Behavioral interventions and cost-effectiveness analysis

Cost-effectiveness of enhancing a Quit-and-Win smoking cessation program for college students

OBJECTIVES

We conducted a cost-effectiveness analysis and model-based cost-utility and cost-benefit analysis of increased dosage (3 vs. 1 consecutive contests) and enhanced content (supplemental smoking-cessation counseling) of the Quit-and-Win contest using data from a randomized control trial enrolling college students in the US.

METHODS

For the cost-utility and cost-benefit analyses, we used a microsimulation model of the life course of current and former smokers to translate the distribution of the duration of continuous abstinence among each treatment arm's participants observed at the end of the trial (N = 1217) into expected quality-adjusted life-years (QALYs) and costs and an incremental net monetary benefit (INMB). Missing observations in the trial were classified as smoking. For our reference case, we took a societal perspective and used a 3% discount rate for costs and benefits. A probabilistic sensitivity analysis (PSA) was performed to account for model and trial-estimated parameter uncertainty. We also conducted a cost-effectiveness analysis (cost per additional intermediate cessation) using direct costs of the intervention and two trial-based estimates of intermediate cessation: (a) biochemically verified (BV) 6-month continuous abstinence and (b) BV 30-day point prevalence abstinence at 6 months.

RESULTS

Multiple contests resulted in a significantly higher BV 6-month continuous abstinence rate (RD 0.04), at a cost of $1275 per additional quit, and increased the duration of continuous abstinence among quitters. In the long run, multiple contests lead to an average gain of 0.03 QALYs and were cost saving. Incorporating parameter uncertainty into the analyses, the expected INMB was greater than $1000 for any realistic willingness to pay (WTP) for a QALY.

CONCLUSIONS

Assuming missing values were smoking, multiple contests appear to dominate a single contest from a societal perspective. Funding agencies seeking to promote population health by funding a Quit-and-Win contest in a university setting should strongly consider offering multiple consecutive contests. Further research is needed to evaluate multiple contests compared to no contest.

Planning a Change Easily (PACE): A randomized controlled trial for smokers who are not ready to quit

Smoking cessation programs are efficacious and have been validated to assist the 10% to 30% of smokers who are ready to quit in the next 30 days. While the majority of smokers want to quit smoking in the future, only 69% are planning to quit within the next year. Planning a Change Easily (PACE) is a nation-wide, telephone-based comparative effectiveness, randomized controlled trial for smokers not ready to quit (SNRTQ). This project, as well as its intervention components, outcomes, and hypotheses are discussed. This study will compare the effectiveness of four intervention conditions that could potentially help SNRTQ to quit smoking: Brief Advice, Motivational Interviewing, Rate Reduction, and Motivational Interviewing plus Rate Reduction combined. Rate Reduction conditions will include the provision of nicotine replacement therapy in the form of gum. Approximately 840 participants will be recruited and randomized to the four intervention conditions. The main outcomes for this study include self-report prolonged and point prevalence abstinence with biochemical verification of cessation. Secondary outcomes include quit attempts, cost-per-quit, and cost-effectiveness analyses. Informed by evidenced-based interventions, strong clinical guidelines, and economic analysis, PACE has the potential for significant public health impact. Results could readily be disseminated and translated to tobacco quitlines, which are present in all 50 states and are offered free to the public.

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

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.

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%.

CONCLUSION

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.

What are consulting services worth?: applying cost analysis techniques to evaluate effectiveness

Occupational health nurse consultants, whether internal or external to the organization, must document the benefit and effectiveness of services provided. In today's business environment, it is imperative that occupational health nurse consultants demonstrate their contribution to the corporate business mission and goals. Both qualitative and quantitative methods provide appropriate techniques that can be used for this purpose. These techniques measure value in monetary terms such as cost-benefit and cost-effective analysis tools, as well as through interviews, focus groups, and case examples. Regardless of how skillfully a service is provided, the value must be demonstrated, documented, and effectively communicated.

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

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.

Conclusion

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.

A case study identifying disease risk factor prevalence in government office workers in Queensland, Australia

Purpose

The purpose of this paper is to identify health and physical activity status and prevalence of chronic diseases risk factors in a sample of Government office employees.

Design/methodology/approach

Quantitative assessment of various health and physical activity measures including blood pressure, BMI, waist‐to‐hip ratio, cholesterol, blood glucose and physical activity in adult male (n=66; age=42 ±9 years) and female (n=262; age=40 ±10 years) Government office employees located in metropolitan, rural and remote areas of central and northern Queensland.

Findings

It was found that 54 per cent of females and 77 per cent of males were classified as overweight or obese, while 38 per cent of all participants did not participate in sufficient weekly physical activity. Metropolitan females reported significantly higher blood glucose levels and diastolic blood pressure but significantly lower waist‐to‐hip ratio than rural and remote females.

Research limitations/implications

There was uneven sampling across geographical locations, however the sample size of each group was largely indicative of the workforce in each location.

Practical implications

There is a large prevalence of chronic disease risk factors in male and female Government office employees working throughout metropolitan, rural and remote areas of central and northern Queensland. Workplace personnel should work to improve the health and physical activity status of employees, as this may have positive effects on workplace participation and productivity.

Originality/value

This study provides insight into the prevalence of chronic disease risk factors in Government office workers undertaking similar work duties across a variety of geographical locations, and provides suggestions for workplace interventions.

What are consulting services worth? Applying cost analysis techniques to evaluate effectiveness

1. Occupational health nurse consultants, whether independent consultants or in house occupational health nurses acting as consultants to management and employees, need to document the benefit and effectiveness of programs provided. 2. Occupational health nurse consultants must demonstrate that occupational health and safety services contribute to the achievement of the overall corporate mission and goals. 3. While the value of these services are intrinsic to the occupational health nurse, they must be translated into business or monetary terms in order to be communicated to corporate managers. Cost benefit analysis and cost effective analysis are tools that can be utilized to evaluate and communicate the business value of occupational health and safety services.