Cost-effectiveness and cost-utility analysis of a work-place smoking cessation intervention with and without financial incentives

Aims To perform an economic evaluation of a work-place smoking cessation group training programme with incentives compared with a training programme without incentives. Design A trial-based cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a societal perspective and an employer's perspective. Setting Sixty-one companies in the Netherlands. Participants A total of 604 tobacco-smoking employees. Intervention and comparator A 7-week work-place smoking cessation group training programme. The intervention group earned gift vouchers of euro350 for 12 months' continuous abstinence. The comparator group received no incentives. Measurements Online questionnaires were administered to assess quality of life (EQ-5D-5 L) and resource use during the 14-month follow-up period (2-month training period plus 12-month abstinence period). For the CEA the primary outcome measure was carbon monoxide (CO)-validated continuous abstinence; for the CUA the primary outcome was quality-adjusted life years (QALY). Bootstrapping and sensitivity analyses were performed to account for uncertainty. Incremental cost-effectiveness ratio (ICER) tables were used to determine cost-effectiveness from a life-time perspective. Findings Of the participants in the intervention group, 41.1% had quit smoking compared with 26.4% in the control group. From a societal perspective with a 14-month follow-up period, the ICER per quitter for an intervention with financial incentives compared with no incentives was euro11 546. From an employer's perspective, the ICER was euro5686. There was no significant difference in QALYs between the intervention and control group within the 14-month follow-up period. The intervention was dominated by the comparator in the primary analysis at a threshold of euro20 000 per QALY. In the sensitivity analysis, these results were uncertain. A life-time perspective showed an ICER of euro1249 (95% confidence interval = euro850-2387) per QALY. Conclusions Financial incentives may be cost-effective in increasing quitting smoking, particularly from a life-time perspective.