title: Are financial incentives cost-effective to support smoking cessation during pregnancy?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cost-effectiveness analysis based on a Phase II randomized controlled trial (RCT) and a cost-utility analysis using a life-time Markov model.
  
  
  METHODS
  The RCT was undertaken in Glasgow, Scotland. The economic analysis was undertaken from the UK National Health Service (NHS) perspective.
  
  
  METHODS
  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.
  
  
  METHODS
  Comparison of usual support and incentive interventions in terms of cotinine-validated quitters, quality-adjusted life years (QALYs) and direct costs to the NHS.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Boyd
authors.affiliation: Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Briggs
authors.affiliation: Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies, Stirling, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Bauld
authors.affiliation: Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies, Stirling, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Sinclair
authors.affiliation: Paediatric Epidemiology and Community Health Unit, University of Glasgow, Glasgow, UK.
authors.forename: David
authors.initials: D
authors.lastname: Tappin
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006293:Health Promotion / Q000191:economics / Q000379:methods; D006801:Humans; D008390:Markov Chains; D009042:Motivation; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000517:prevention & control*; D011295:Prenatal Care / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D012606:Scotland; D012907:Smoking / Q000191:economics; D016540:Smoking Cessation / Q000191:economics*; D000074606:Smoking Prevention
keywords: Cost-effectiveness; financial incentives; pregnancy; smoking cessation