Annals of Behavioral Medicine

, Volume 37, Issue 2, pp 218–227 | Cite as

Costing Behavioral Interventions: A Practical Guide to Enhance Translation

  • Debra P. Ritzwoller
  • Anna Sukhanova
  • Bridget Gaglio
  • Russell E. Glasgow
Original Article



Cost and cost effectiveness of behavioral interventions are critical parts of dissemination and implementation into non-academic settings. Due to the lack of indicative data and policy makers’ increasing demands for both program effectiveness and efficiency, cost analyses can serve as valuable tools in the evaluation process.


To stimulate and promote broader use of practical techniques that can be used to efficiently estimate the implementation costs of behavioral interventions, we propose a set of analytic steps that can be employed across a broad range of interventions.


Intervention costs must be distinguished from research, development, and recruitment costs. The inclusion of sensitivity analyses is recommended to understand the implications of implementation of the intervention into different settings using different intervention resources. To illustrate these procedures, we use data from a smoking reduction practical clinical trial to describe the techniques and methods used to estimate and evaluate the costs associated with the intervention. Estimated intervention costs per participant were $419, with a range of $276 to $703, depending on the number of participants.


Cost effectiveness Behavioral interventions Intervention costs 


  1. 1.
    Glasgow RE, Emmons KM. How can we increase translation of research into practice? Annu Rev Pub Health. 2007; 281: 413–433.CrossRefGoogle Scholar
  2. 2.
    Grosse SD, Teutsch SM, Haddix C. Lessons from cost-effectiveness research for United States public health policy. Annu Rev Pub Health. 2007; 28: 365–391.CrossRefGoogle Scholar
  3. 3.
    Hoffmann C, Stoykova BA, Nixon J, et al. Do healthcare decision makers find economic evaluations useful? The findings of focus group research in UK health authorities. Value Health. 2002; 52: 71–78.PubMedCrossRefGoogle Scholar
  4. 4.
    Reinhardt UE. Making economic evaluations respectable. Soc Sci Med. 1997; 454: 555–562.PubMedCrossRefGoogle Scholar
  5. 5.
    Sloan FA, Whetten-Goldstein K, Wilson A. Hospital pharmacy decision, cost containment, and the use of cost-effectiveness analysis. Soc Sci Med. 1997; 454: 523–533.PubMedCrossRefGoogle Scholar
  6. 6.
    Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003.Google Scholar
  7. 7.
    Glasgow RE, Linnan L. Evaluation of theory-based Interventions. In: Glanz K, ed. Health Education: Theory, research and Practice. 4th ed. Hoboken, NJ: Jossey-Bass; 2007.Google Scholar
  8. 8.
    Ronckers ST, Groot W, Ament AJ. Systematic review of economic evaluations of smoking cessation: Standardizing the cost-effectiveness. Med Decis Making. 2005; 254: 437–438.PubMedCrossRefGoogle Scholar
  9. 9.
    Cromwell J, Bartosch WJ, Fiore MC, et al. Cost-effectiveness of the clinical practice recommendations in the AHCPR Guideline for Smoking Cessation. JAMA. 1997; 27821: 1759–1766.PubMedCrossRefGoogle Scholar
  10. 10.
    Coffield AB, Maciosek Mv, McGinnis JM, et al. Priorities among recommended clinical preventive services. Am J Prev Med. 2001; 211: 1–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Fiscella K, Franks P. Cost-effectiveness of the transdermal nicotine patch as an adjunct to physicians’ smoking cessation counseling. JAMA. 1996; 27516: 1247–1251.PubMedCrossRefGoogle Scholar
  12. 12.
    Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in health and medicine. New York: Oxford University Press; 2003.Google Scholar
  13. 13.
    Hurley SF, Matthews JP. The Quit Benefits Model: A Markov model for assessing the health benefits and health care cost savings of quitting smoking. Cost Eff Resour Allocation. 2007; 235: 2.CrossRefGoogle Scholar
  14. 14.
    Cornuz J, Gilbert A, Pinget C, et al. Cost-effectiveness of pharmacotherapies for nicotine dependence in primary care settings: A multinational comparison. Tob Cont. 2006; 153: 152–159.CrossRefGoogle Scholar
  15. 15.
    Tomson T, Helgason AR, Gilljam H. Quitline in smoking cessation: A cost-effectiveness analysis. Int J Technol Assess Health Care. 2004; 204: 469–474.PubMedCrossRefGoogle Scholar
  16. 16.
    Lennox AS, Osman LM, Reiter E, et al. Cost effectiveness of computer tailored and non-tailored smoking letters in general practice: Randomised controlled trial. BMJ. 2001; 3227299: 1396.PubMedCrossRefGoogle Scholar
