An exploratory economic assessment of the effect of the smoke‐free generation policy in England on smoking in pregnancy

AIMS: To estimate the impact of England's proposed smoke-free generation (SFG) policy on smoking at time of delivery, adverse maternal and offspring outcomes and the cost-effectiveness of the policy compared with no intervention. DESIGN: Decision analytic modelling using the Economics of Smoking in Pregnancy model, taking a health service and personal social services perspective. Three scenarios (central, pessimistic, optimistic) were simulated deterministically and through probabilistic sensitivity analyses (10 000 iterations). SETTING: England, United Kingdom. PARTICIPANTS: A synthetic birth cohort of 11 995 women born in 2014 giving birth at a mean maternal age of 28, representing the women affected by the first 15 years of the proposed 2027 SFG policy. INTERVENTION AND COMPARATOR: The intervention was England's proposed SFG policy to ban tobacco sales to those born on or after 1 January 2009. The comparator was no change in policy. MEASUREMENTS: We reported maternal and offspring outcomes (analysed separately), reductions in adverse pregnancy and offspring outcomes, life years gained, benefit-cost ratio and incremental cost-effectiveness ratio per quality-adjusted life year (QALY) gained for combined maternal lifetime and offspring outcomes to age 15. RESULTS: In the central scenario, SFG was projected to save £334 and gain 0.152 QALYs per mother and child combined. The policy was estimated to avert 11 stillbirths, 35 premature births and 157 low-birthweight infants in the modelled birth cohort, and reduce child asthma prevalence by 0.8 percentage points and child mortality by 0.7 percentage points at age 15. Across all scenarios, SFG dominated the comparator, with projections of both cost savings to health and personal social services and QALY gains. When controlling for uncertainty, this dominance persisted in probabilistic sensitivity analyses, with all three scenarios having a 100% chance of being cost-effective. Additional analyses assuming 15-fold increased costs for each of the three scenarios still found SFG to be dominant. SUMMARY: In England, introducing a smoke-free generation policy is projected to reduce smoking in pregnancy, prevent adverse birth outcomes and deliver substantial health gains for mothers and children while reducing healthcare costs.