An exploratory economic evaluation of the effect of the smokefree generation policy in England on smoking in pregnancy

AimsTo estimate the impact of Englands proposed smokefree generation (SFG) policy on smoking at time of delivery (SATOD), adverse maternal and offspring outcomes, and the cost-effectiveness of the policy compared with no intervention. DesignDecision analytic modelling using the Economics of Smoking in Pregnancy (ESIP) model, taking a health service and personal social services perspective. Three scenarios (central, pessimistic, optimistic) were simulated deterministically and through probabilistic sensitivity analyses (10,000 iterations). SettingEngland, United Kingdom. ParticipantsA synthetic birth cohort of 19,843 women projected to give birth in 2042 at a mean maternal age of 28, representing the women affected by the first 15 years of the proposed 2027 SFG policy. Intervention and comparatorThe intervention is Englands proposed SFG policy to ban tobacco sales to those born on or after 1 January 2009. The comparator is no change in policy. MeasurementsThe primary outcome is incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained for combined maternal lifetime and offspring outcomes to age 15. Secondary outcomes are maternal and offspring outcomes (analysed separately), reductions in adverse pregnancy and offspring outcomes, life years gained, and benefit-cost ratio. FindingsAcross all scenarios, SFG dominated the comparator, with projections of both cost savings to health and personal social services and QALY gains. In the central scenario, SFG was projected to save 338 GBP and gain 0.152 QALYs per mother and child combined. The policy was estimated to avert 18 stillbirths, 58 premature births and 260 low-birthweight infants in 2042, and reduce child asthma prevalence by 0.8 percentage points and child mortality by 0.7 percentage points at age 15. When controlling for uncertainty, this dominance persisted in probabilistic sensitivity analyses, with all three scenarios having a 100% chance of being cost-effective. Additional analyses assuming 15-fold increased costs for each of the three scenarios still found SFG to be dominant. ConclusionsIn England, introducing a smokefree generation policy is projected to reduce smoking in pregnancy, prevent adverse birth outcomes, and deliver substantial health gains for mothers and children while reducing healthcare costs.