeism, job tenure, and job performance). Conclusions and Relevance: Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months. Although limited by incomplete data on some outcomes, these findings may temper expectations about the financial return on investment that wellness programs can deliver in the short term. Trial Registration: ClinicalTrials.gov Identifier: NCT03167658.

Workplace Smoke-Free Policies and Cessation Programs Among U.S. Working Adults.

INTRODUCTION: Workplace tobacco control interventions reduce smoking and secondhand smoke exposure among U.S. workers. Data on smoke-free workplace policy coverage and cessation programs by industry and occupation are limited. This study assessed smoke-free workplace policies and employer-offered cessation programs among U.S. workers, by industry and occupation. METHODS: Data from the 2014-2015 Tobacco Use Supplement to the Current Population Survey, a random sample of the civilian, non-institutionalized population, were analyzed in 2018. Self-reported smoke-free policy coverage and employer-offered cessation programs were assessed among working adults aged ≥18 years, overall and by occupation and industry. Respondents were considered to have a 100% smoke-free policy if they indicated smoking was not permitted in any indoor areas of their workplace, and to have a cessation program if their employer offered any stop-smoking program within the past year. RESULTS: Overall, 80.3% of indoor workers reported having smoke-free policies at their workplace and 27.2% had cessation programs. Smoke-free policy coverage was highest among workers in the education services (90.6%) industry and lowest among workers in agriculture, forestry, fishing, and hunting industry (64.1%). Employer-offered cessation programs were significantly higher among workers reporting 100% smoke-free workplace policies (30.9%) than those with partial/no policies (23.3%) and were significantly higher among indoor workers (29.2%) than outdoor workers (15.0%). CONCLUSIONS: Among U.S. workers, 100% smoke-free policy and cessation program coverage varies by industry and occupation. Lower smoke-free policy coverage and higher tobacco use in certain industry and occupation groups suggests opportunities for workplace tobacco control interventions to reduce tobacco use and secondhand smoke exposure.

Economic Evaluation of Combining Pharmaco- and Behavioral Therapies for Smoking Cessation in an Occupational Medicine Setting.

OBJECTIVE: To estimate the budget impact (BI) of funding pharmaco+behavioral therapies for smoking cessation from an employer perspective. METHODS: A hybrid economic model was applied to estimate the BI, which considered up to four cessation attempts over a 3-year horizon. The model estimated the costs of funding a cessation programme, and the mean savings due to avoided loss of productivity and absenteeism because of smoking cessation. RESULTS: 53.8% of smokers quit smoking. The programme, which costs &OV0556;394,468, would generate earnings of &OV0556;1,342,133; with &OV0556;644,974 in incremental net savings. These mean &OV0556;1.64 in return per each euro invested. Results show net benefits from two cigarettes smoked while working every day. CONCLUSIONS: Considering the avoided costs of loss of productivity and absenteeism, funding a smoking cessation programme of pharmaco+behavioral therapies would produce substantial savings for the employer.

Kentucky's Smoking Cessation Quitline: Annual Estimated Return on Investment to Employers.

PURPOSE: State-based smoking cessation telephone quitlines offer a cost-effective method of providing tobacco treatment at no cost to participants. The study objective was to assess the annual return on investment (ROI) to employers if they were to bear the entire responsibility from the Kentucky quitline. DESIGN: A retrospective design was used to estimate the annual ROI to employers from the Kentucky quitline. SETTING: The telephone quitline (1-800-QUIT-NOW) provided intake and follow-up data for all Kentucky participants who enrolled in the program from 2012 to 2014. PARTICIPANTS: All individuals aged 18+ who enrolled in the Kentucky quitline from 2012 to 2014. MEASURES: Successful tobacco cessation was assessed from follow-up surveys that took place after individuals completed the program. Cost savings to employers associated with tobacco cessation were gleaned from a published meta-analysis. The Kentucky quitline provided estimates for annual program expenses. ANALYSIS: The annual ROI was calculated as the difference between estimated annual cost savings due to smoking cessation and annual program expenses. RESULTS: From 2012 to 2014, 5425 individuals were enrolled in the quitline. The annual ROI to employers was estimated to be $998 680, with an ROI ratio of 6.2:1. CONCLUSIONS: Employers may receive a substantial ROI if they were to fund the Kentucky quitline. Study results may be used as evidence to support cost-sharing partnerships between public health agencies and employers to sustain funding for telephone quitlines.

What do employers spend to protect the health of workers?

Objective This study aimed to estimate firm-level expenditures on occupational health and safety (OHS) for a representative sample of Canadian employers. Methods A cross-sectional survey of 334 employers with ≥20 employees in 18 economic sectors in the Ontario economy. Participants provided information on five dimensions of OHS expenditures: (i) organizational management and supervision; (ii) staff training in health and safety; (iii) personal protective equipment; (iv) professional services and, (v) estimates of the share of new capital investment that could be attributed to improved OHS performance. Expenditures for each of the five dimensions were summed for each organization and divided by the number of employees, resulting in an estimate of OHS expenditure per employee per year. Results The average OHS expenditure per worker per year was Can$1303 [95% confidence interval (CI) Can$1167-1454]. Expenditures were three times higher in the goods-producing sectors (Can$2417, 95% CI Can$2026-2809) relative to the service sectors (Can$847, 95% CI Can$777-915). The proportion of expenditures allocated to each of the five dimensions was generally consistent across economic sectors: 58% to organizational management and supervision, 22% to staff training in health and safety and 14% to personal protective equipment. On average, <5% of OHS expenditures per worker per year were allocated to professional services or estimated as the share of new capital investment attributed to OHS. Conclusions Employer expenditures on OHS are substantial. The results of this study are consistent with recent European estimates and strengthen understanding of the scale of employer financial expenditures to protect the health of workers.