Assessing smoking cessation preferences in Germany: A discrete choice experiment

INTRODUCTION: Smoking prevalence in Germany remains high (30%) and uptake of cessation services is low. E-cigarettes are promoted as a cessation aid but whether they are preferred over established methods is unknown. To improve cessation efforts, understanding the extent different characteristics of a smoking cessation program are preferred are important. This study estimated preferences and willingness-to-pay for a smoking cessation program using a discrete choice experiment (DCE). METHODS: Potential participants who resided in Germany and smoked ≥5 cigarettes daily (cpd) were recruited for the main study between July-September 2023. The DCE included 12 choice tasks. Attributes were cessation aids (nicotine replacement, medication, and e-cigarettes), counseling, referral by a health professional, effectiveness, and out-of-pocket costs. RESULTS: The study sample (N=1052) was 51.4% female with a mean cpd of 17 (SD=8.2). Mixed logit regression found counseling, referrals, and program effectiveness significantly influenced choices (p<0.001). None of the levels for cessation aids were significant. However, in subgroup analyses the use of e-cigarettes for quitting was preferred by those with prior e-cigarette use, while evidence-based cessation aids were preferred by several other subgroups. While low costs were preferred, particularly among those with no experience using cessation aids, participants were willing to pay a high cost for an effective program (€91.48/month). CONCLUSION: To increase engagement, smoking cessation programs in Germany should include counseling and be explicit on the evidence of cessation therapies, as program effectiveness is highly valued. Improving access to cessation aids through referrals and lower costs can increase cessation efforts. IMPLICATIONS: Our findings suggest that German adults who smoke are most likely to engage in cessation programs that demonstrate proven effectiveness, include counseling support, and are recommended by a health professional. The lack of preference for specific cessation aids, except e-cigarettes among prior users, indicates that better communication about the effectiveness of evidence-based pharmacotherapies is needed. Health professionals should provide clear, evidence-based guidance on all cessation methods, including transparent discussion of the current evidence regarding e-cigarettes for smoking cessation, to support informed decision-making and optimize treatment selection.