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Addiction. 2016 Feb;111(2):360-70. doi: 10.1111/add.13160. Epub 2015 Nov 11.

Are financial incentives cost-effective to support smoking cessation during pregnancy?

Author information

1
Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK.
2
Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies, Stirling, UK.
3
Paediatric Epidemiology and Community Health Unit, University of Glasgow, Glasgow, UK.

Abstract

AIMS:

To investigate the cost-effectiveness of up to £400 worth of financial incentives for smoking cessation in pregnancy as an adjunct to routine health care.

DESIGN:

Cost-effectiveness analysis based on a Phase II randomized controlled trial (RCT) and a cost-utility analysis using a life-time Markov model.

SETTING:

The RCT was undertaken in Glasgow, Scotland. The economic analysis was undertaken from the UK National Health Service (NHS) perspective.

PARTICIPANTS:

A total of 612 pregnant women randomized to receive usual cessation support plus or minus financial incentives of up to £400 vouchers (US $609), contingent upon smoking cessation.

MEASUREMENTS:

Comparison of usual support and incentive interventions in terms of cotinine-validated quitters, quality-adjusted life years (QALYs) and direct costs to the NHS.

FINDINGS:

The incremental cost per quitter at 34-38 weeks pregnant was £1127 ($1716).This is similar to the standard look-up value derived from Stapleton & West's published ICER tables, £1390 per quitter, by looking up the Cessation in Pregnancy Incentives Trial (CIPT) incremental cost (£157) and incremental 6-month quit outcome (0.14). The life-time model resulted in an incremental cost of £17 [95% confidence interval (CI) = -£93, £107] and a gain of 0.04 QALYs (95% CI = -0.058, 0.145), giving an ICER of £482/QALY ($734/QALY). Probabilistic sensitivity analysis indicates uncertainty in these results, particularly regarding relapse after birth. The expected value of perfect information was £30 million (at a willingness to pay of £30 000/QALY), so given current uncertainty, additional research is potentially worthwhile.

CONCLUSION:

Financial incentives for smoking cessation in pregnancy are highly cost-effective, with an incremental cost per quality-adjusted life years of £482, which is well below recommended decision thresholds.

KEYWORDS:

Cost-effectiveness; financial incentives; pregnancy; smoking cessation

PMID:
26370095
DOI:
10.1111/add.13160
[Indexed for MEDLINE]

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