The cost‐effectiveness of three types of worksite wellness programs for reducing the cardiovascular disease risk factors of employees was examined at three manufacturing plants in terms of their incremental costs and effectiveness over a comparison site that used a simpler and cheaper program design. The risks targeted were hypertension, obesity, cigarette smoking, and lack of regular physical exercise. The annual direct cost per employee for post‐screening interventions was $17.68 for Site A (the comparison site that offered health education classes), $39.28 for Site B (physical fitness facility), $30.96 for Site C (health education plus follow‐up counseling), and $38.57 for Site D (health education, follow‐up counseling, plus plant organization for health promotion). The addition of a physical fitness facility (Site B) did not produce any incremental benefit in reducing risks, as compared with health education classes (Site A), and Site B showed the lowest percentage of employees exercising regularly at the end of the 3‐year study period. In contrast, the sites that used systematic outreach and follow‐up counseling (Sites C and D) were more effecti