The role of cognition in cost-effectiveness analyses of behavioral interventions

Abstract

BackgroundBehavioral interventions typically focus on objective behavioral endpoints like weight loss and smoking cessation. In reality, though, achieving full behavior change is a complex process in which several steps towards success are taken. Any progress in this process may also be considered as a beneficial outcome of the intervention, assuming that this increases the likelihood to achieve successful behavior change eventually. Until recently, there has been little consideration about whether partial behavior change at follow-up should be incorporated in cost-effectiveness analyses (CEAs). The aim of this explorative review is to identify CEAs of behavioral interventions in which cognitive outcome measures of behavior change are analyzed.MethodsData sources were searched for publications before May 2011.ResultsTwelve studies were found eligible for inclusion. Two different approaches were found: three studies calculated separate incremental cost-effectiveness ratios for cognitive outcome measures, and one study modeled partial behavior change into the final outcome. Both approaches rely on the assumption, be it implicitly or explicitly, that changes in cognitive outcome measures are predictive of future behavior change and may affect CEA outcomes.ConclusionPotential value of cognitive states in CEA, as a way to account for partial behavior change, is to some extent recognized but not (yet) integrated in the field. In conclusion, CEAs should consider, and where appropriate incorporate measures of partial behavior change when reporting effectiveness and hence cost-effectiveness.

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

“…First, many intervention studies have a relatively short follow‐up period of 6 months or less. Delayed behavior change can occur after a study period ends, which may lead to biased (cost‐)effectiveness results (Prenger et al ., , ; Smith et al ., ; Wagner and Goldstein, ). When people attempt to change habitual behaviors, the likelihood of relapsing to their old habit after a while is high.…”

“…Generally, health promotion interventions are designed to accomplish behavior change. CEAs of these interventions typically focus on objective outcome measures, that is, physical endpoints such as weight loss, less alcohol consumption, or biochemically validated smoking cessation (Wagner and Goldstein, ; Prenger et al ., ). However, behavior change is a complex process in which several steps need to be taken, including changes in cognitive antecedents of behavior change.…”

“…Few studies have been conducted on the inclusion of intermediate behavior change in CEAs by means of changed cognitions. Our recent review on the role of cognitions in CEAs of behavioral interventions found that the use of cognitive parameters in calculating cost-effectiveness outcomes is to some extent recognized but still in its infancy (Prenger et al, 2012). One of the frameworks that was distinguished when considering the inclusion of cognitions in CEA consisted of an approach to model final physical endpoints based on intermediate, cognitive measures of behavior change.…”