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Systematic Review
To assess the impact of reducing the costs for tobacco smokers or healthcare providers for using orproviding smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both,and on the number of smokers making a quit attempt (quitting smoking for at least 24 hours). The authors also assessed the cost effectiveness ofdifferent financial interventions, and analysed the costs per additional quitter, or per quality-adjusted life year (QALY) gained.
Full financial interventions directed at smokers had a favourable effect on abstinence at six months or longer when compared to no intervention (RR 1.77, 95% CI 1.37 to 2.28, IO = 33%, 9333 participants). There was no evidence that full coverage interventions increased smoking abstinence compared to partial coverage interventions (RR 1.02, 95% CI 0.71 to 1.48, IO = 64%, 5914 participants), but partial coverage interventions were more effective in increasing abstinence than no intervention (RR 1.27 95% CI 1.02 to 1.59, IO = 21%, 7108 participants). The economic evaluation showed costs per additional quitter ranging from USD 97 to USD 7646 for the comparison of full coverage with partial or no coverage.
Full financial interventions increased the number of participants making a quit attempt when compared to no interventions (RR 1.11, 95%CI 1.04 to 1.17, IO = 15%, 9065 participants). There was insufficient evidence to show whether partial financial interventions increased quit attempts compared to no interventions (RR 1.13, 95% CI 0.98 to 1.31, IO = 88%, 6944 participants).
Full financial interventions increased the use of smoking cessation treatment compared to no interventions with regard to various pharmacological and behavioural treatments: nicotine replacement therapy (NRT): RR 1.79, 95% CI 1.54 to 2.09, IO = 35%, 9455 participants; bupropion: RR 3.22, 95% CI 1.41 to 7.34, IO = 71%, 6321 participants; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65, IO = 75%, 9215 participants.
Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers whoattempt to quit, use smoking cessation treatments, and succeed in quitting. There was no clear and consistent evidence of an effect on smoking cessation from financial incentives directed at healthcare providers. The authors are only moderately confident in the effect estimate because there was some risk of bias due to a lack of blinding in participants and researchers, and insufficient information on attrition rates.