Setting Standards for Economic Analyses for Behavioral Interventions

Systematic standardized methodologies for valuing health outcomes are increasingly available, but are not commonly used in health psychology and behavioral medicine.

A special section in the August 2019 issue of Health Psychology addresses how researchers can utilize standardized methodologies to evaluate the cost-effectiveness of both clinical and nonclinical interventions in health psychology and behavioral medicine.

Dawn K. Wilson, Paul B. Jacobsen, and Robert M. Kaplan discuss the special section.

What is this special section about?

Systematic standardized methodologies for valuing health outcomes are available and are being applied by economists and health services researchers but are not widely used in health psychology and behavioral medicine.

In the August 2019 issue of Health Psychology, three papers address these issues.

The first paper provides an overview of standardizing methods for conducting cost-effectiveness and cost-utility analyses. The second paper provides examples to illustrate progress in applying these methods to evaluate interventions delivered in whole or in part in clinical settings. The third paper offers nonclinical intervention examples, selected to highlight the challenges and opportunities for evaluating the cost-effectiveness of interventions in more diverse settings.

What is the significance of this special section?

Behavioral interventions can be offered within a wide range of contexts, including public health, medicine, surgery, physical rehabilitation, nutrition, and other health services. These differing services compete for the same resources, but decision makers have trouble comparing them because the value of programs is measured using different metrics.

The ability of our field to communicate cost-effectiveness data using standardization of methods to policy makers, employers, and insurers that incorporates implementation costs is central to the likelihood of behavioral interventions being adopted by practitioners and reimbursed by payers.

Given the escalating costs of health care, health psychologists and behavioral medicine researchers are in a unique position to contribute to the collective understanding of how best to deliver high-quality, cost-effective health care and promote health across a broad range of interventions in highly diverse clinical and nonclinical environments.

How did this special section come about?

With support from the Society for Health Psychology, the National Cancer Institute, and the Office for Behavioral and Social Sciences Research at the National Institutes of Health, two working groups held meetings to consider the use of well-established cost-effectiveness methodologies for the evaluation of behavioral and public health interventions.

The working groups paid particular attention to patient populations with chronic disease diagnoses and comorbid mental health problems. The combination of chronic illness and a mental health problem is an important risk factor for high expenditure.

Early in the first meeting, the group considered the many factors that affect human health. The group concluded that it would be important to consider a wide array of factors including behavioral, social, and environmental influences that are now known to influence health outcomes.

Tell us a few key takeaways.

In order to make better use of scarce resources, cost-effectiveness methodologies have been developed to evaluate how to produce the most health within the constraints of available resources.

Application of standardized methods of cost-effectiveness analysis will allow for direct comparisons between investing in behavioral interventions programs in comparison to a wide range of other alternatives. The methods are general and can be used to estimate the cost-effectiveness of social and environmental interventions in addition to traditional medical and surgical treatments.

Collaborative care has been widely studied from an economic perspective, with most studies demonstrating its relative cost-effectiveness per quality-adjusted life year and some studies demonstrating its potential for cost neutrality or cost savings.

The success of collaborative care for depression can be viewed as a model for how to promote greater adoption of other interventions, such as psychological therapies for chronic pain and insomnia.

Nonclinical settings are defined as those involving systems outside of traditional medical/clinical settings, and include interventions tested in clinical settings that can also be implemented in nonclinical settings.

The examples in this paper reflect the use of a varying degree of existing cost-effectiveness data and previous health economic analyses and include examples of the Chronic Disease Self-Management Program model, tobacco quitlines (e.g., National Tobacco Quit Line), and environmental interventions for promoting walking and physical activity in community-based contexts (e.g., PATH trial).

What are some practical implications of the article in this special section?

Founding figures in Western medicine both puzzled over and anticipated a day when demand for expensive treatments would outstrip financial resources. In the United States, that day has arrived and, with it, the need for sound health care economic policy that selectively covers treatments of demonstrable effectiveness and efficiency.

Standard cost-effectiveness methods can be applied to determine the value of alternative treatments, but they have rarely been applied to behavioral interventions in the United States.

Stepping up the availability of economic data relevant to behavioral interventions has the potential to impact utilization, insurance coverage, and policymaker decision making pertaining to the integration of behavioral interventions in our increasingly fragmented health care system.

Employing modern standardized economic evaluation methods will figure prominently in the field’s future growth, relevance, access, and uptake.

Citation

• Wilson, D. K., Christensen, A., Jacobsen, P. B., & Kaplan, R. M. (2019). Standards for economic analyses of interventions for the field of health psychology and behavioral medicine. Health Psychology, 38(8), 669–671.

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