title: The role of cognition in cost-effectiveness analyses of behavioral interventions.
abstract: BACKGROUND
  Behavioral 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.
  
  
  METHODS
  Data sources were searched for publications before May 2011.
  
  
  RESULTS
  Twelve 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.
  
  
  CONCLUSIONS
  Potential 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.
authors.affiliation: University of Twente, Department of Psychology, Health and Technology, PO Box 217, 7500 AE Enschede, The Netherlands. h.c.prenger@utwente.nl.
authors.forename: Rilana
authors.initials: R
authors.lastname: Prenger
authors.forename: Louise M
authors.initials: LM
authors.lastname: Braakman-Jansen
authors.forename: Marcel E
authors.initials: ME
authors.lastname: Pieterse
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.forename: Erwin R
authors.initials: ER
authors.lastname: Seydel