Health Policy


Economic Evaluation of Infants with Low Birth Weight Attributed to Maternal Smoking

With a grant from the University of Northern Iowa and the Iowa Department of Public Health, the costs of LBW infants attributable to smoking during pregnancy were calculated for the state of Iowa.

In all countries, infants with low birth weight (LBW) have increased morbidity and mortality. Both smoking during pregnancy and more recently, environmental tobacco smoke (ETS) exposure have been shown to be significant risk factors for LBW. In turn, LBW results in significant increased healthcare costs and therefore consume greater health care resources of infants of normal birth weights. By improving newborn birth outcomes including the number of LBW infants born, excess medical costs can be avoided.

The data was were extrapolated to determine the potential cost savings of avoided cases of LBW infants as a result of cigarette tax increases for the entire state and for the population whose medical care is funded by Medicaid. Data were sourced from primary, secondary and published literature sources. All costs not available in 2007 dollars were adjusted using the appropriate medical consumer price index.

Results showed that in Iowa in 2005, it is estimated that 7,462 infants were born to maternal smokers. Of these infants, 320 (11.34%) were of LBW that could be considered attributable to maternal, prenatal smoking. This result indicates that smoking during pregnancy is a significant risk factor for LBW. In 2007 dollars, for every LBW infant born to a maternal smoker in Iowa, the mean excess healthcare cost for the neonatal period is $6,518. As a result, the 320 LBW infants attributable to smoking during pregnancy account for over $2 million in excess health expenditures correlating to over $700 in excess healthcare costs per maternal smoker for the State of Iowa. Considering that nearly 70% of maternal smokers are covered by Medicaid, the health expenses of 219 to these LBW infants are covered by this service. Medicaid is therefore responsible for nearly $1.5 million in annual excess health care costs of LBW infants attributable to smoking during pregnancy.

Many of these excess healthcare costs could be avoided by decreasing the prevalence of smoking during pregnancy through an increase in cigarette taxes. If there was just a 1% drop in the prevalence of smoking during pregnancy, 17 infants with LBW could be prevented and would account for cost-savings of over $100,000. For the Medicaid population, it could potentially prevent 12 infants with LBW and account for a cost savings of nearly $80,000. Considering the $1.00 tax increase recently introduced, it would be expected that the prevalence of smoking during pregnancy in Iowa could fall from 19.00% to just 12.4%. With this prevalence, LBW in 111 infants would be avoided at a cost-saving of over $700,000. For the Medicaid population, LBW in 76 infants would be avoided at a cost saving of nearly $500,000.

By decreasing the smoking during pregnancy prevalence, considerable excess healthcare costs can be avoided. Furthermore, these potential cost savings are conservative, considering only the neonatal period and only those costs associated with moderately LBW infants. If other potentially avoidable costs were considered including those related to maternal health, reduction in infant mortality and reduction in additional healthcare and societal costs into childhood and potentially adulthood, the cost savings seen by a reduction in smoking during pregnancy would be considerably greater.