The Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney, Sydney, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
BMC Health Serv Res. 2023 Sep 1;23(1):939. doi: 10.1186/s12913-023-09898-3.
Tobacco smoking during pregnancy is the most important preventable risk factor for pregnancy complications and adverse birth outcomes and can have lifelong consequences for infants. Smoking during pregnancy is associated with higher healthcare costs related to birth complications and during childhood. Psychosocial interventions to support pregnant women to quit are effective, yet provision of smoking cessation support has been inconsistent. The Midwives and Obstetricians Helping Mothers to Quit Smoking (MOHMQuit) intervention provides systems change, and leadership and clinician elements, to support clinicians to help women stop smoking in pregnancy. There have been few long-term analyses conducted of the cost-effectiveness of smoking cessation interventions for pregnant women that target healthcare providers. This protocol describes the economic evaluation of the MOHMQuit trial, a pragmatic stepped-wedge cluster-randomised controlled implementation trial in nine public maternity services in New South Wales (NSW), Australia, to ascertain whether MOHMQuit is cost-effective in supporting clinicians to help women quit smoking in pregnancy compared to usual care.
Two primary analyses will be carried out comparing MOHMQuit with usual care from an Australian health care system perspective: i) a within-trial cost-effectiveness analysis with results presented as the incremental cost per additional quitter; and ii) a lifetime cost-utility analysis using a published probabilistic decision analytic Markov model with results presented as incremental cost per quality-adjusted life-year (QALY) gained for mother and child. Patient-level data on resource use and outcomes will be used in the within-trial analysis and extrapolated and supplemented with national population statistics and published data from the literature for the lifetime analysis.
There is increasing demand for information on the cost-effectiveness of implementing healthcare interventions to provide policy makers with critical information for the best value for money within finite budgets. Economic evaluation of the MOHMQuit trial will provide essential, policy-relevant information for decision makers on the value of evidence-based implementation of support for healthcare providers delivering services for pregnant women.
ACTRN12622000167763, registered 2 February 2022.
怀孕期间吸烟是导致妊娠并发症和不良分娩结局的最重要的可预防风险因素，并且会对婴儿造成终生影响。怀孕期间吸烟与与分娩并发症和儿童时期相关的更高的医疗保健成本有关。支持孕妇戒烟的心理社会干预措施是有效的，但戒烟支持的提供一直不一致。助产士和妇产科医生帮助母亲戒烟（MOHMQuit）干预措施提供了系统的改变，以及领导力和临床医生的要素，以支持临床医生帮助孕妇戒烟。针对医疗保健提供者的孕妇戒烟干预措施的成本效益进行的长期分析很少。本方案描述了 MOHMQuit 试验的经济评估，这是一项在澳大利亚新南威尔士州（NSW）九家公立产科服务机构中进行的实用分步楔形集群随机对照实施试验，以确定与常规护理相比，MOHMQuit 在支持临床医生帮助孕妇戒烟方面是否具有成本效益。
将从澳大利亚医疗保健系统的角度进行两项主要分析，将 MOHMQuit 与常规护理进行比较：i）基于试验的成本效益分析，结果表示为每增加一名戒烟者的增量成本；ii）使用已发表的概率决策分析马尔可夫模型进行终生成本效用分析，结果表示为母亲和孩子每获得一个质量调整生命年（QALY）的增量成本。将使用患者层面的资源使用和结果数据进行基于试验的分析，并进行推断和补充，同时使用国家人口统计数据和文献中的已发表数据进行终生分析。
对于实施医疗保健干预措施以提供决策者在有限预算内获得最佳性价比的信息的需求不断增加。MOHMQuit 试验的经济评估将为决策者提供有关为提供服务的医疗保健提供者提供基于证据的支持的实施价值的重要、与政策相关的信息。
ACTRN12622000167763，于 2022 年 2 月 2 日注册。
