Financial Incentives for Quitting Smoking in Pregnancy: Are they cost-effective?

Abstract

ABSTRACTAimsTo evaluate whether adding financial incentives to usual care is cost-effective in encouraging pregnant women to quit tobacco smoking, compared to usual care alone.DesignCost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a healthcare provider’s perspective, embedded in the Smoking Cessation in Pregnancy Incentives Trial (CPIT III). Long-term analyses were conducted from the same perspective, using an existing Markov model over a lifetime horizon.SettingSeven maternity smoking cessation sites in Scotland, England and Northern Ireland in the United Kingdom.ParticipantsIn the short-term analysis CPIT III participants were assessed: women 16 years or older, self-reporting as smokers, less than 24 weeks pregnant and English speaking (n=944). The same population was used for the lifetime analysis, plus their infants.MeasurementsCosts include financial incentive vouchers and postage, cessation support and nicotine replacement therapy and neonatal stays. The outcome measure was biochemically verified quit rate for the CEA and quality adjusted life-years (QALY) for CUA. Costs are presented in 2020 GBP sterling (£).Data for the lifetime analysis came from the trial and was combined with data from published literature embedded in the model, reporting incremental cost per quitter and QALY. A 3.5% discount rate was applied.FindingsThe short-term incremental cost per quitter was £4,400, uncertainty in QALY gains resulted in a cost per QALY of £150,000. Results of sensitivity analyses confirm these results. The long-term analysis combined costs and outcomes for mother and infants, results show a cost saving of £37 (-£35 to £106) and increase in QALYs of 0.171 (0.124 to 0.229). These findings indicate that, over a lifetime, financial incentives are cost saving and improve health outcomes.ConclusionsOffering up to £400 financial incentives, in addition to usual care, to support pregnant women to stop smoking is cost-effective over a lifetime for mother and infants.EthicsEthics approval received from NHS West of Scotland Research Ethics Committee-2, August 2017.Registration detailsTrial registration number: ISRCTN15236311, date registered 09/10/2017 https://doi.org/10.1186/ISRCTN15236311