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

Addiction. 2016 Feb;111(2):360-70. doi: 10.1111/add.13160. Epub 2015 Nov 11.


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.

Publication types

  • Clinical Trial, Phase II
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost-Benefit Analysis
  • Female
  • Health Promotion / economics
  • Health Promotion / methods
  • Humans
  • Markov Chains
  • Motivation*
  • Pregnancy
  • Pregnancy Complications / economics
  • Pregnancy Complications / prevention & control*
  • Prenatal Care / economics*
  • Prenatal Care / methods
  • Quality-Adjusted Life Years
  • Scotland
  • Smoking / economics
  • Smoking Cessation / economics*
  • Smoking Prevention*