Are financial incentives cost effective to support smoking cessation during pregnancy?
AIMS To investigate the cost effectiveness of up to PS400 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 PS400 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 PS1127 $1716).This is similar to the standard look up value derived from Stapleton West's published ICER tables, PS1390 per quitter, by looking up the Cessation in Pregnancy Incentives Trial (CIPT) incremental cost (PS157) and incremental 6 month quit outcome (0.14) The life time model resulted in an incremental cost of PS17 [95% confidence interval (CI) PS93, PS107] and a gain of 0.04 QALYs (95% CI 0.058, 0.145) giving an ICER of PS482/QALY $734/QALY) Probabilistic sensitivity analysis indicates uncertainty in these results, particularly regarding relapse after birth. The expected value of perfect information was PS30 million (at a willingness to pay of PS30 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 PS482, which is well below recommended decision thresholds.
Addiction