Are financial incentives cost-effective to support smoking cessation during pregnancy?

AimsTo investigate the cost-effectiveness of up to 400 worth of financial incentives for smoking cessation in pregnancy as an adjunct to routine health care. DesignCost-effectiveness analysis based on a Phase II randomized controlled trial (RCT) and a cost-utility analysis using a life-time Markov model. SettingThe RCT was undertaken in Glasgow, Scotland. The economic analysis was undertaken from the UK National Health Service (NHS) perspective. ParticipantsA total of 612 pregnant women randomized to receive usual cessation support plus or minus financial incentives of up to 400 vouchers (US $609), contingent upon smoking cessation. MeasurementsComparison of usual support and incentive interventions in terms of cotinine-validated quitters, quality-adjusted life years (QALYs) and direct costs to the NHS. FindingsThe incremental cost per quitter at 34-38 weeks pregnant was 1127 pound ($1716).This is similar to the standard look-up value derived from Stapleton & West's published ICER tables, 1390 pound per quitter, by looking up the Cessation in Pregnancy Incentives Trial (CIPT) incremental cost (157) pound and incremental 6-month quit outcome (0.14). The life-time model resulted in an incremental cost of 17 pound [95% confidence interval (CI)=-93 pound, 107] pound and a gain of 0.04 QALYs (95% CI=-0.058, 0.145), giving an ICER of 482 pound/QALY ($734/QALY). Probabilistic sensitivity analysis indicates uncertainty in these results, particularly regarding relapse after birth. The expected value of perfect information was 30 pound million (at a willingness to pay of 30000 pound/QALY), so given current uncertainty, additional research is potentially worthwhile. ConclusionFinancial incentives for smoking cessation in pregnancy are highly cost-effective, with an incremental cost per quality-adjusted life years of 482 pound, which is well below recommended decision thresholds.