What if the state of Wisconsin could help pregnant women quit smoking, help babies grow up smoke-free, and it would pay for itself?
Researchers from UW-CTRI and First Breath discovered that paying pregnant Medicaid members to engage in help to quit smoking not only worked, but the costs to Medicaid would likely be recovered.
Maternal smoking increases risks for pre-term delivery, low birthweight, Sudden Infant Death Syndrome (SIDS), asthma, wheezing and cognitive deficits.
By investing a modest amount of money to help moms and their newborns stay smoke-free, Wisconsin could potentially avoid associated medical costs to Medicaid for these maladies, including:
- Excess neonatal costs for infants of mothers who smoke, estimated to exceed $880 per child.
- Treatment for infant asthma averaging $3279 per year.
Meanwhile, it only cost $317 per person to help the Medicaid moms in the incentive group to quit. This was an average cost that accounted for people who participated fully, partially or dropped out.
“The literature is clear that there will be healthcare cost reductions for women who quit smoking and for their babies,” said Dr. Marlon Mundt, lead author of the paper published in the journal Preventive Medicine. “It’s not just improving the health of moms and children, there are possibly savings in health expenditures.”
The First Breath Wisconsin Study enrolled 1014 Medicaid-enrolled pregnant women recruited from September 2012 to April 2015 through public health departments, community health clinics and other clinics in Wisconsin. The 505 women in the incentive group could receive $460 for completing pre-birth visits ($25 each), post-birth home visits ($40, $25, $25, $40 for 1-week, 2-month, 4-month and 6-month visits), monthly smoking cessation phone calls post-birth ($20 each), and biochemically-verified tobacco abstinence at 1-week ($40) and 6-months ($40) after birth.
The 509 women in the control group received up to $80 for 1-week ($40) and 6-month ($40) post-birth assessments. Intervention costs included incentive payments to participants, counselor and administrative staff time, and medications to help them quit smoking.
“The incentive group during the postpartum time period was much more likely to accept treatment,” Mundt said. He pointed out that home visits from First Breath take a holistic approach to the health of the mother and infant—from being sure the home is safe from smoke and other dangers to asking the mother what she needs. First Breath professionals offer help with coping strategies for stress as well as practical items like free diapers.
“By meeting participants in their homes, we are able to support other family and household members and focus on reducing infant and childhood exposure to tobacco smoke in the home,” Krissy Alaniz, Wisconsin Women’s Health Foundation (WWHF) Director of Programs. WWHF manages the First Breath program.
Of course, not everyone who participated in the study quit. So, accounting for all Medicaid members who are pregnant or postpartum, including those who continue to smoke, it would cost approximately $3300 to help one additional baby grow up smoke-free. Still, if that baby avoids developing asthma, that investment from Medicaid could pay for itself in a year.
Following the promising outcomes of the research study, the First Breath program adopted the incentives into their standard care for moms, despite limited resources. With additional funding, more moms who are Medicaid members could get the incentives and quit smoking.
Approximately seven percent of US women report cigarette smoking during pregnancy, and 85 percent who quit smoking while pregnant relapse in the first six months postpartum.
Read more about this topic in the Wisconsin State Journal.