Health & Economic Impact:
Smoking Cessation for Pregnant Women
July, 2002
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Introduction
The Problem of Smoking During Pregnancy
Background Statistics | Health
Consequences of Smoking During Pregnancy | Cost
of Smoking to Medicaid | Cost
of Interventions to Reduce Prenatal Smoking |
A Cost Effective Solution
Effectiveness of Cessation Interventions
| Economic Benefits of Prenatal Smoking Cessation
Interventions | CDC-CMS Benefit-Cost
Analysis
References
The Centers for Medicare and Medicaid Services (CMS) and the
Centers for Disease Control and Prevention (CDC) are exploring the possibility
of providing coverage for smoking cessation services for pregnant and
post-partum women through Medicaid. Both agencies are dedicated to working with
state Medicaid agencies and state health departments to develop and implement
innovative, cost-effective ways to reduce the public health burden of tobacco
use.
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Background Statistics
In 1999 21% of all U.S. women smoked (CDC 2000a) and 12.3% of
women giving birth reported smoking during pregnancy (Mathews 2001). Other
surveys report even higher rates (Lipscomb et al., 2000, USDHHS, 1997, Gilbert
et. al., 1997)
In 1998, the proportion of pregnant women covered by Medicaid
who smoked during the last 3 months of pregnancy ranged from 15.8% to 38.5% in
15 states. On average, smoking among pregnant women on Medicaid was 2.5 times
that of pregnant women without Medicaid coverage (Lipscomb et al., 2000)
Many pregnant women need extra help to quit smoking. A
recommended strategy is to reduce patient costs by including effective
treatments as covered health insurance benefits (Fiore et al. 2000). In 2000, 33
states and the District of Columbia offered some coverage for tobacco dependence
treatments, yet only one state offered coverage for all treatments recommended
by PHS (Schauffler, 2001).
A pregnant woman who smokes is between 1.5 and 3.5 times more
likely than a nonsmoker to have a low
birth weight (LBW) baby (USDHHS, 2001).
Infants whose mothers smoked during pregnancy have 2.3 times the
risk of SIDS (Sudden Infant Death Syndrome) than infants of nonsmoking pregnant
mothers. For infants exposed to maternal smoking both during pregnancy and
after birth, the risk of SIDS is 3 times the risk for infants not exposed (USDHHS,
2001; Gavin et al., 2001).
Annually, an estimated 150,000 to 300,000 cases of lower
respiratory infection in infants and children are attributable to
environmental tobacco smoke (ETS). Most ETS exposure in infants and young
children is from maternal smoking (EPA, 1993).
Cigarette smoking has been associated with increased risk of ectopic
pregnancy. A pregnant woman who smokes is 1.8 times more likely than a
nonsmoker to have this condition (Castles et al., 1999).
Women who smoke during pregnancy are at increased risk of spontaneous
abortions (miscarriages). A pregnant woman who smokes is 1.6 times more
likely than a nonsmoker to have a spontaneous abortion (Castles et al., 1999).
The total cost of adult smoking to Medicaid in 1997 was
estimated to be more than $17 billion, or 12.1% of all Medicaid expenditures
(Zhang et al., 1999). This estimate does not include neonatal health care costs.
Direct neonatal health care costs attributable to maternal
smoking that were paid by Medicaid in 1996 are estimated to be more than $227
million (CDC, 2002b).
A fully-covered comprehensive smoking cessation benefit
(counseling and pharmacotherapy) cost less than $5.92 per member per year (about
$0.40 per month) (Curry et al., 1998).
A 15-minute counseling session provided to a pregnant woman by a
nurse, along with written materials, costs approximately $6.00 per patient
(Windsor, 1993).
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Effectiveness of Cessation Interventions
Infants of women who quit smoking by the first trimester have
weight and body measurements comparable to infants of nonsmokers (USDHHS, 2001).
Prenatal smoking cessation programs have been shown to have a
protective effect on intrauterine growth retardation (Ershoff et al., 1990).
For pregnant women who smoke fewer than 20 cigarettes per day, a
brief 5-15 minute counseling session with pregnancy-specific educational
materials delivered by a trained provider increases cessation rates (Melvin et
al., 2000).
Earlier studies suggest that every $1 spent on smoking cessation
for pregnant women could save about $3 in reduced neonatal intensive care costs
(Marks et al. 1990, Ershoff et al., 1990).
A single percentage point decline in smoking prevalence among
pregnant women would prevent 1,300 cases of low birth weight among babies
annually and save $21 million in direct medical costs, 1995 U.S. dollars
(Lightwood et al., 1999).
The smoking-attributable cost of neonatal health care per LBW
birth is estimated to be $1,338 in 1999 U.S. dollars (CDC 2002b).
Smoking-attributable neonatal health care costs for the Medicaid
system total almost $228 million, or about $738 per smoker whose delivery is
paid for by states’ Medicaid programs (CDC 2002b).
If 25% of pregnant smokers on Medicaid receive counseling that
achieves an 18% quit rate, almost $10 million in excess Medicaid neonatal health
care costs could be averted (CDC 2002b).
