Are Financial Incentives Effective and Cost Effective in a 'Real Life' Smoking Cessation Program for Pregnant Women? A Phase IV 'Before and After' Study to Provide Evidence to Secure Long-Term Funding.

Objectives: The aim was to secure, long term, financial voucher incentives for pregnancy Stop Smoking Services. Objectives were integration without disruption, improved outcomes and cost-effectiveness assessment.

Design: Prospective phase IV non-randomised time-matched ‘before and after’ study.

Setting: Maternity Public Health Programme in the most deprived United Kingdom city.

Participants: Women who self-reported current smoking at first antenatal visit (a least 1 cigarette in last 7 days) and lived in National Health Service Greater Glasgow and Clyde Health Board area. 672 mostly white Caucasian women age ≥ 16 years were approached from Jan-Jun’18 pre-incentives and 739 from Jan-Jun’19 with incentives.

Interventions: Specialist advisers telephoned inviting an ‘engagement’ face-to-face appointment when a quit date was set. Dispensed through local pharmacies, free Nicotine Replacement Therapy was offered with weekly telephone counselling- Withdrawal-orientated Therapy-for 12 weeks. At 4, 12 (plus 24 weeks incentives period only), follow-up included self-report and Carbon Monoxide (CO) breath test. Incentive cards were topped-up with £ 20 for ‘engaging’, £ 40 at 4 and 12 weeks, and £ 60 at 24 weeks for CO-verified (<4 ppm) abstinence, total £ 160.

Primary outcomes: Engagement, cessation at 4 and 12 weeks, and Incremental Cost- Effectiveness Ratio (ICER) per 4 and 12-week quitter. Secondary outcomes included SSS signposting and 24-week cessation with incentives.

Results: Before incentives, 277/672 (41.2%) accepted support compared with 375/739 (50.7%) with incentives p<0.001, [difference 9.5% (95%CI 4.3%-14.7%)]. CO verified cessation increased from 52/672 (7.7%) to 83/739 (11.2%) p=0.032, [difference 3.5% (95%CI 0.4%-6.5%)] at 4 weeks and 35/672 (5.2%) to 59/739 (8.0%) p=0.047, [difference 2.8% (95%CI 0.2%-5.4%)] at 12 weeks. Offering incentives to 24 and 31 women produced one extra 4 and 12-week quitter. After 24 weeks, 34/739 (4.6%) remained abstinent with incentives. ICER was £ 517 and £ 546 per 4 and 12-week quitter.

Conclusions: Financial voucher incentives were integrated successfully; significantly increasing CO verified cessation at 4 and 12 weeks and was cost-effective.

Author(s): Elsie Too, Claire E Hastie , Nicola McMeekin , Geraldine Lucas and David M Tappin

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