Estimation of the Break-Even Point for Smoking Cessation Programs in Pregnancy

Economic Evaluations of Smoking Cessation and Relapse Prevention Programs for Pregnant Women: A Systematic Review

“…Half of the studies [15,17,18,20] employed a CBA, measuring both the costs and consequences of alternatives in dollars, though the CBA types performed were closer to cost‐saving analyses than traditional CBA methods (e.g., valuing a life‐year saved in monetary terms) in that they estimate savings in health‐care expenditures resulting from not smoking. Two studies employed CEA to estimate the “break‐even” cost for a given quit rate [19,21], and one employed CEA to estimate the cost per percentage that quit [16]. One study used CEA to estimate the cost per SIDS death averted [22].…”

“…One study used CEA to estimate the cost per SIDS death averted [22]. In terms of study design and modeling, three studies [16,17,20] were randomized controlled trials, one was a nonrandomized comparison [15], two employed decision trees to model costs and consequences [19,21], and a third used conditional logistic regression analysis to estimate the consequences of smoking cessation (in terms of SIDS risk) [22]. One study did not specify the model type, but did use estimates from the literature [18].…”

“…Two of the studies reviewed reported results from the societal perspective [18,22]. Other points of view included agency [16,20], health maintenance organization (HMO) [15,17], and program [19], while one study [21] did not specify a perspective in their analysis. Although, according to the Panel, employing any perspective other than societal limits the generalizability of the results and weakens the strength of the study findings, alternative perspectives from these studies compliment the societal point of view in providing useful information to program, insurance, and agency representatives.…”

“…Although, according to the Panel, employing any perspective other than societal limits the generalizability of the results and weakens the strength of the study findings, alternative perspectives from these studies compliment the societal point of view in providing useful information to program, insurance, and agency representatives. In terms of the time horizon, three studies ended at the end of pregnancy [16,21] or postdelivery [19], while two studies extended through the infant's first year of life [15,17] and the remaining three studies extended 35 years [18] or a lifetime [20,22] intervention (comparator).…”

“…These studies included programs with a 15‐minute session with a health counselor, social support, and written materials [20]; a hypothetical model program consisting of a 15‐minute counseling session, two follow‐up phone calls, and instructional materials [18]; brief counseling and eight booklets mailed weekly [17]; and quit advice supplemented with either an American Lung Association manual or a pregnancy‐specific manual [16]. Three studies looked at hypothetical prenatal smoking cessation programs, but did not specify the components of these programs [19,21,22]. One study involved an 8‐week home‐correspondence program [15].…”