Cost analysis of motivational interviewing and preschool education for secondhand smoke exposures

Introduction: This study determines if expenditures associated with implementing a combinedmotivational interviewing (MI) and Head Start-level education program (MI+Education), as comparedto education alone, yield cost savings to society.Methods: Post hoc cost analyses were applied to a randomized controlled-trial of MI among predominantlyAfrican American, low-income caregivers of 330 Baltimore City Head Start studentswho reside with a smoker. The primary outcome was the cost savings of MI+Education from averteddirect secondhand smoke exposure (SHSe)-related acute healthcare events and inferred indirectcosts (work days lost, transportation and reduction in cigarettes smoked). The net direction of savingswas defined by the sum of averted direct and indirect costs of the MI+Education intervention at3, 6 and 12 months, benchmarked against the Education alone cohort at the equivalent time periods.Results: The costs saved by the MI+Education intervention, relative to Education alone, resultedin savings at solely the 12-month follow-up time point. Significant savings were appreciated fromaverted emergency department (ED) visits at 12 months ($4410; 95% simulation interval [SI]: $2241,$6626) for the MI+Education group. The total savings at 12 months ($2274; 95% SI: -3916, $8442)could not overcome additional program costs of implementing MI to Head Start-level education($13 695; 95% SI: $11 250, $16 034).Conclusions: This study is the first to examine the cost of either intervention on SHSe-attributedpediatric healthcare costs from a population level relevant for federal and community decisionmakers. Intervention costs could not be offset by short-term savings but a trend towards positivesavings was appreciated 1 year after implementation.Implications: Behavioral interventions are effective in reducing SHSe in children. However, manyof these interventions are not implemented in community settings due to lack of resources andmoney. Behavioral strategies may be a cost-saving addition to the national initiatives to createsmoke-free home environments. The long-term benefits of MI, as evidenced from cost savings fromaverted ED visits, appeared to show MI+Education to be a robust long-term strategy. The decreaseof acute healthcare services at 12 months may be informative for policy decision makers seekingto allocate limited resources to reduce the usage of costly ED services and hospital readmissions.