Cost-effectiveness of nicotine patches for smoking cessation in pregnancy: a placebo randomized controlled trial (SNAP).
Open accessAbstract
INTRODUCTION: Smoking during pregnancy is the most important, preventable cause of adverse pregnancy outcomes including miscarriage, premature birth, and low birth weight with huge financial costs to the National Health Service. However, there are very few published economic evaluations of smoking cessation interventions in pregnancy and previous studies are predominantly U.S.-based and do not present incremental cost-effectiveness ratios (ICER). A number of studies have demonstrated cost-effectiveness of nicotine replacement therapy (NRT) in the general population, but this has yet to be tested among pregnant smokers. METHODS: A cost-effectiveness analysis was undertaken alongside the smoking, nicotine, and pregnancy trial to compare NRT patches plus behavioral support to behavioral support alone, for pregnant women who smoked. RESULTS: At delivery, biochemically verified quit rates were slightly higher at 9.4% in the NRT group compared to 7.6% in the control group (odds ratio = 1.26, 95% CI = 0.82-1.96), at an increased cost of around £90 per participant. Higher costs in the NRT group were mainly attributable to the cost of NRT patches (mean = £46.07). The incremental cost-effectiveness ratio associated with NRT was £4,926 per quitter and a sensitivity analysis including only singleton births yielded an ICER of £4,156 per quitter. However, wide confidence intervals indicated a high level of uncertainty. CONCLUSIONS: Without a specific willingness to pay threshold, and due to high levels of statistical uncertainty, it is hard to determine the cost-effectiveness of NRT in this population. Furthermore, future research should address compliance issues, as these may dilute any potential effects of NRT, thus reducing the cost-effectiveness.
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The results of the two smaller trials with no treatment controls were not statistically significant, and estimates of efficacy were greater than for the placebo-controlled trials.
“The results of the two smaller trials with no treatment controls[97](#R97),[102](#R102) were not statistically significant, and estimates of efficacy were greater than for the placebo-controlled trials.”
From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [97]
The cited paper is not one of the two smaller trials with no-treatment controls: its Introduction (p. 2) identifies SNAP as a large trial comparing nicotine patches with visually identical placebo patches, and its Results (p. 4) report 1,050 randomized participants. Its nonsignificant result concerns that placebo-controlled trial, not the two trials described in the claim. (LLM, conf=0.87)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredTwo trials without placebo controls were imprecise (very wide confidence intervals) and estimated effects in opposite directions.
“Two trials without placebo controls were imprecise (very wide confidence intervals) and estimated effects in opposite directions.[97](#R97),[102](#R102)”
From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [97]
The Smoking, Nicotine, and Pregnancy Trial section (p. 2) says the study compared nicotine patches with identical placebo patches. The Results (p. 4) report one trial with NRT and placebo arms, not two trials without placebo controls estimating effects in opposite directions. The paper does report uncertainty, but not the claimed comparison between two non-placebo trials. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredAll seven included randomized clinical trials (N=2,285) were designed to test the effectiveness of NRT on smoking cessation and reported infant, child, and maternal health.
“All seven included RCTs (N=2,285) were designed to test the effectiveness of NRT on smoking cessation and reported infant, child, and maternal health.[93](#R93),[94](#R94),[97](#R97),[100](#R100)-[102](#R102),[104](#R104)”
From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [97]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThere was no evidence of perinatal harms related to NRT use among pregnant women, but data for assessing rare harms were very limited.
“There was no evidence of perinatal harms related to NRT use among pregnant women, but data for assessing rare harms were very limited.”
From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [97]
The Costs section (p. 4) reports similar neonatal-unit and maternal antenatal admission rates in the NRT and placebo groups, supporting a limited finding of no observed increase in those outcomes. The Introduction (p. 2) says earlier small trials provided insufficient evidence on NRT safety, but this paper does not specifically assess rare perinatal harms or establish the broader safety claim. (LLM, conf=0.80)
Experimental — accuracy not yet measuredAll seven trials reported the association between NRT and mean birthweight.
“All seven trials reported the association between NRT and mean birthweight.[93](#R93),[94](#R94),[97](#R97),[100](#R100)-[102](#R102),[104](#R104)”
From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [97]
The Results (p. 4) compare the NRT and placebo groups on smoking cessation, while the healthcare-use table (p. 5) reports neonatal admissions. A search for mean birthweight and birthweight found no NRT-versus-placebo mean birthweight result in this paper, so our copy cannot verify that this trial reported the claimed association. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Darling, E., Jansen, A., Jameel, B., & Tarride, J. (2024) · International Journal for Equity in Health · doi:10.1186/s12939-024-02252-x
- Authors
- Essex, H. N., Parrott, S., Wu, Q., Li, J., Cooper, S., & Coleman, T.
- Affiliations
- University of York (GB)
- University of Nottingham (GB)
- Venue
- Nicotine & Tobacco Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-12-06
- Volume
- 17
- Issue
- 6
- Pages
- 636-642
- ISSN
- 1462-2203 (ISSN-L)
- 1469-994X
- OpenAlex
- W2127129294
- Semantic Scholar
- 6ac6d4bf2272e354e5e4f6692a0f02ceba426ab4
- Cited by
- 9
- References
- 25
- Citations by year
- 2024: 1 · 2022: 1 · 2021: 1 · 2020: 2 · 2018: 1 · 2016: 1 · 2015: 2
- FWCI
- 0.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Nicotine & Tobacco Research (publishedVersion)
- PubMed (publishedVersion)
- Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Cancer Research UK
- National Institute for Health and Care Research (06/07/01)
- British Heart Foundation
- Medical Research Council (MR/K023195/1)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- smoking cessation, pregnancy, nicotine replacement therapy, nicotine patch, cost-effectiveness, behavioral support, quit rates, adverse pregnancy outcomes, incremental cost-effectiveness ratio, medication adherence
- MeSH terms
- Adult, Behavior Therapy, Cost-Benefit Analysis, Costs and Cost Analysis, Female, United Kingdom, Health Promotion, Humans, Nicotine, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Smoking, Smoking Cessation, Treatment Outcome, Nicotinic Agonists, Young Adult, Transdermal Patch, Tobacco Use Cessation Devices
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