Cost-effectiveness of stop smoking incentives for medicaid-enrolled pregnant women.

Maternal 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.

A decade of experience promoting the clinical treatment of tobacco dependence in Wisconsin.

BACKGROUND: The University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI) is the designated lead agency at the University of Wisconsin-Madison charged with the responsibility of reducing the harms from tobacco use in Wisconsin and beyond. In 2000, the UW-CTRI, with funding from the state of Wisconsin, launched a population-wide effort--the Wisconsin Cessation Outreach Program (Program)--to increase the availability and use of evidence-based clinical treatments for tobacco dependence. This paper describes the Program's strategies, outcomes, and impact on the clinical treatment of tobacco dependence in Wisconsin. PROGRAM STRATEGIES: The Program was designed to change the standard of health care in Wisconsin, so that primary care professionals, and the health systems in which they work, universally identified and intervened with tobacco users. Five primary strategies were used to accomplish its goal: (1) deliver clinic-based and Web-based training and technical assistance for clinicians, including free continuing medical education (CME); (2) provide technical assistance to accomplish health systems' change to support the routine provision of tobacco-dependence treatment; (3) include evidence-based cessation treatment as a covered insurance benefit and reduce other barriers to cessation treatment such as co-pays; (4) provide telephonic tobacco cessation quit line services to all state residents and integrate it with routine medical services; and (5) reduce tobacco-related disparities by increasing access to and use of evidence-based treatment by priority populations. OUTCOMES: In the 10 years since the Program was initiated, progress has been achieved in a number of tobacco use parameters in Wisconsin, including higher rates of Wisconsin smokers making a quit attempt; increased insurance coverage for cessation counseling and medications; higher rates of discussion of cessation treatment options by clinicians; and integration of the Wisconsin Tobacco Quit Line (WTQL) into routine primary care, with almost 100,000 Wisconsin smokers using the WTQL. Nearly half of all WTQL callers were uninsured or Medicaid enrollees. Additionally, smoking rates in Wisconsin have fallen by almost 20% during this period, from about 24% of all adults in 2000 to <20% today.

The Wisconsin Tobacco Quit Line's Fax to Quit program: participant satisfaction and effectiveness.

OBJECTIVE: The purpose of this study was to assess the Wisconsin Tobacco Quit Line's (WTQL) clinic-based Fax to Quit (FTQ) provider referral program in terms of participant satisfaction and short-term quit outcomes, and to compare those findings to a non-FTQ provider referral group. METHODS: A sample of 432 WTQL callers completed a telephone survey approximately 3 months after they received WTQL services. Of these, 265 contacted the WTQL based on a clinic referral and served as the basis for analyses. Of these 265, 158 FTQ respondents were compared to 107 non-FTQ respondents in terms of satisfaction with the WTQL as well as quit attempts and tobacco abstinence. RESULTS: Overall, survey respondents reported high levels of satisfaction with the WTQL (FTQ = 96.8%, non-FTQ = 92.7%). Other measures of satisfaction (cultural sensitivity, respondent needs and concerns understood) showed similarly high levels of respondent satisfaction for both groups. FTQ respondents reported a statistically significantly higher 30-day abstinence rate (46.8%) compared to non-FTQ respondents (32.7%). CONCLUSIONS: Participants expressed high levels of satisfaction with WTQL services and demonstrated high short-term quit rates. FTQ-referred WTQL users reported higher rates of tobacco cessation than non-FTQ-referred WTQL users. These findings suggest that fax referral has potential to successfully link smokers visiting primary care clinics to the WTQL, an evidence-based cessation option.