Are financial incentives cost-effective for smoking cessation amongst pregnant women?

Boyd, K.A. , Briggs, A.H. , Bauld, L., Sinclair, L. and Tappin, D. (2014) Are financial incentives cost-effective for smoking cessation amongst pregnant women? European Journal of Public Health, 24(S2), p. 146. (doi: 10.1093/eurpub/cku162.090)

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Background: Smoking during pregnancy causes over 2200 premature births and 5000 miscarriages in the UK every year. Treating mothers and their babies for problems caused by smoking during pregnancy costs the NHS £20-87million per annum. Evidence from the US has shown that financial incentives can promote smoking cessation in pregnancy, yet there is little evidence of this in the UK setting. We undertook a trial to investigate the effectiveness and cost-effectiveness of incentives for smoking cessation in pregnancy as an adjunct to routine health care (ISRCTN87508788). This abstract reports results on the potential cost-effectiveness of financial incentives for smoking cessation in pregnant women. Methods: An economic evaluation using data from a phase II RCT of 612 pregnant women in Glasgow, Scotland. Women were randomised to receive usual cessation support +/- financial incentives of up to £400 vouchers, contingent on smoking cessation. The primary outcome was cotinine validated quit at 34-38 weeks gestation. Trial data fed into a lifetime Markov model to compare the usual support and incentive intervention in terms of quitters, quality of life, survival and cost impacts. Results: The incremental cost per quitter at 34-38 weeks pregnant was £1127. The lifetime model resulted in an incremental cost of £17 (95% CI: -£93, £107) and a gain of 0.04 Quality Adjusted Life Years (QALYs) (95% CI: -0.058, 0.145), giving an ICER of £482/QALY. Probabilistic sensitivity analysis indicates uncertainty in these results, particularly regarding relapse post 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: The incremental cost per quitter is low and the incremental cost-effectiveness ratio (ICER) of £482/QALY is well below the recommended threshold of £20,000/QALY. However, considerable uncertainty remains regarding postnatal relapse. Smoking in pregnancy is the leading preventable cause of maternal and neonatal ill health and death in the UK. Existing interventions are not highly effective. This study provides substantial evidence on the cost-effectiveness of a very promising new intervention to add to existing NHS support.

Item Type:Articles
Additional Information:7th European Public Health Conference, Glasgow, UK, 19–22 November 2014
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:European Journal of Public Health
Publisher:Oxford University Press
ISSN (Online):1464-360X

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