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A dynamic, modifiable model for estimating cost-effectiveness of smoking cessation interventions in pregnancy: application to an RCT of self-help delivered by text message

Jones, Matthew; Smith, Murray; Lewis, Sarah; Parrott, Steve; Coleman, Tim

A dynamic, modifiable model for estimating cost-effectiveness of smoking cessation interventions in pregnancy: application to an RCT of self-help delivered by text message Thumbnail


Authors

Dr MATTHEW JONES MATTHEW.JONES3@NOTTINGHAM.AC.UK
ASSISTANT PROFESSOR IN HEALTH ECONOMICS

Murray Smith

Steve Parrott



Abstract

Background/Aims: Previous evaluations of smoking cessation interventions in pregnancy have several limitations. Our solution to these limitations is the Economics of Smoking in Pregnancy (ESIP) model which estimates the lifetime cost-effectiveness of smoking cessation interventions in pregnancy from a National Health Service (NHS) and personal social services perspective. We aim to (1) describe how ESIP has been constructed, and (2) illustrate its use with trial data.

Methods: ESIP links mothers’ and offspring pregnancy outcomes to estimate the burdens of smoking-related disease they experience with different rates of smoking in pregnancy, both in pregnancy and across their lifetimes. Smoking rates are inputted by model users. ESIP then estimates the costs of treating disease burdens and also mothers’ and offspring life years and quality-adjusted life years (QALYs). By comparing costs incurred and healthy life following different smoking rates, ESIP estimates incremental cost-effectiveness and benefit-cost ratios for mothers or offspring or both combined. We illustrate ESIP using data from a pragmatic randomised controlled trial that tested a smoking cessation intervention in pregnancy.

Results: Across women’s and offspring lifetimes, the intervention proved cheaper than usual care, having a negative incremental cost of £38.37 (interquartile range £21.46-£56.96) and it improved health, demonstrating a 0.04 increase in incremental QALYs for mothers and offspring, implying it is ‘dominant’ over usual care. Benefit-cost ratios suggested that every £1 spent would generate a median of £14 (interquartile range £8-£20) in healthcare savings.

Conclusions: Economics of Smoking in Pregnancy (ESIP) is the first economic model to link mothers’ and infants’ costs and benefits whilst reporting cost-effectiveness in readily-comparable units. Using ESIP with data from a trial which reported only short-term economic analysis showed that the intervention was very likely to be cost-effective in the longer-term and to generate healthcare savings.

Citation

Jones, M., Smith, M., Lewis, S., Parrott, S., & Coleman, T. (2019). A dynamic, modifiable model for estimating cost-effectiveness of smoking cessation interventions in pregnancy: application to an RCT of self-help delivered by text message. Addiction, 114(2), 353-365. https://doi.org/10.1111/add.14476

Journal Article Type Article
Acceptance Date Oct 13, 2018
Online Publication Date Oct 22, 2018
Publication Date 2019-02
Deposit Date Oct 29, 2018
Publicly Available Date Feb 14, 2019
Journal Addiction
Print ISSN 0965-2140
Electronic ISSN 1360-0443
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 114
Issue 2
Pages 353-365
DOI https://doi.org/10.1111/add.14476
Keywords Smoking; Tobacco; Smoking Cessation; Pregnancy; Economic Evaluation; Cost-Effective.
Public URL https://nottingham-repository.worktribe.com/output/1204218
Publisher URL https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14476
Contract Date Oct 29, 2018