Ek. Adams et Cl. Melvin, COSTS OF MATERNAL CONDITIONS ATTRIBUTABLE TO SMOKING DURING PREGNANCY, American journal of preventive medicine, 15(3), 1998, pp. 212-219
Citations number
25
Categorie Soggetti
Medicine, General & Internal","Public, Environmental & Occupation Heath
Context: Despite known adverse health effects, many women continue to
smoke during pregnancy. Public attention has now focused on the econom
ic as well as health effects of this behavior. Objective: To estimate
health care costs associated with smoking-attributable cases of placen
ta previa, abruptio placenta, ectopic pregnancy, preterm premature rup
ture of the membrane (PPROM), preeclampsia, and spontaneous abortion.
Design: Pooled odds ratios were used with data on total cases to estim
ate smoking-attributable cases. Estimated average costs for cases of e
ctopic pregnancy and spontaneous abortion were used to estimate smokin
g-attributable health care costs for these conditions. Incremental cos
ts, or costs above those for a ''normal'' delivery, were used to estim
ate smoking-attributable costs of placenta previa, abruptio placenta,
PPROM, and preeclampsia associated with delivery. Setting: National es
timates for 1993. Participants: Data from the National Hospital Discha
rge Survey (NHDS) and claims data from a sample of large, self-insured
employers across the country. Results: Smoking-attributable costs ran
ged from $1.3 million for PPROM to $86 million for ectopic pregnancy.
Smoking during pregnancy apparently protects against pre-eclampsia and
saves between $36 and $49 million, depending on smoking prevalence. O
ver all conditions smoking-attributable costs ranged from $135 to $167
million. Conclusions: Smoking during pregnancy is a preventable cause
of higher health care costs for the conditions studied. While smoking
during pregnancy was found to be protective against pre-eclampsia and
, hence, saves costs, the net costs were still positive and significan
t. Effective smoking-cessation programs can reduce health care costs b
ut clinicians will perhaps need to manage increased cases of pre-eclam
psia in a cost-effective manner.