Dealing With Missing Behavioral Endpoints in Health Promotion Research by Modeling Cognitive Parameters in Cost‐Effectiveness Analyses of Behavioral Interventions: A Validation Study

Abstract

Cost-effectiveness analyses (CEAs) of behavioral interventions typically use physical outcome criteria. However, any progress in cognitive antecedents of behavior change may be seen as a beneficial outcome of an intervention. The aim of this study is to explore the feasibility and validity of incorporating cognitive parameters of behavior change in CEAs. The CEA from a randomized controlled trial on smoking cessation was reanalyzed. First, relevant cognitive antecedents of behavior change in this dataset were identified. Then, transition probabilities between combined states of smoking and cognitions at 6 weeks and corresponding 6 months smoking status were obtained from the dataset. These rates were extrapolated to the period from 6 to 12 months in a decision analytic model. Simulated results were compared with the 12 months' observed cost-effectiveness results. Self-efficacy was the strongest time-varying predictor of smoking cessation. Twelve months' observed CEA results for the multiple tailoring intervention versus usual care showed € 3188 had to be paid for each additional quitter versus € 10,600 in the simulated model. The simulated CEA showed largely similar but somewhat more conservative results. Using self-efficacy to enhance the estimation of the true behavioral outcome seems a feasible and valid way to estimate future cost-effectiveness.

Exploring Outcomes to Consider in Economic Evaluations of Health Promotion Programs: What Broader Non-Health Outcomes Matter Most?

“…Ideally, the resulting most important non-health outcomes should be included in future economic evaluations of health promotion. A researcher who is performing an economic evaluation, and has instruments available that measure “self-confidence” and “insights into one’s unhealthy behavior”, for example, could use valuations of these outcomes in a cost utility analysis, as has been done with capabilities and the ICECAP instrument [ 39 ] – see also the article of Prenger et al [ 40 ] that describes how to include self efficacy in economic evaluations. Another possibility would be to incorporate the non-health outcomes into a cost consequence analysis.…”

Intention to maintain and willingness to stop: Applying a dual‐process model to understanding the maintenance of COVID‐19 preventive behaviors

“…The knowledge about which factors affect individuals' tendency to maintain or stop preventive behaviors may not only help to limit the spread and harm of COVID‐19 but also allow us to contain epidemics more efficiently and effectively in the future. Because psychological factors such as social‐cognitive variables are suggested to be a cost‐effective means to promote health (Bandura, 2004 ; Pinkerton et al, 2000 ; Prenger et al, 2016 ), the present study aims at evaluating the effectiveness of social‐cognitive factors in the maintenance of COVID‐19 preventive behaviors.…”