If participants receive one counseling session that costs $30
and this results in an 18% quit rate, Medicaid could save almost $3.50 in
averted neonatal medical expenditures for every $1 spent on counseling pregnant
smokers to quit. This ratio of net savings to program costs is similar to the
3-to-1 ratio described by Marks et al., 1990.
State Medicaid agencies and state health departments can work
together to reduce smoking during pregnancy by jointly supporting initiatives to
provide and increase the use of smoking cessation benefits; provide managed care
organizations with data on the cost-effectiveness of cessation services; and
train providers on tobacco use screening, counseling, and other behavioral and
systems interventions.
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Castles A, Adams EK, Melvin CL, Kelsch C. Boulton ML. Effects of
smoking during pregnancy. Five meta-analyses. American Journal of Preventive
Medicine 1999; 16(3):208-15.
Centers for Disease Control and Prevention. National Center for
Health Statistics (2002a). Data File Documentation, National Health Interview
Survey, 2000 (machine readable data file and documentation). NCHS, Hyattsville,
MD.
Centers for Disease Control and Prevention. Smoking-Attributable
Mortality, Morbidity, and Economic Costs (SAMMEC): Maternal and Child Health (MCH)
SAMMEC software, 2002b. Available at: http://www.cdc.gov/tobacco/sammec
Curry SJ, Grothaus LC, McAfee T, Pabniniak C. Use and cost
effectiveness of smokingcessation services under four insurance plans in a
health maintenance organization.
New England Journal of Medicine 1998; 339:673-9.
Environmental Protection Agency. Respiratory Health Effects of
Passive Smoking: Lung Cancer and Other Disorders. Washington DC: U.S.
Environmental Protection Agency, Office of Research and Development, Office of
Air Radiation. Report No. Report No. EPA/600/6-90/0006F, 1993.
Ershoff DH,Quinn VP, Mullen PD, et al. Pregnancy and medical
cost outcomes of a selfhelp prenatal smoking cessation program in a HMO. Public
Health Reports 1990; 105(4):340-7.
Fingerhut LA, Kleinman JC, Kendrick JS. Smoking before, during,
and after pregnancy. American Journal of Public Health 1990; 80(5):541-4.
Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and
Dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department of
Health and Human Services. June 2000.
Gavin NI, Wiesen C, and Layton C, Review and Meta-Analysis of
the Evidence on the Impact of Smoking on Perinatal Conditions Built into SAMMEC
II, Final Report to the National Center for Chronic Disease Prevention and
Health Promotion, Research Triangle Institute (RTI), RTI Project NO. 7171-010,
September 2001.
Gilbert BJC, Johnson CH, Morrow B, Gaffield ME, Ahluwalia I,
PRAMS Working Group. Prevalence of selected maternal and infant characteristics,
Pregnancy Risk Assessment Monitoring System (PRAMS), 1997. Morbidity and
Mortality Weekly Report 1999;48(SS-5):1-37.
Lightwood JM, Phibbs, CS, Glantz SA. Short-term economic and
health benefits of smoking cessation: low birth weight. Pediatrics 1999; 104(6):
1312-20.
Lipscomb LE, Johnson CH, Morrow B, Colley Gilbert B, Ahluwalia
IB, Beck LF, Gaffield ME, Rogers M, Whitehead N. PRAMS 1998 Surveillance Report.
Atlanta: Division of Reproductive Health, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and Prevention,
2000.
Marks JS, Koplan, JP, Hogue CJR, Dalmat ME. A
cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant
women. American Journal of Preventive Medicine 1990;6(5):282-9.
Mathews, TJ. Smoking During Pregnancy in the 1990s. National
Vital Statistics Reports 2001; 49(7). Hyattsville, Maryland: National Center for
Health Statistics, Centers for Disease Control and Prevention.
Melvin CL, Dolan-Mullen P, Windsor RA, Whiteside HP, Goldenberg
RL. Recommended cessation counseling for pregnant women who smoke: a review of
the evidence. Tobacco Control 2000; 9(Suppl III):iii80-84.
Schauffler HH, Mordavsky J, Barker D, et al. State Medicaid
coverage for tobacco dependence treatments– United States, 1998 and 2000.
Morbidity and Mortality Weekly Report 2001; 50(44): 979-82.
U.S. Department of Health and Human Services. The Health
Benefits of Smoking Cessation. U.S. Department of Health and Human Services,
Public Health Service, Centers for Disease Control and Prevention, Center for
Chronic Disease
Prevention and Health Promotion, Office on Smoking and Health.
DHHS Publication No. (CDC) 90-8416, 1990.
U.S. Department of Health and Human Services. Women and Smoking:
a Report of the Surgeon General. Rockville, MD: U.S. Department of Health and
Human Services, Public Health Service, Office of the Surgeon General; Washington
D.C.: For sale by the Supt of Docs., U.S. G.P.O. 2001
Windsor, RA, Lowe, JB, Perkins, LL, et al. Health education for
pregnant smokers: its behavioral impact and cost benefit. American Journal of
Public Health, February 1993, Vol. 83, No. 2. 201-6.
Zhang X, Miller L, Max W, Rice DP. Cost of smoking to the
Medicare program. Health Care Financing Review, Summer 1999, Vol. 20, No. 4.
179-96.
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