Parental smoking intervention cost effective in pediatric primary care setting

A parental smoking intervention was effective and “inexpensive” to implement in pediatric primary care practices, with costs per quit that were comparable to other interventions, according to researchers.

Results of the randomized clinical trial were recently published in JAMA Network.

“The impetus for screening parents for tobacco use in the pediatric setting is to protect children from exposure to secondhand smoke,” Douglas E. Levy, PhD, MPH, associate professor of medicine at Harvard Medical School and associate investigator at the Mongan Institute Health Policy Center at Massachusetts General Hospital, told Healio Primary Care. “Parents may be more receptive to smoking cessation messages when the recommendation comes from pediatric health care providers because the benefits are framed in terms of protecting their child’s health.”

Levy and colleagues conducted an economic evaluation of the Clinical Effort Against Secondhand Smoke Exposure, or CEASE, randomized clinical trial, which prospectively collected parental smoking cessation data at pediatric primary care offices from April 2015 to October 2017. The researchers compared the CEASE intervention vs. usual care for 3,054 participants (70.8% aged 25 to 44 years; 81.2% women), including 1,523 at baseline and 1,531 at follow up. The primary outcome measures were changes in smoking prevalence at baseline and 2-year follow up as well as the proportion of parents who smoked and achieved cotinine-confirmed smoking cessation from baseline through the 2-year follow-up period.

The cost of the CEASE intervention over 2 years at five intervention practices was $115,778, with an incremental cost per quit vs. usual care of $1,132 (95% CI, 653-3,603) and a cotinine-confirmed smoking cessation cost of $762 (95% CI, 418-2,883). The researchers wrote that there was a $2,000 per-quit willingness to pay threshold for 88% of simulations based on parent-reported smoking and 94.6% of simulations based on cotinine-confirmed smoking cessation measures.

“The CEASE cluster randomized clinical trial was associated with a 3.7% difference in parent-reported smoking prevalence rate among parents attending pediatric primary care compared with usual care practices, at a cost conservatively estimated to be $1,132 per parent who became a nonsmoker,” the researchers wrote. “This cost-per-quit compares favorably with other smoking cessation interventions in the clinical setting and suggests that the CEASE intervention could be broadly disseminated.”