Economic evaluation of smoking cessation interventions for pregnant women

Abstract

Smoking during pregnancy (SDP) is a significant health problem, associated with high healthcare costs and health inequalities. Current SDP interventions are typically cost-effective, but their uptake, content and outcomes are very limited. This thesis aimed to produce evidence to identify the characteristics of ‘optimum’ SDP interventions, relating to aims (achieving smoke-free households or reducing smoking in the pregnant woman), content (higher financial incentives and more intense behavioural support) and longer duration. A Markov-based economic model was developed, which extended an existing model by incorporating partners’ smoking and the number of cigarettes consumed. A systematic umbrella review informed inclusion of additional health conditions. Three hypothetical interventions were designed based on available evidence, and cost-utility analysis was undertaken to assess their outcomes, healthcare costs and long-term cost-effectiveness compared to standard NHS care. Additionally, a qualitative study in an international public health organisation explored the applicability of high-income country-based economic evidence on SDP interventions in low and middle-income countries (LMICs). The economic modelling found that the hypothetical cessation interventions would greatly extend reach, reduce smoking, address inequalities, and be cost-effective. Piloting of SDP interventions based on this research would be warranted by UK policy-makers, and the findings have potential applicability to LMICs settings