Cost-effectiveness of a Smoking Cessation Intervention for Parents in Pediatric Primary Care

Olivier Drouin,Jeremy E Drehmer,Ryoko Sato,Bethany Hipple Walters,Emara Nabi-Burza,Douglas E Levy,Jonathan P Winickoff

doi:10.1001/jamanetworkopen.2021.3927

Abstract

Parental smoking adversely affects parents' and children's health. There are effective interventions delivered in pediatric settings to help parents quit smoking. The cost-effectiveness of this type of intervention is not known. To evaluate the cost-effectiveness of a parental smoking cessation intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE) program, delivered in pediatric primary care, compared with usual care from a health care organization's perspective. This economic evaluation used data on intervention costs and parental smoking cessation collected prospectively as part of the CEASE randomized clinical trial. Data were collected at pediatric offices in 5 US states from April 2015 to October 2017. Participants included parents of children attending 10 pediatric primary care practices (5 control, 5 intervention). Data analysis was performed from October 2019 to August 2020. The trial compared CEASE (practice training and support to address family tobacco use) vs usual care. The overall cost and incremental cost per quit of the CEASE intervention were calculated using microcosting methods. CEASE effectiveness was estimated using 2 trial outcomes measures assessed in repeated cross-sections: (1) change in smoking prevalence assessed by parental report for intervention vs usual care practices at 2 weeks after program initiation (baseline) and at 2-year follow-up and (2) changes in the proportion of smokers who achieved cotinine-confirmed smoking cessation in the previous 2 years at baseline vs follow-up. Monte Carlo analyses were used to provide 95% CIs. The study included a total of 3054 participants (1523 at baseline and 1531 at follow-up); 2163 (70.8%) were aged 25 to 44 years old, and 2481 (81.2%) were women. Over 2 years, the total cost of implementing and sustaining CEASE across 5 intervention practices was $115 778. The incremental cost per quit for CEASE compared with usual care was $1132 (95% CI, $653-$3603), according to the change in parent-reported smoking prevalence, and $762 (95% CI, $418-$2883), according to cotinine-confirmed cessation. CEASE was cost-effective at a willingness-to-pay threshold of $2000 per quit in 88.0% of simulations based on the parent-reported smoking prevalence and 94.6% of simulations based on cotinine-confirmed smoking cessation measures. These findings suggest that the CEASE intervention was associated with an incremental cost per quit that compared favorably with those of other clinical smoking cessation interventions. CEASE is inexpensive to initiate and maintain in the clinical pediatric setting, suggesting that it has the potential for a high impact on population health.

Highlights

Tobacco smoke exposure remains a major cause of morbidity in the pediatric population, and parental smoking cessation has major benefits for both child and adult health.[1]
The incremental cost per quit for Clinical Effort Against Secondhand Smoke Exposure (CEASE) compared with usual care was $1132, according to the change in parent-reported smoking prevalence, and $762, according to cotinine-confirmed cessation
These findings suggest that the CEASE intervention was associated with an incremental cost per quit that compared favorably with those of other clinical

Summary

Introduction

Tobacco smoke exposure remains a major cause of morbidity in the pediatric population, and parental smoking cessation has major benefits for both child and adult health.[1]. The Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention provides a framework for systematically screening families in pediatric primary care practices for tobacco use and delivering evidence-based cessation assistance.[7] In prior research,[8] CEASE was associated with decreased smoking prevalence and increased smoking cessation among parents whose children had received pediatric care. One response to these promising findings was concern about the resource and economic burden CEASE might impose on pediatric practices.[9] In this economic evaluation, we describe a prespecified analysis quantifying the total costs and incremental cost-effectiveness of CEASE from the perspective of a health care organization

Methods

Results

Discussion

Conclusion