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

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.