title: Evaluation of a complex healthcare intervention to increase smoking cessation in pregnant women: interrupted time series analysis with economic evaluation.
abstract: To evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking.
  
  
  
  Interrupted time series analysis of routine data before and after introducing the intervention, within-study economic evaluation.
  
  
  
  Eight acute NHS hospital trusts and 12 local authority areas in North East England.
  
  
  
  37 726 records of singleton delivery including 10 594 to mothers classified as smoking during pregnancy.
  
  
  
  A package of measures implemented in trusts and smoking cessation services, aimed at increasing the proportion of pregnant smokers quitting during pregnancy, comprising skills training for healthcare and smoking cessation staff; universal carbon monoxide monitoring with routine opt-out referral for smoking cessation support; provision of carbon monoxide monitors and supporting materials; and an explicit referral pathway and follow-up protocol.
  
  
  
  Referrals to smoking cessation services; probability of quitting smoking during pregnancy; additional costs to health services; incremental cost per additional woman quitting.
  
  
  
  After introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter.
  
  
  
  The implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery.
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Bell
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Svetlana V
authors.initials: SV
authors.lastname: Glinianaia
authors.affiliation: School of Biology, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Zelda van der
authors.initials: ZV
authors.lastname: Waal
authors.affiliation: School of Biology, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Close
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Eoin
authors.initials: E
authors.lastname: Moloney
authors.affiliation: Health and Social Care Institute, Teesside University, Middlesbrough, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Jones
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Vera
authors.initials: V
authors.lastname: Araújo-Soares
authors.affiliation: Health and Social Care Institute, Teesside University, Middlesbrough, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Hamilton
authors.affiliation: Newcastle City Council, Newcastle upon Tyne, UK.
authors.forename: Eugene Mg
authors.initials: EM
authors.lastname: Milne
authors.affiliation: Health and Social Care Institute, Teesside University, Middlesbrough, UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Shucksmith
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Luke
authors.initials: L
authors.lastname: Vale
authors.affiliation: Fresh, Smoke Free North East, Durham, UK.
authors.forename: Martyn
authors.initials: M
authors.lastname: Willmore
authors.affiliation: MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: White
authors.affiliation: School of Biology, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Rushton
mesh_terms: D000293:Adolescent; D000328:Adult; D002248:Carbon Monoxide / Q000032:analysis; D004739:England; D005260:Female; D017048:Health Care Costs; D006801:Humans; D065186:Interrupted Time Series Analysis; D008137:Longitudinal Studies; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000517:prevention & control*; D012017:Referral and Consultation; D012907:Smoking / Q000191:economics / Q000453:epidemiology*; D016540:Smoking Cessation / Q000191:economics / Q000379:methods*; D000074606:Smoking Prevention / Q000191:economics / Q000379:methods*; D055815:Young Adult
chemical_list: D002248:Carbon Monoxide
keywords: economic evaluation; guidelines; implementation; natural experimental evaluation; pregnancy; smoking cessation