Potential Country-Level Health and Cost Impacts of Legalizing Domestic Sale of Vaporized Nicotine Products

Summary of Study

Bottom LineWidening access to vaporized nicotine products in New Zealand and other countries with (to date) restrictive policies around these products could achieve substantive overall health gains and cost-savings to the health system. Policies to prevent youth uptake of either smoking or vaping should be an important adjunct to vaporized nicotine product liberalization. 

This study modeled the impacts of liberalization of the vaporized nicotine product market in New Zealand (NZ). As a result of a NZ court ruling, the products became legal to sell in 2018.

Liberalization of the vaporized nicotine product market, compared to the business as usual scenario, was estimated to gain 236,000 Quality-Adjusted Life Years (QALYs) for the NZ population alive in 2011 over the remainder of their lives and save $NZ3.4 billion ($US2.5 billion). 

This translates to 0.054 QALYs gained per capita (i.e., 19 additional days lived in full health for each person alive in 2011), and $NZ 780 health system costs saved per capita or avoidance of 0.43% of all future health care expenditure in this cohort. By time horizon, 5.9% of all QALY gains were estimated to occur within the first 20 years (1.3% in the first 10 years, and 4.6% in the second 10 years).

This modeling suggested that a fairly permissive regulatory environment around vaporized nicotine products achieves net health gain and cost-savings, albeit with wide uncertainty. The results suggest that optimal strategies will also be influenced by targeted smoking cessation advice, regulations around chemical constituents of these products, and marketing and age limits to prevent youth uptake of vaping.

However, modeling could not confidently rule out potential net health harm for the youngest age cohort (0-14 year olds) or for the 65+ year olds, under base-case assumptions. For the young this is due to uncertainty about the percentage of non-smoking youth becoming long-term vapers (i.e., beyond short-term experimentation) and the impact on tobacco smoking uptake rates.

For 65+ year olds (and to some extent 45-64 year olds), there is potential net health harm as a proportion of smokers who quit smoking will move into long-term vaping. In sum, while overall health gain appears likely, this gain will be decades into the future given health gains and cost-savings were predominantly for the younger age groups who are decades away from their peak non-communicable disease rates.

Access the full report here.