Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
Obstet Gynecol. 2021 Apr 1;137(4):703-712. doi: 10.1097/AOG.0000000000004327.
To examine the cost effectiveness of using behavioral smoking cessation counseling during pregnancy.
We designed a decision-analytic model using TreeAge Pro 2020 software to compare the cost effectiveness and outcomes among women who received behavioral smoking cessation counseling compared with women who received usual care during pregnancy. We used a theoretical cohort of 285,000 women, the approximate number of pregnant women who smoke each year in the United States. Outcomes included maternal abstinence from smoking, fetal growth restriction, stillbirth, preterm delivery, neonatal death, and cerebral palsy, in addition to cost and quality-adjusted life-years (QALYs) for both the woman and the neonate. All model inputs were derived from the literature, and a willingness-to-pay threshold was set at $100,000 per QALY. Sensitivity analyses were performed to determine the robustness of baseline assumptions.
In our theoretical cohort, behavioral smoking cessation counseling compared with usual care was associated with 9,019 additional women stopping smoking during pregnancy (34,604 vs 25,585). Smoking cessation counseling also resulted in 911 fewer cases of fetal growth restriction, 20 fewer stillbirths, 250 fewer preterm deliveries, 11 fewer neonatal deaths, and one less case of cerebral palsy. Using behavioral smoking cessation counseling interventions during pregnancy led to better outcomes despite higher costs, with an incremental cost-effectiveness ratio of $71,658 per QALY, which was below our willingness-to-pay threshold of $100,000 per QALY, making the intervention cost effective. Sensitivity analyses demonstrated that the counseling intervention was cost effective at probabilities of smoking cessation greater than 11.6% (baseline input: 12.1%) or the cost of the behavioral intervention was less than $475.21 (baseline input: $368.78).
Behavioral smoking cessation counseling during pregnancy was associated with fewer adverse neonatal outcomes and was cost effective. Increasing utilization of such interventions and increasing insurance coverage of this care are important initiatives to improve outcomes in this at-risk population.
研究在怀孕期间进行行为戒烟咨询的成本效益。
我们使用 TreeAge Pro 2020 软件设计了一个决策分析模型，以比较接受行为戒烟咨询的女性与怀孕期间接受常规护理的女性的成本效益和结果。我们使用了一个 285000 名女性的理论队列，这是美国每年吸烟孕妇的大致数量。结果包括母婴吸烟戒断、胎儿生长受限、死胎、早产、新生儿死亡和脑瘫，以及母婴的成本和质量调整生命年（QALY）。所有模型输入均源自文献，支付意愿阈值设定为每 QALY 10 万美元。进行了敏感性分析以确定基本假设的稳健性。
在我们的理论队列中，与常规护理相比，行为戒烟咨询与怀孕期间增加的 9019 名女性戒烟相关（34604 名与 25585 名）。戒烟咨询还导致胎儿生长受限减少 911 例，死产减少 20 例，早产减少 250 例，新生儿死亡减少 11 例，脑瘫减少 1 例。尽管成本较高，但在怀孕期间使用行为戒烟咨询干预措施可带来更好的结果，增量成本效益比为每 QALY71658 美元，低于我们每 QALY100000 美元的支付意愿阈值，使干预措施具有成本效益。敏感性分析表明，在戒烟率大于 11.6%（基础输入：12.1%）或行为干预成本低于 475.21 美元（基础输入：368.78 美元）的情况下，咨询干预措施具有成本效益。
怀孕期间的行为戒烟咨询与较少的不良新生儿结局相关，并且具有成本效益。增加此类干预措施的利用率并增加这种护理的保险覆盖范围是改善这一高危人群结局的重要举措。
