title: 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.
authors.affiliation: Department of Psychology, Health & Technology, University of Twente, The Netherlands.
authors.forename: Rilana
authors.initials: R
authors.lastname: Prenger
authors.affiliation: Department of Psychology, Health & Technology, University of Twente, The Netherlands.
authors.forename: Marcel E
authors.initials: ME
authors.lastname: Pieterse
authors.affiliation: Department of Psychology, Health & Technology, University of Twente, The Netherlands.
authors.forename: Louise M A
authors.initials: LM
authors.lastname: Braakman-Jansen
authors.affiliation: Centre for Nutrition, Prevention & Health Services Research, National Institute for Public Health & the Environment (RIVM), the Netherlands.|University Medical Center Groningen, University of Groningen, the Netherlands.
authors.forename: Talitha L
authors.initials: TL
authors.lastname: Feenstra
authors.affiliation: Department of Health Promotion, Maastricht University/ CAPHRI School for Public Health and Primary Care, The Netherlands.|Department of Communication Science, University of Amsterdam/Amsterdam School of Communication Research (ASCoR), The Netherlands.
authors.forename: Eline S
authors.initials: ES
authors.lastname: Smit
authors.affiliation: Department of Health Promotion, Maastricht University/ CAPHRI School for Public Health and Primary Care, The Netherlands.
authors.forename: Ciska
authors.initials: C
authors.lastname: Hoving
authors.affiliation: Department of Health Promotion, Maastricht University/ CAPHRI School for Public Health and Primary Care, The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
authors.affiliation: Department of Stochastic Operational Research, University of Twente, The Netherlands.
authors.forename: Jan-Kees
authors.initials: JK
authors.lastname: van Ommeren
authors.affiliation: Department of Health Services Research, Maastricht University/ CAPHRI School for Public Health and Primary Care, The Netherlands.|Trimbos Institute, Netherlands Institute of Mental Health and Addiction, the Netherlands.
authors.forename: Silvia M A A
authors.initials: SM
authors.lastname: Evers
authors.affiliation: Department of Research Methodology, Measurement & Data Analysis, University of Twente, The Netherlands.|Department of Epidemiology, Medical School Twente, Medisch Spectrum Twente, The Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
mesh_terms: D000328:Adult; D035843:Biomedical Research; D003071:Cognition; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016540:Smoking Cessation / Q000379:methods
keywords: behavior change; cognitions; cost-effectiveness analyses; modeling; self-efficacy