Professor David M Tappin, Professor Linda Bauld, Dr Kathleen Anne Boyd, Professor Andrew H Briggs and Ms Lesley Sinclair
Presenter(s)
Professor Linda Bauld Professor of Health Policy and Director of the Institute for Social Marketing, University of Stirling and Deputy Director, UK Centre for Tobacco and Alcohol Studies.
Dr Kathleen Anne Boyd Lecturer (Health Economics), Health Economics and Health Technology Assessment Unit, University of Glasgow
Abstract
Introduction
Small trials in the USA have shown that financial incentives for smoking cessation in pregnancy can be effective, but further evidence is required. This study aimed to explore whether adding incentives to existing services is effective, acceptable and cost-effective (ISRCTN87508788).
Methods
A phase II RCT compared standard smoking cessation support for pregnant smokers with standard support plus shopping voucher incentives up to £400, contingent on smoking cessation. Participants (n=612) were pregnant smokers identified at maternity booking in Glasgow, UK. The primary outcome was self-reported abstinence in late pregnancy verified by cotinine. A lifetime Markov model was used to compare trial arms in terms of incremental cost per quitter and incremental cost per QALY.
Results
The offer of vouchers increased the quit rate at the end of pregnancy from 9% to 23%. The incremental cost per quitter at 34-38 weeks pregnant was £1127. The lifetime model resulted in an incremental cost of £17 (95% CI: -£93, £107) and 0.04 QALY gains (95% CI: -0.058, 0.145), giving an ICER of £482/QALY.
Conclusion
Financial incentives may double the quit rate when added to stop smoking in pregnancy services. The incremental cost per quitter of this intervention is well below the NICE threshold of £20,000/QALY.
Source of funding: Chief Scientist Office Scotland, Glasgow Centre for Population Health, and Greater Glasgow & Clyde Health Board
