{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T10:48:56Z","timestamp":1782211736194,"version":"3.54.5"},"reference-count":45,"publisher":"Wiley","issue":"13-14","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Statistics in Medicine"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Sequential multiple assignment randomized trials (SMARTs) have grown in popularity in recent years, and many of their study protocols propose conducting a cost\u2010effectiveness analysis of the adaptive strategies embedded within them. The cost\u2010effectiveness of these regimes is often proposed to be assessed using incremental cost\u2010effectiveness ratios (ICERs). In this paper, we present an estimation and inference procedure for such cost\u2010effectiveness measures for the embedded dynamic treatment regimes within a SMART design. In particular, we describe a targeted maximum likelihood estimator for the ICER of a SMART's embedded regimes with influence curve\u2010based inference. We illustrate the performance of these methods using simulations. Throughout, we use as illustration a cost\u2010effectiveness analysis for the Adaptive Strategies for Preventing and Treating Lapses of Retention in HIV Care (ADAPT\u2010R; NCT02338739) trial, presenting estimated ICERs (with inference) for embedded regimes aimed at increasing HIV care adherence. This manuscript is one of the first to present cost\u2010effectiveness analysis results from a SMART.<\/jats:p>","DOI":"10.1002\/sim.70634","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T10:11:57Z","timestamp":1781086317000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness Analyses for Sequential Multiple Assignment Randomized Trials"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0975-4306","authenticated-orcid":false,"given":"Lina M.","family":"Montoya","sequence":"first","affiliation":[{"name":"School of Data Science and Society University of North Carolina at Chapel Hill  Chapel Hill NC USA"},{"name":"Department of Biostatistics University of North Carolina at Chapel Hill  Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvin H.","family":"Geng","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Washington University in St. Louis School of Medicine  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet F.","family":"Adhiambo","sequence":"additional","affiliation":[{"name":"Department of Child, Family, and Population Health Nursing University of Washington  Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliud","family":"Akama","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Starley B.","family":"Shade","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of California, San Francisco  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assurah","family":"Elly","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Odeny","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Missouri\u2010Kansas City  Kansas City MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya L.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Division of Biostatistics University of California, Berkeley  Berkeley CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.24324"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13142-014-0265-0"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDoa2200076"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-011-0038-4"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0010923"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/749718"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.2196\/11183"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-022-07025-x"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-019-2395-x"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-020-00990-4"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2023.107123"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-020-04573-y"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780195108248.001.0001"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2019.05.007"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0029372"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2019.105921"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2020.106089"},{"key":"e_1_2_14_19_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13012-018-0807-9","article-title":"Protocol for the ROSE Sustainment (ROSES) Study, a Sequential Multiple Assignment Randomized Trial to Determine the Minimum Necessary Intervention to Maintain a Postpartum Depression Prevention Program in Prenatal Clinics Serving Low\u2010Income Women","volume":"13","author":"Johnson J. 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