• Marlon P Mundt, Michael C Fiore, Megan E Piper, Robert T Adsit, Kathleen H Kobinsky, Kristine M Alaniz, and Timothy B Baker.
• Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America. Electronic address: marlon.mundt@fammed.wisc.edu.
• Prev Med. 2021 Dec 1; 153: 106777.

AbstractMaternal smoking increases mortality and morbidity risks for both mother and infant. The First Breath Wisconsin study examined the cost-effectiveness of providing incentives to pregnant women who smoked to engage in stop smoking treatment. Participants (N = 1014) were Medicaid-enrolled pregnant women recruited from September 2012 to April 2015 through public health departments, private, and community health clinics in Wisconsin. The incentive group (n = 505) could receive $460 for completing pre-birth visits ($25 each), post-birth home visits ($40, $25, $25, $40 for 1-week, 2-month, 4-month and 6-month visits), monthly smoking cessation phone calls post-birth ($20 each), and biochemically-verified tobacco abstinence at 1-week ($40) and 6-months ($40) post-birth. The control group (n = 509) received up to $80 for 1-week ($40) and 6-month ($40) post-birth assessments. Intervention costs included incentive payments to participants, counselor and administrative staff time, and smoking cessation medications. Cost-effectiveness analysis calculated the incremental cost-effectiveness ratio (ICER) per one additional smoker who quit. The incentive group had higher 6-month post-birth biochemically-confirmed tobacco abstinence than the control group (14.7% vs. 9.2%). Incremental costs averaged $184 per participant for the incentive group compared to controls ($317 vs $133). The ICER of financial incentives was $3399 (95% CI $2228 to $8509) per additional woman who was tobacco abstinent at 6 months post-birth. The ICER was lower ($2518 vs $4760) for women who did not live with another smoker. This study shows use of financial incentives for stop smoking treatment is a cost-effective option for low-income pregnant women who smoke.Copyright © 2021. Published by Elsevier Inc.

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