Moving beyond a limited follow-up in cost-effectiveness analyses of behavioral interventions.
BACKGROUND
Cost-effectiveness analyses of behavioral interventions typically use a dichotomous outcome criterion. However, achieving behavioral change is a complex process involving several steps towards a change in behavior. Delayed effects may occur after an intervention period ends, which can lead to underestimation of these interventions. To account for such delayed effects, intermediate outcomes of behavioral change may be used in cost-effectiveness analyses. The aim of this study is to model cognitive parameters of behavioral change into a cost-effectiveness model of a behavioral intervention.


METHODS
The cost-effectiveness analysis (CEA) of an existing dataset from an RCT in which an high-intensity smoking cessation intervention was compared with a medium-intensity intervention, was re-analyzed by modeling the stages of change of the Transtheoretical Model of behavioral change. Probabilities were obtained from the dataset and literature and a sensitivity analysis was performed.


RESULTS
In the original CEA over the first 12 months, the high-intensity intervention dominated in approximately 58% of the cases. After modeling the cognitive parameters to a future 2nd year of follow-up, this was the case in approximately 79%.


CONCLUSIONS
This study showed that modeling of future behavioral change in CEA of a behavioral intervention further strengthened the results of the standard CEA. Ultimately, modeling future behavioral change could have important consequences for health policy development in general and the adoption of behavioral interventions in particular.
Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands. h.c.prenger@utwente.nl
Rilana
R
Prenger
Marcel E
ME
Pieterse
Louise M A
LM
Braakman-Jansen
Job
J
van der Palen
Lieke C A
LC
Christenhusz
Erwin R
ER
Seydel
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D015337:Multicenter Studies as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods*