Cost-Effectiveness of E-Cigarettes Compared with Nicotine Replacement Therapy in Stop Smoking Services in England: A Randomized Controlled Trial

Summary of Study

Bottom Line: This study examines the cost-effectiveness of e-cigarettes as a stop-smoking tool and finds that e-cigarettes are a relatively inexpensive means of extending lifespans compared to nicotine replacement therapy (NRT). The incremental cost-effectiveness ratio (ICER) of e-cigarettes was £1,100 per quality-adjusted life-year (QALY) in the first 12 months after quitting smoking. The lifetime ICER of e-cigarettes was £65 per QALY.

This study found that the average treatment cost was £201 for study participants who received NRT versus £105 for study participants who used e-cigarettes. The 12-month ICER in the primary analysis was £1,100 per QALY gained. The long-term modeling estimated a lifetime ICER at £65 per QALY gained for e-cigarette users.

These results indicate that e-cigarettes are a highly cost-effective cessation aid, compared to NRT. Participants’ expenses on smoking cessation between NRT and e-cigarettes showed no difference, but the costs of smoking cessation borne by the UK Stop Smoking Service (SSS) and National Health Service (NHS) were lower among e-cigarette participants. This suggests that e-cigarette intervention could potentially reduce the costs to the SSS and NHS without increasing the financial burden on smokers’ part.

The long-term model to evaluate the e-cigarette effectiveness demonstrated a significantly higher abstinence rate at 12 months. Yet the model did not take into account repeated attempts to quit nor the possible long-term effects of e-cigarettes on health. There is a lack of evidence on e-cigarette use on long-term health.

The study also provided the initial e-cigarette products at no cost to the participants, which is not common practice within SSS at the present time. These results suggest that people who want to quit smoking should ask for advice on the use of e-cigarettes. This means staff in the SSS and NHS must be equipped with correct and sufficient information about the potential role of e-cigarettes in aiding smoking cessation.

The relative cost-effectiveness of e-cigarettes compared to NRT suggests that policymakers should consider providing e-cigarette starter packs to those who want to quit smoking free of charge.

Read the full study here