(769) Financial incentives for smoking cessation during pregnancy and postpartum: a cost-effectiveness analysis

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: About 7% of patients smoke tobacco during pregnancy. Smoking is one of the leading preventable causes of stillbirth, preterm delivery, and infant death. Contingency management (CM) programs provide financial incentives dependent on cutting down on smoking. CM has been shown to be more effective for smoking cessation than other strategies during pregnancy. This study examined the cost-effectiveness of financial incentive programs during pregnancy and postpartum.

Study Design: A decision-analytic model was constructed to compare CM programs to standard smoking cessation programs for pregnant individuals who smoke. We estimated a theoretical cohort of 250,000 patients who smoked tobacco during pregnancy per year. We assumed CM patients received $525 in incentives throughout pregnancy. Primary outcomes included costs, quality-adjusted life years (QALYs), smoking cessation in pregnancy, continued abstinence postpartum, cases of stillbirth, preterm birth, infant death, and neurodevelopmental delay. The cost-effectiveness threshold was $100,000/QALY.

Results: Contingency management was associated with smoking cessation in 26,387 more individuals by late pregnancy, 7,410 more individuals who maintained abstinence postpartum, 164 fewer stillbirths, 454 fewer preterm births, 599 fewer SGA neonates, 4 fewer infant deaths, and 3 fewer cases of neurodevelopmental delay. Overall, contingency management was a cost-effective strategy associated with increased costs of $116 million and an increase of 22,636 QALYs yielding an incremental cost-effectiveness ratio (ICER) of $5,124/QALY. On univariable sensitivity analysis, contingency management was cost-effective until the incentive cost more than $9,100 per pregnancy, far above the current cost.

Conclusion: Providing financial incentives for smoking cessation during pregnancy is a cost-effective strategy as it results in fewer preterm births and increased abstinence from smoking compared to alternate practices. Those involved in the care of patients who smoke in pregnancy should consider implementing such programs, but will need help from payers to finance them.

Primary & Presenting Author(s)

Jessica D. Wallace, BA (she/her/hers)
Medical student
Oregon Health and Science University
Portland, Oregon, United States

Coauthor(s)

UD
Uma Doshi, BS (she/her/hers)
Medical Student
Oregon Health and Science University
Portland, Oregon, United States
Sarina R. Chaiken, BA (she/her/hers)
Medical Student
Oregon Health and Science University
Portland, Oregon, United States
Aaron B. Caughey, MD,MPH,PhD
Professor and Chair
Oregon Health and Science University
Portland, Oregon, United States