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Article in Journal ()

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

Citation
Boyd K, Briggs A, Bauld L, Sinclair L & Tappin D (2016) Are financial incentives cost-effective to support smoking cessation during pregnancy?, Addiction, 111 (2), pp. 360-370.

Abstract
Aims 

To investigate the cost-effectiveness of up to £400 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 £400 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 £1127 ($1716).This is similar to the standard look-up value derived from Stapleton & West's published ICER tables, £1390 per quitter, by looking up the Cessation in Pregnancy Incentives Trial (CIPT) incremental cost (£157) and incremental 6-month quit outcome (0.14). The life-time model resulted in an incremental cost of £17 [95% confidence interval (CI) = –£93, £107] and a gain of 0.04 QALYs (95% CI = –0.058, 0.145), giving an ICER of £482/QALY ($734/QALY). Probabilistic sensitivity analysis indicates uncertainty in these results, particularly regarding relapse after birth. The expected value of perfect information was £30 million (at a willingness to pay of £30 000/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 £482, which is well below recommended decision thresholds.

Keywords
Cost-effectiveness; financial incentives; pregnancy; smoking cessation

StatusPublished
AuthorsBoyd Kathleen, Briggs Andrew, Bauld Linda, Sinclair Lesley, Tappin David
Publication date02/2016
Publication date online11/11/2015
Date accepted by journal07/09/2015
PublisherWiley-Blackwell for Society for the Study of Addiction
ISSN 0965-2140
LanguageEnglish

Journal
Addiction: Volume 111, Issue 2

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