Are financial incentives effective and cost-effective in a ‘real life’ smoking cessation program for pregnant women? A phase IV ‘before and after’ study to provide evidence to secure long-term funding.

Too, E., Hastie, C. E. , McMeekin, N., Lucas, G. and Tappin, D. M. (2021) Are financial incentives effective and cost-effective in a ‘real life’ smoking cessation program for pregnant women? A phase IV ‘before and after’ study to provide evidence to secure long-term funding. Journal of Womens Health and Reproductive Medicine, 5(4), 17.

Abstract

Objectives: The aim was to secure, long term, financial voucher incentives for pregnancy Stop Smoking Services. Objectives were integration without disruption, improved outcomes and cost-effectiveness assessment. Design: Prospective phase IV non-randomised time-matched ‘before and after’study. Setting: Maternity Public Health Programme in the most deprived United Kingdom city. Participants: Women who self-reported currentsmoking at first antenatal visit(a least 1 cigarette in last 7 days) and lived in National Health Service Greater Glasgow and Clyde Health Board area. 672 mostly white Caucasian women age ≥ 16 years were approached from Jan-Jun’18 pre-incentives and 739 from Jan-Jun’19 with incentives. Interventions: Specialist advisers telephoned inviting an ‘engagement’ face-to-face appointment when a quit date was set. Dispensed through local pharmacies, free Nicotine Replacement Therapy was offered with weekly telephone counselling-Withdrawal-orientated Therapy-for 12 weeks. At 4, 12 (plus 24 weeks incentives period only), follow-up included self-report and Carbon Monoxide (CO) breath test. Incentive cards were topped-up with £ 20 for‘engaging’, £ 40 at 4 and 12 weeks, and £ 60 at 24 weeksfor CO-verified (<4 ppm) abstinence,total £ 160. Primary outcomes: Engagement, cessation at 4 and 12 weeks, and Incremental Cost-Effectiveness Ratio (ICER) per 4 and 12-week quitter. Secondary outcomes included SSS signposting and 24-week cessation with incentives. Results: Before incentives, 277/672 (41.2%) accepted support compared with 375/739 (50.7%) with incentives p<0.001, [difference 9.5% (95%CI 4.3%-14.7%)]. CO verified cessation increased from 52/672 (7.7%) to 83/739 (11.2%) p=0.032, [difference 3.5% (95%CI 0.4%-6.5%)] at 4 weeks and 35/672 (5.2%) to 59/739 (8.0%) p=0.047, [difference 2.8% (95%CI 0.2%-5.4%)] at 12 weeks. Offering incentives to 24 and 31 women produced one extra 4 and 12-week quitter. After 24 weeks, 34/739 (4.6%) remained abstinent with incentives. ICER was £ 517 and £ 546 per 4 and 12-week quitter. Conclusions: Financial voucher incentives were integrated successfully; significantly increasing CO verified cessation at 4 and 12 weeks and was cost-effective.

• Item Type: Articles
• Additional Information: Funding: The service development of adding financial incentive payments to current pregnancy SSS services was provided by NHS Greater Glasgow and Clyde Endowments Committee. This service evaluation was not supported by a grant and was undertaken by ET as the Masters degree project for the Masters degree in Public Health at Glasgow University.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Hastie, Dr Claire and Mcmeekin, Dr Nicola and Tappin, Professor David
• Authors: Too, E., Hastie, C. E., McMeekin, N., Lucas, G., and Tappin, D. M.
• 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 Health & Wellbeing > Public Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Womens Health and Reproductive Medicine
• Publisher: iMedPub Ltd
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Journal of Womens Health and Reproductive Medicine 5(4):17
• Publisher Policy: Reproduced under a Creative Commons License

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