Behaviour Change Update: Stage 3. BCT analysis of behaviour change interventions reported in studies of cost effectiveness
2013
Using a search strategy of studies with economic analyses by Bazian, 251
interventions targeting smoking cessation, diet, physical activity, sexual
health, alcohol and multiple health-related behaviours were identified. Of
these, 102 provided cost-utility (CUA) estimates and 85.3% were
considered to be cost-effective based on a conservative NICE threshold.
Overall, smoking cessation interventions provided lower CUA values and
were more likely to be cost-effective than interventions for multiple
health-related behaviours. Across all interventions, those targeting the
general population had lower CUA results and were more likely to be costeffective
than those aimed at vulnerable populations. In addition,
interventions featuring behaviour change techniques (BCTs) related to
“Reduce negative emotions” had higher CUA values and those featuring
the BCT “Monitoring outcome(s) of behaviour by others without feedback”
were less likely to be cost-effective.
When looking at health-related behaviours separately, diet interventions
that provided medication only had higher CUA outcomes than other types
of diet interventions. Moreover, diet interventions including BCTs related
to “Comparison of outcomes” and interventions for multiple health-related
behaviours that used electronic supporting material were less likely to be
cost-effective than interventions that did not.
Cost-effective interventions included in this report had CUA estimates
broadly similar to interventions already appraised as cost-effective by NICE
(reported in Stage 1). However, a higher proportion of interventions in this
report focused on multiple health-related behaviours, were set in primary
care, aimed at vulnerable populations, involved training and included BCTs
pertaining to practical and social support and to discussing body changes.
By contrast, fewer interventions than in Stage 1 focused on alcohol, were
set in the work place, delivered at population level, used self-help material
or incentives, and featured ‘choice architecture’ (CA). In general,
interventions in this report served fewer functions, covered fewer BCT
clusters and included fewer individual BCTs compared with Stage 1
interventions. Based on the present analysis, there is no consistent and
little association between the presence of an individual BCT or BCT cluster
and an intervention being considered cost-effective.
These findings need to be interpreted cautiously given 1) different search
strategies for this and the Stage 1 report, 2) reliance on incomplete
information in published papers, 3) heterogeneity in economic analyses, 4)
lack of consensus for a definition of CA and 5) bias in reporting of study
findings.
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