Cost-effectiveness of a voucher-based intervention for smoking cessation

Background: Contingency management (CM) has been shown to be effective in reducing smoking consumption, but has traditionally been criticized for its costs. Objectives: This study assessed the cost-effectiveness of using a voucher-based CM protocol added to a cognitive behavioral treatment (CBT) for smoking cessation among treatment-seeking patients from the general population. Methods: A total of 92 patients were randomly assigned to CBT or CBT plus CM for abstinence. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the increase in costs by the increase in effects (continuous abstinence, longest duration of abstinence at 6-month follow-up and cotinine results during the treatment). An acceptability curve illustrated the statistical uncertainty surrounding the cost-effectiveness estimate. We also determined the optimum cost per participant for predicting the smoking status at 6-month follow-up. Results: The average cost per participant in the CBT condition was Euro138.73 (US$ 150.23) as opposed to Euro411.61 (US$ 445.73) in the CBT plus CM condition (p < 0.01). The incremental cost of using voucher-based CM to increase the number of participants that maintained abstinence at 6-month follow-up by one extra participant was Euro68.22 (US$ 73.88), and to lengthen the longest duration of abstinence by 1 week was Euro53.92 (US$ 58.39). The incremental cost to obtain an extra cotinine-negative result was Euro181.90 (US$ 196.98). Conclusion: Compared with CBT alone, the voucher-based protocol required additional costs but achieved significantly better outcomes. These results will allow stakeholders to make policy decisions about CM implementation for smoking cessation in the broader community.