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Addiction. 2019 Oct 9. doi: 10.1111/add.14829. [Epub ahead of print]

Cost-effectiveness of e-cigarettes compared with nicotine replacement therapy in stop smoking services in England (TEC study): a randomized controlled trial.

Author information

1
Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK.
2
Queen Mary University of London, London, UK.
3
King's College London, London, UK.
4
London South Bank University, London, UK.
5
Leicester City Council, Leicester, UK.
6
Roswell Park Comprehensive Cancer Centre, Buffalo, NY, USA.

Abstract

AIM:

To evaluate the cost-effectiveness of e-cigarettes as a smoking cessation aid used in routine stop smoking services in England.

DESIGN:

Cost-effectiveness analysis was performed from the National Health Service (NHS) and Personal Social Services (PSS) perspective for 12-month periods and life-time. Costs, including that of both treatments, other smoking cessation help and health-care services, and health benefits, estimated from EQ-5D-5L and measured in quality-adjusted life-years (QALYs), for the 12-month analysis, came from a randomized controlled trial. Life-time analysis was model-based with input from both trial data and published secondary data sources. Cost-effectiveness was measured by an incremental cost-effectiveness ratio (ICER).

SETTING:

Three stop-smoking service sites in England.

PARTICIPANTS:

Adult smokers (n = 886) who sought help to quit in the participating sites.

INTERVENTION AND COMPARATOR:

An e-cigarette (EC) starter kit versus provision of nicotine replacement therapy (NRT) for up to 3 months, both with standard behavioural support. A total of 886 participants were randomized (439 in the EC arm, 447 in the NRT arm). Excluding one death in each arm, the 1-year quit rate was 18.0 and 9.9%, respectively.

MEASUREMENTS:

Cost of treatments was estimated from the treatment log. Costs of other smoking cessation help and health-care services and EQ-5D-5L were collected at baseline, 6- and 12-month follow-ups. Incremental costs and incremental QALYs were estimated using regression adjusting for baseline covariates and their respective baseline values.

FINDINGS:

The ICER was £1100 per QALY gained at the 12 months after quit date (87% probability below £20 000/QALY). Markov model estimated the life-time ICER of EC to be £65 per QALY (85% probability below £20 000/QALY).

CONCLUSION:

Using e-cigarettes as a smoking cessation aid with standard behavioural support in stop-smoking services in England is likely to be more cost-effective than using nicotine replacement therapy in the same setting.

KEYWORDS:

Cost-effectiveness; Markov model; e-cigarette; economic evaluation; life-time modelling; nicotine replacement therapy; smoking cessation; stop smoking services

PMID:
31597207
DOI:
10.1111/add.14829

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