  17. 17.
    Buck DJ, Richmond RL, Mendelsohn CP. Cost-effectiveness analysis of a family physician delivered smoking cessation program. Prev Med. 2000; 316: 641–648.PubMedCrossRefGoogle Scholar
  18. 18.
    Glasgow RE, Klesges LM, Dzewaltowski DA, et al. The future of health behavior change research: What is needed to improve translation of research into health promotion practice? Ann Behav Med. 2004; 271: 3–12. PMID 14979358.PubMedCrossRefGoogle Scholar
  19. 19.
    Centers for Disease Control. The Guide to Community Preventive Services. Available at http://thecommunityguide org. Accessibility verified December 15, 2008.
  20. 20.
    Kaplan RM, Groessl EJ. Applications of cost-effectiveness methodologies in behavioral medicine. J Consult Clin Psychol. 2002; 703: 482–493.PubMedCrossRefGoogle Scholar
  21. 21.
    Diabetes Prevention Program Research Group. Available at 2007; Accessibility verified 6/11/08.
  22. 22.
    The Diabetes Prevention Program Research Group. Costs associated with the primary prevention of type 2 diabetes mellitus in the Diabetes Prevention Program. Diabetes Care. 2003; 26: 36–47.CrossRefGoogle Scholar
  23. 23.
    Meenan RT, Stevens VJ, Hornbrook MC, et al. Cost-effectiveness of a hospital-based smoking-cessation intervention. Med Care. 1998; 365: 670–678.PubMedCrossRefGoogle Scholar
  24. 24.
    Ritzwoller DP, Toobert D, Sukhanova A, Glasgow RE. Economic analysis of the Mediterranean Lifestyle Program for Postmenopausal women with diabetes. Diabetes Educ. 2006; 325: 761–769. PMID 16971709.PubMedCrossRefGoogle Scholar
  25. 25.
    Koriat A. How do we know that we know? The accessibility model of the feelling of knowing. Psychol Rev. 1993; 1004: 609–639.PubMedCrossRefGoogle Scholar
  26. 26.
    Newport DJ, Brennan PA, Green P, et al. Maternal depression and medication exposure during pregnancy: Comparison of maternal recall to prospective documentation. Psychol Rev. 1993; 1004: 609–639.CrossRefGoogle Scholar
  27. 27.
    Bradburn N, Rips L, Shevell S. Answering autobiographic questions: The impacto memory and inference on surveys. Science, New Series. 1987; 2364798: 157–161.Google Scholar
  28. 28.
    Levinson AH, Glasgow RE, Gaglio B, et al. Tailored behavioral support for smoking reduction: Development and pilot results of an innovative intervention. Health Educ Res. 2008; 232: 335–346. Apr.PubMedCrossRefGoogle Scholar
  29. 29.
    Shiffman S, Gitchell JG, Warner KE, et al. Tobacco harm reduction: conceptual structure and nomenclature for analysis and research. Nicotine Tob Res. 2002; 4Suppl 2: S113–S129.PubMedCrossRefGoogle Scholar
  30. 30.
    Tunis SR, Stryer DB, Clancey CM. Practical clinical trials. Increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003; 290: 1624–1632.PubMedCrossRefGoogle Scholar
  31. 31.
    Glasgow RE, Magid DJ, Beck A, et al. Practical clinical trials for translating research to practice: Design and measurement recommendations. Med Care. 2005; 436: 551–557. PMID 15908849.PubMedCrossRefGoogle Scholar
  32. 32.
    Glasgow RE, Fisher L, Skaff M, et al. Problem-solving and diabetes self-management: Investigation in a large, multi-racial sample. Diabetes Care. 2007; 301: 33–37.PubMedCrossRefGoogle Scholar
  33. 33.
    Bureau of Labor Statistics. Available at Accessibility verified 11/05/07.
  34. 34.
    Keller PA, Bailey LA, Koss KJ, et al. Organization, financing, promotion, and cost of U.S. Quitlines, 2004. Am J Prev Med. 2007; 321: 32–37.PubMedCrossRefGoogle Scholar
  35. 35.
    Fishman PA, Thompson E, Merikle E, Curry SJ. Changes in health care costs before and after smoking cessation. Nicotine Tob Res. 2006; 83: 393–401.PubMedCrossRefGoogle Scholar
  36. 36.
    Fishman PA, Khan ZM, Thompson EE, Curry SJ. Health care costs among smokers, former smokers, and never smokers in an HMO. Health Serv Res. 2003; 382: 733–749.PubMedCrossRefGoogle Scholar
  37. 37.
    Cutler TW, Palmieri J, Khalsa M, Stebbins M. Evaluation of the relationship between a chronic disease care management program and California pay-for-performance diabetes care cholesterol measures in one medical group. J Manage Care Pharm. 2007; 137: 578–588.Google Scholar

Copyright information

© The Society of Behavioral Medicine 2009

Authors and Affiliations

  • Debra P. Ritzwoller
    • 1
  • Anna Sukhanova
    • 1
  • Bridget Gaglio
    • 1
  • Russell E. Glasgow
    • 1
  1. 1.Institute for Health ResearchKaiser Permanente ColoradoDenverUSA

Personalised recommendations