Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Heller School for Social Poilcy and Management, MS 035, Brandeis University, Waltham, MA 02454-9110 USA.
Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, USA; Johns Hopkins University School of Nursing, USA.
Prev Med. 2022 Dec;165(Pt B):107079. doi: 10.1016/j.ypmed.2022.107079. Epub 2022 May 6.
Higgins and colleagues' recently-completed randomized controlled trial and pooled data with 4 related trials of smoking cessation in pregnant women in Vermont (USA) showed that abstinence-contingent financial incentives (FI) increased abstinence over control conditions from early pregnancy through 24-weeks postpartum. Control conditions were best practices (BP) alone in the recent trial and payments provided independent of smoking status (noncontingently) in the others. This paper reports economic analyses of abstinence-contingent FI. Merging trial results with maternal and infant healthcare costs from all Vermont Medicaid deliveries in 2019, we computed incremental cost-effectiveness ratios (ICERs) for quality-adjusted life years (QALYs) and compared them to established thresholds. The healthcare sector cost (±standard error) of adding FI to BP averaged $634.76 ± $531.61 per participant. Based on this trial, the increased probability per BP + FI participant of smoking abstinence at 24-weeks postpartum was 3.17%, the cost per additional abstinent woman was $20,043, the incremental health gain was 0.0270 ± 0.0412 QALYs, the ICER was $23,511/QALY gained, and the probabilities that BP + FI was very cost-effective (ICER≤$65,910) and cost-effective (ICER≤$100,000) were 67.9% and 71.0%, respectively. Based on the pooled trials, the corresponding values were even more favorable-8.89%, $7138, 0.0758 ± 0.0178 QALYs, $8371/QALY, 98.6% and 99.3%, respectively. Each dollar invested in abstinence-contingent FI over control smoking-cessation programs yielded $4.20 in economic benefits in the recent trial and $11.90 in the pooled trials (very favorable benefit-cost ratios). Medicaid and commercial insurers may wish to consider covering financial incentives for smoking abstinence as a cost-effective service for pregnant beneficiaries who smoke. Trial Registration: ClinicalTrials.gov identifier: NCT02210832.
希金斯及其同事最近完成的一项随机对照试验以及在佛蒙特州（美国）进行的 4 项相关孕妇戒烟试验的汇总数据表明，与对照组相比，对戒烟的经济奖励（FI）从孕早期持续到产后 24 周，增加了戒烟率。对照组是最近试验中的最佳实践（BP），而其他试验中的付款则与吸烟状况无关（非条件）。本文报告了对戒烟相关 FI 的经济分析。将试验结果与 2019 年佛蒙特州所有医疗补助分娩的母婴保健费用合并，我们计算了质量调整生命年（QALY）的增量成本效益比（ICER），并将其与既定阈值进行了比较。在 BP 中添加 FI 的医疗保健部门成本（±标准误差）平均为每位参与者 634.76 美元±531.61 美元。基于该试验，BP+FI 参与者在产后 24 周时戒烟的概率增加了 3.17%，每增加一位戒烟的女性的成本为 20043 美元，增量健康收益为 0.0270±0.0412 QALY，ICER 为 23511 美元/QALY，BP+FI 非常有效（ICER≤65910 美元）和有效的概率（ICER≤100000 美元）分别为 67.9%和 71.0%。基于汇总试验，相应的值甚至更有利-8.89%，7138 美元，0.0758±0.0178 QALY，8371 美元/QALY，98.6%和 99.3%。与对照组的戒烟计划相比，最近的试验中，每投资 1 美元用于戒烟相关的 FI 就可以获得 4.20 美元的经济效益，而在汇总试验中则为 11.90 美元（非常有利的效益成本比）。医疗补助和商业保险公司可能希望考虑为吸烟的孕妇受益人的戒烟提供经济奖励，将其作为一项具有成本效益的服务。试验注册：ClinicalTrials.gov 标识符：NCT02210832。
