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

Boyd, K. A. , Briggs, A. H. , Bauld, L., Sinclair, L. and Tappin, D. (2016) Are financial incentives cost-effective to support smoking cessation during pregnancy? Addiction, 111(2), pp. 360-370. (doi: 10.1111/add.13160) (PMID:26370095)

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 healthcare. DESIGN: Cost-effectiveness analysis based on a phase II RCT and a cost-utility analysis using a lifetime Markov model. SETTING: The RCT was undertaken in Glasgow, Scotland. The economic analysis was undertaken from the UK NHS perspective. PARTICIPANTS: 612 pregnant women randomised to receive usual cessation support +/- financial incentives of up to £400 vouchers ($609 USD), contingent on smoking cessation. MEASUREMENTS: Comparison of usual support and incentive interventions in terms of cotinine validate 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 & Wests published ICER tables (72), £1390 per quitter, by looking-up the CPIT trial incremental cost (£157) and incremental 6 month quit outcome (0.14). The lifetime model resulted in an incremental cost of £17 (95% 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 QALY of £482, which is well below recommended decision thresholds. This article is protected by copyright. All rights reserved.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Tappin, Professor David and Sinclair, Ms Lesley and Briggs, Professor Andrew and Boyd, Professor Kathleen
• Authors: Boyd, K. A., Briggs, A. H., Bauld, L., Sinclair, L., and Tappin, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Addiction
• Publisher: Wiley-Blackwell Publishing Ltd.
• ISSN: 1360-0443
• ISSN (Online): 1360-0443
• Copyright Holders: Copyright © 2016 Wiley-Blackwell Publishing Ltd.
• First Published: First published in Addiction 111(2):360-370
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher.