Immediate health care savings if pregnant women quit smoking, says UCSF study

By Wallace Ravven

Anti-smoking programs, if effective, would immediately pay for themselves by reducing the number of low birth weight babies and cutting the incidence of heart disease, according to a new study by UC San Francisco researchers. The evidence on low birth weight babies adds to a 1997 report by the researchers projecting significant short-term health care savings from reduced incidence of stroke and heart attacks if smoking is cut just one percent.

Most people think health care savings from smoking cessation programs will only show up many years later with a lowered risk of cancer and lung diseases, said the study’s author Stanton A. Glantz, PhD, UCSF professor of medicine and researcher at the UCSF Institute for Health Policy Studies (IHPS), and the Cardiovascular Research Institute. But Glantz and his colleagues decided to see what the short-term effects of an anti-smoking programs would be - a perspective a politician or HMO manager might use to assess a program’s value.

In the new study, they estimated the immediate monetary savings from smoking cessation, in terms of the reduced number of low birth weight babies born to mothers who smoked during pregnancy.

“We wanted to talk to the HMO manager or short sighted politician who only cared how much money smoking cessation would save right now,” Glantz said.

Their results are published in the December issue of the journal Pediatrics.

Collaborators on the research and co-authors with Glantz on the paper are James Lightwood, PhD, assistant adjunct professor in UCSF’s Department of Clinical Pharmacy and IHPS, and Ciaran Phibbs of the Department of Health Research and Policy at the Stanford University School of Medicine.

The researchers analyzed the 1990 California Linked Perinatal Data, which shows the percentage of low weight births in the state for that year, and the added short-term cost of caring for those babies. Low weight infants are more likely to be put immediately into an intensive care unit, and they are more vulnerable to illnesses, such as respiratory tract infections, the paper explained.

The researchers then factored in the nationwide smoking rate for pregnant mothers (13%), and the likelihood that an infant’s low birth weight is caused by its mother’s smoking - roughly 10% as measured by a 1990 study. 

They found that each pregnant woman who smokes after her first trimester costs an average of $511 more during the pregnancy hospitalization than a non-smoker. That adds up to $263 million per year, and doesn’t include the cost of any later hospitalizations or care for other problems that smoking might cause the child or the mother. 

Health insurance plans, which usually pay this added cost, would save $21 million in direct medical costs for each one percent drop in the smoking rate, Glantz said. A seven-year anti-smoking program that successfully promotes annual one percent reductions in smoking rates would prevent 57,200 infants from being below normal in birth weight, and would save $572 million in direct medical costs. The researchers based the seven-year/one percent model on the success of California’s anti-smoking program, which helped reduce smoking rates during its first seven years.

“If you can promote smoking cessation, there are substantial immediate, short term benefits, both in health, and in medical cost savings,” Glantz said. 

Smoking cessation also saves money over the short term in heart disease care, according to the earlier study by Glantz and Lightwood. That study showed that cutting the smoking rate by one percent would save $44 million dollars in the first year alone through reduced risks of heart attacks and strokes. 

“If you look at the short term savings from both low birth weight babies and heart disease, that more than pays for the cost of a major tobacco control program like the one we’ve had in California,” Glantz said. California’s anti-smoking program, begun in 1989, has used money from a 25-cent-per-pack cigarette tax to pay for anti-tobacco television and billboard ads, as well as anti-smoking campaigns in communities and schools.

The new study in Pediatrics is the first to be conducted since lung surfactants were introduced to neonatal care, dramatically improving the chances of survival for low birth weight babies.

The research was supported by grants from the National Cancer Institute, and the Agency for Health Care Policy and Research.