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

Abstract

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 €350 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 €11 546. From an employer's perspective, the ICER was €5686. 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 €20 000 per QALY. In the sensitivity analysis, these results were uncertain. A life-time perspective showed an ICER of €1249 (95% confidence interval = €850-2387) per QALY.

Conclusions: Financial incentives may be cost-effective in increasing quitting smoking, particularly from a life-time perspective.

Keywords: Cost-effectiveness; QALY; RCT; cost-utility; economic evaluation; employees; financial incentives; smoking cessation; work-place.