PMU5 Costs and Health Outcomes of Korean Children Attributable to Secondhand Smoke Exposure at HOME: An Analysis By a Markov MODEL

Abstract

Children exposed to secondhand smoke (SHS) are at increased risk for diseases. We sought to estimate costs and health outcomes for Korean children who were exposed to SHS at home. A Markov model was developed to project the health and economic outcomes of a hypothetical cohort of Korean newborn infants who’s at least one of family member is current smoker. Outcomes significantly associated with the SHS (asthma, acute otitis media, acute bronchitis, pneumonia, and SIDS) were included in the model. The time horizon of the analysis was 20 years (from birth to adulthood) and the cycle length was 1 week. The direct healthcare costs, QALYs and LYs were annually discounted at 5%. The validity of the model was evaluated and one-way/probabilistic sensitivity analysis were conducted. The estimated healthcare costs per SHS exposed child was 659.61 USD, which was 30% higher compared with non-exposed child (507.32 USD). The cumulative QALYs were 636.16 and 638.47 QALYs in exposed and unexposed group, respectively. One-way sensitivity analysis showed that our model was robust in all variables except the odds ratio for pneumonia. According to the PSA, there was no significant difference between health outcomes in the SHS exposed and non-exposed, but the costs varied significantly. External validity of our estimates was evaluated by comparing with the existing epidemiological data. The increase in healthcare costs was noticeable when child was exposed to SHS, but there was no significant difference in QALYs and LYs according to the exposure. This study conservatively approached the effects of SHS exposure on children, because we simulated the period from birth to adulthood, and did not take into account the disease that occurs after adulthood. Our study is the first attempt to evaluate the long-term impact of the SHS in children based on a validated model.