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Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Are financial incentives cost-effective to support smoking cessation during pregnancy?
Author(s): Boyd, Kathleen
Briggs, Andrew
Bauld, Linda
Sinclair, Lesley
Tappin, David
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Keywords: Cost-effectiveness
financial incentives
smoking cessation
Issue Date: Feb-2016
Date Deposited: 17-Jul-2016
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.
DOI Link: 10.1111/add.13160
Rights: This item has been embargoed for a period. During the embargo please use the Request a Copy feature at the foot of the Repository record to request a copy directly from the author. You can only request a copy if you wish to use this work for your own research or private study. This is the peer reviewed version of the following article: Boyd, K. A., Briggs, A. H., Bauld, L., Sinclair, L., and Tappin, D. (2016) Are financial incentives cost-effective to support smoking cessation during pregnancy? Addiction, 111: 360–370. doi:10.1111/add.13160, which has been published in final form at This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.

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