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. 2023 Aug;118(8):1445-1456.
doi: 10.1111/add.16176. Epub 2023 Mar 15.

Financial incentives for quitting smoking in pregnancy: Are they cost-effective?

Nicola McMeekin  1 , Lesley Sinclair  2 , Lyn Robinson-Smith  2 , Alex Mitchell  2 , Linda Bauld  3 , David M Tappin  4 , Kathleen A Boyd  1
Affiliations

Financial incentives for quitting smoking in pregnancy: Are they cost-effective?

Nicola McMeekin et al. Addiction. 2023 Aug.

Abstract

Aims: To evaluate whether adding financial incentives to usual care is cost-effective in encouraging pregnant women to quit tobacco smoking, compared with usual care alone.

Design: Cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a health-care 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 life-time horizon.

Setting: Seven maternity smoking cessation sites in Scotland, England and Northern Ireland in the United Kingdom.

Participants: In the short-term analysis, CPIT III participants were assessed: women 16 years or older, self-reporting as smokers, fewer than 24 weeks pregnant and English-speaking (n = 944). The same population was used for the life-time analysis, plus their infants.

Measurements: Costs included financial incentive vouchers and postage, cessation support and nicotine replacement therapy and neonatal stays. The outcome measure was a biochemically verified quit rate for the CEA and quality-adjusted life-years (QALYs) for CUA. Costs are presented in 2020 GBP sterling (£). Data for the life-time analysis came from the trial and were combined with data from published literature embedded in the model, reporting incremental cost per quitter and QALY. A 3.5% discount rate was applied.

Findings: The short-term incremental cost per quitter was £4400 and cost per QALY was £150 000. Results of sensitivity analyses confirmed these results. The long-term analysis combined costs and outcomes for mother and infants; results showed a cost saving of £37 [95% confidence interval (CI]) = £35-106] and increase in QALYs of 0.171 (95% CI = 0.124-0.229). These findings indicate that, over a life-time, financial incentives are cost-saving and improve health outcomes.

Conclusions: In the United Kingdom, offering up to £400 financial incentives, in addition to usual care, to support pregnant women to stop smoking appears to be highly cost-effective over a life-time for mother and infants.

Keywords: Child health; cost-effectiveness analysis; economic evaluation; financial incentives; pregnancy; smoking cessation.

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Conflict of interest statement

CLINICAL TRIAL REGISTRATION

Trial registration number: ISRCTN15236311, date registered 09/10/2017 https://doi.org/10.1186/ISRCTN15236311.

Figures

FIGURE 1
FIGURE 1
Model structure (Jones et al. [36]).
FIGURE 2
FIGURE 2
Base‐case cost‐effectiveness plane and cost‐effectiveness acceptability curve.
FIGURE 3
FIGURE 3
Life‐time model cost‐effectiveness plane.
See this image and copyright information in PMC

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