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

Data sources were searched for publications before May 2011.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.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.Resources in health care are generally limited. Consequently, funding priorities have to be set, preferably based on information that concerns the effectiveness and efficiency of available alternatives. In the health care systems in developed countries, cost-effectiveness analyses (CEAs) have become an accepted method to assess and improve the efficiency of pharmaceutical treatments [1,2] as in the field of health psychology and health promotion.Performing a CEA on a health promotion intervention, however, has some implications for the CEA methodology, compared to pharmaceutical interventions. Generally, health promotion interventions are designed to accomplish behavior change. CEAs of these interventions typically focus on objective behavioral data, i.e. physical endpoints like weight loss or biochemically validated smoking cessation [3,4]. In reality, though, behavior change is a complex process in which several steps towards success are taken, including changes in cognitive antecedents of behavior. Any progress in behavior change without accomplishing full behavior change may also be considered as a beneficial outcome of an intervention, assuming t