Behavioral Smoking Cessation Counseling During Pregnancy: A Cost-Effectiveness Analysis
Hannah L Bacheller1, Alyssa R Hersh, Aaron B Caughey
1Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
Obstetrics and Gynecology
|March 11, 2021
Summary
Behavioral smoking cessation counseling during pregnancy significantly improves maternal and neonatal outcomes and is cost-effective. Increasing access to these interventions is crucial for improving care for pregnant smokers.
Area of Science:
- Public Health
- Maternal and Child Health
- Health Economics
Background:
- Smoking during pregnancy poses significant risks to both maternal and fetal health.
- Effective smoking cessation interventions during pregnancy are essential for improving outcomes.
- The cost-effectiveness of behavioral smoking cessation counseling in this population requires examination.
Purpose of the Study:
- To evaluate the cost-effectiveness of behavioral smoking cessation counseling for pregnant women.
- To compare outcomes of behavioral counseling versus usual care for smoking cessation in pregnancy.
Main Methods:
- A decision-analytic model was developed using TreeAge Pro 2020.
- A theoretical cohort of 285,000 pregnant smokers in the U.S. was analyzed.
- Outcomes included smoking abstinence, fetal growth restriction, stillbirth, preterm delivery, neonatal death, cerebral palsy, costs, and quality-adjusted life-years (QALYs).
Main Results:
- Behavioral counseling resulted in 9,019 additional women quitting smoking during pregnancy.
- The intervention was associated with reductions in fetal growth restriction, stillbirth, preterm delivery, neonatal death, and cerebral palsy.
- The incremental cost-effectiveness ratio was $71,658 per QALY, below the $100,000 willingness-to-pay threshold, indicating cost-effectiveness.
Conclusions:
- Behavioral smoking cessation counseling during pregnancy is a cost-effective intervention.
- This counseling is linked to improved maternal and neonatal outcomes.
- Increased utilization and insurance coverage of these interventions are recommended to benefit this at-risk population.
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