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Cost-effectiveness of nicotine patches for smoking cessation in pregnancy: a placebo randomised controlled trial (SNAP)

Essex, Holly; Parrott, Steve; Wu, Qi; Li, Jinshuo; Cooper, Sue; Coleman, Tim


Holly Essex

Steve Parrott

Qi Wu

Jinshuo Li

Professor of Primary Care


Introduction: Smoking during pregnancy is the most important, preventable cause of adverse pregnancy outcomes including miscarriage, premature birth and low birth weight, with huge financial costs to the NHS. However, there are very few published economic evaluations of smoking cessation interventions in pregnancy and previous studies are predominantly US-based and do not present incremental cost-effectiveness ratios (ICER). A number of studies have demonstrated cost-effectiveness of nicotine replacement therapy (NRT) in the general population, but this has yet to be tested among pregnant smokers.

Methods: A cost-effectiveness analysis was undertaken alongside the SNAP trial to compare NRT patches plus behavioural support to behavioural support alone, for pregnant women who smoked.

Results: At delivery, biochemically verified quit rates were slightly higher at 9.4% in the NRT group compared to 7.6% in the control group (odds ratio: 1.26, 95% CI: 0.82-1.96), at an increased cost of around £90 per participant. Higher costs in the NRT group were mainly attributable to the cost of NRT patches (mean = £46.07). The incremental cost-effectiveness ratio associated with NRT was £4,926 per quitter and a sensitivity analysis including only singleton births yielded an ICER of £4,156 per quitter. However, wide confidence intervals indicated a high level of uncertainty.

Conclusions: Without a specific willingness to pay threshold, and due to high levels of statistical uncertainty, it is hard to determine the cost-effectiveness of NRT in this population. Furthermore, future research should address compliance issues, as these may dilute any potential effects of NRT, thus reducing the cost-effectiveness.


Essex, H., Parrott, S., Wu, Q., Li, J., Cooper, S., & Coleman, T. (2014). Cost-effectiveness of nicotine patches for smoking cessation in pregnancy: a placebo randomised controlled trial (SNAP). Nicotine and Tobacco Research,

Journal Article Type Article
Publication Date Dec 6, 2014
Deposit Date Oct 8, 2015
Publicly Available Date Oct 8, 2015
Journal Nicotine and Tobacco Research
Print ISSN 1462-2203
Electronic ISSN 1462-2203
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Public URL
Publisher URL
Additional Information This is a pre-copyedited, author-produced PDF of an article accepted for publication in Nicotine and Tobacco Research following peer review. The version of record Holly N. Essex, Steve Parrott, Qi Wu, Jinshuo Li, Sue Cooper, and Tim Coleman Cost-effectiveness of nicotine patches for smoking cessation in pregnancy: A placebo randomised controlled trial (SNAP) Nicotine Tob Res 2014 : ntu258v1-ntu258. is available online at: