Offering smoking mothers-to-be a financial incentive to put down their cigarettes may not only be a successful approach but a cost-effective one as well. At least, that's the verdict handed down by a study published this November in the journal Addiction.

The study authors, after analyzing the results of a randomized trial of more than 600 Scottish pregnant smokers, found that the potential reward of a $600 voucher to quit smoking ultimately proved to be both a clinically and economically worthwhile treatment — accruing an incremental cost-effectiveness ratio (ICER) of $734 per quality-adjusted life year (QUALY). According to the authors, these costs are well below the recommended threshold of money that should be spent on a preventative treatment capable of providing a person with a healthy year of life — in the UK, that’s £20 000 ($30,000 US), a standard comparable with other high-income countries like the US.

Meanwhile, when compared to a control group, the women offered a voucher were able to abstain from smoking during pregnancy at more than twice the rate (22.5 percent to 8.6 percent), and their self-reported relapse rates six months after pregnancy were lower as well (33 percent vs 54 percent). “Existing interventions for pregnant smokers are not highly effective; however, this study provides substantial evidence on the cost-effectiveness of a financial incentives intervention to add to existing cessation support,” the authors wrote.

The researchers divided the women into two groups, both given the opportunity to enroll in services to help quit smoking, such as counseling sessions and/or free nicotine-replacement therapy. One group was additionally offered a series of vouchers depending on how many goals they reached: $75 for attending a face-to -face counseling session, $150 for passing a cessation test 12 weeks later, and $300 for passing it 34-38 weeks later.

As noted by the researchers, many efforts at encouraging smoking cessation fall short, and even when they don't, the chances of relapse at any time loom precariously in the distance. But in nearly all the ICER analyses they conducted, using various models that accounted for a high relapse rate, a high gaming rate (essentially, women who cheated), and a larger financial incentive, they still found that the vouchers were a cost-effective intervention. Projected over a lifetime, they found that the voucher program incurred a $26 cost and a gain of 0.04 QALYs per quitter, while within the study itself, the ICER was $1716 per late pregnancy quitter compared to routine care. Most importantly, these costs were roughly comparable to other cessation interventions, if not cheaper.

The authors advocate that more precise long-term research be conducted to determine how successful these vouchers are at sustaining quitting after pregnancy, since the Scottish study only relied on self-reported surveys. Because of that, they’re careful to note that their findings are subject to some uncertainty. Overall, however, they are optimistic about using vouchers as a source of quitting motivation, especially considering that low-income women are more likely to be smokers.

“Identifying pregnant women who smoke, engaging with them and supporting them to quit smoking during pregnancy is a key international tobacco policy priority, and this study provides evidence on the cost-effectiveness of financial incentives as a means to achieving cessation during pregnancy,” they concluded.

Source: Boyd K, Briggs A. Bauld L, et al. Are financial incentives cost-effective to support smoking cessation during pregnancy? Addiction. 2015.