Costs and outcomes of an 11-year smoking cessation contest: Croatia and EU comparison

Background

Smoking remains a major preventable cause of disease. Public health contests with incentives are one way to support quitting. Comparing costs across countries is difficult due to differences in prices and labour costs.

Methods

We analysed outcomes and costs of a smoking cessation contest conducted over 11 years in Croatia. Costs included staff time, materials and financial incentives. Cost per quitter was calculated. All costs were standardised to current price levels to allow comparison. For cross-country comparison, costs were separated into incentive and material costs (adjusted using purchasing power parity, PPP) and workforce costs (adjusted using Eurostat labour cost data, 2025, and OECD-based wage ratios). Croatia was used as the reference. Selected EU countries were chosen to represent low, medium, and high labour cost groups, with three countries included in each group.

Results

A total of 348 applications were recorded, of which 276 (79.3%) resulted in one-month abstinence. For long-term outcomes, 229 unique participants were analysed, and follow-up data were available for 186 (81%). Among those followed up, 53 participants (28.5%) reported remaining non-smokers at six months, corresponding to 23.1% of all eligible unique participants. The cost was €167 per one-month quitter and €869 per six-month quitter. Across selected EU countries, the estimated cost per six-month quitter ranged from €867 to €2,110, with variation mainly driven by workforce costs, while PPP-adjusted costs showed smaller differences.

Conclusions

Smoking cessation contests are a feasible public health intervention. The proposed cross-country cost comparison approach can support the transfer of programmes across EU settings and inform planning of cost-effective interventions. Future research will examine whether reduced specialist input, while maintaining current levels of other staff involvement, can maintain effectiveness.

Key messages

• Smoking cessation contests can achieve meaningful quit rates at relatively low cost in public health programmes.

• A simple cross-country cost comparison approach supports the transfer of smoking cessation programmes across EU settings.