Estimation of the break-even point for smoking cessation programs in pregnancy.

Abstract

BACKGROUND. Successful programs to help pregnant women quit smoking have been developed and evaluated, but formal smoking cessation programs are not a part of care at most prenatal sites. The cost of such programs may be an issue. Considering the costs of adverse maternal and infant outcomes resulting from smoking, we estimated there would be an amount of money a prenatal program could invest in smoking cessation and still "break even" economically. METHODS. A model was developed and published data, along with 1989 hospital charge data, were used to arrive at a break-even point for smoking cessation programs in pregnancy. RESULTS. Using overall United States data, we arrived at a break-even cost of $32 per pregnant woman. When these data were varied to fit specific US populations, the break-even costs varied from $10 to $237, with the incidence of preterm low birth weight having the most impact on the cost. CONCLUSIONS. It may be advisable to invest greater amounts of money in a prenatal smoking cessation program for some populations. However, for every population there is an amount that can be invested while still breaking even.

Short-term Health and Economic Benefits of Smoking Cessation: Low Birth Weight

“…Because our analysis is based on a much larger population database than earlier estimates, the level of uncertainty in our estimates is much lower than earlier studies. 12,13,49,50 As a check on our results, we calculated the mean excess hospital cost per live birth using similar cost data for Maryland, 51 which covered all recorded discharges from Maryland nonfederal hospitals in 1995 for newborn admissions and transfers of newborns within 7 days of birth. The average US excess cost per live birth to a maternal smoker were similar.…”

Systematic critical review of previous economic evaluations of smoking cessation during pregnancy

“… 33 Two studies investigated interventions that had previously been described in the literature, 53 54 while four studies modelled hypothetical interventions. 44 45 47 49 Comparator interventions among studies with primary data collection were self-help materials (four studies); 41 43 48 52 brief advice (four studies); 41 48 51 52 and standard UK National Health Service treatment (see online supplementary file 3 for details) (two studies). 33 35 The following were used by one study each, placebo patches with behavioural support; 32 no intervention; 46 and a cessation programme that was not defined.…”

“… 33 35 The following were used by one study each, placebo patches with behavioural support; 32 no intervention; 46 and a cessation programme that was not defined. 42 For studies without primary data collection, seven used an assumed or spontaneous background quit rate, 40 44 45 49 50 53 55 while one study used multiple comparators which included low intensity behavioural support, non-conditional incentives and usual care (not defined). 54…”

Smoking cessation in pregnancy: failure of an HMO pilot project to improve guideline implementation

“…Studies have demonstrated that if a woman quits smoking early in pregnancy the risk of an adverse fetal outcome decreases toward that of a non-smoker (Dolan- Mullen, Ramirez, & Groff, 1994;Li, Windsor, Perkins, Goldenberg, & Lowe, 1993;Sexton & Hebel, 1984). Studies have also established the cost-effectiveness of programs for smoking cessation in pregnancy (Ershoff, Quinn, Dolan-Mullen, & Lairson, 1990;Melvin, 1997;Shipp, Croughan-Minihane, Petitti, & Washington, 1992) and have determined that for every dollar spent on smoking cessation, $6 can be saved in longterm costs (Marks, Koplan, Hogue, & Dalmat, 1990). Despite this, few comprehensive programs are available to the commercially insured population to help with smoking cessation in pregnancy (Barker, Robinson, & Rosenthal, 2000), and while obstetric providers have been sensitized to the need to identify smokers, they are not systematically counseling pregnant smokers (Helwig, Swain, & Gottlieb, 1998;Mullen, Pollak, Titus, Sockrider, & Moy, 1998).…”

“…MCOs may be reluctant to implement these systems changes because of a delay in realized cost savings or failure to realize savings at all because of rapid member turnover (Warner, 1998). Pregnancy, however, is a time when the health benefits and cost savings of smoking cessation may be realized almost immediately because of improved birth outcomes and improved infant health (Ershoff et al, 1990;Melvin, 1997;Shipp et al, 1992). Therefore, providing a smoking-cessation benefit for pregnant women can have public health benefits as well as managed-care financial benefits.…”