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Randomized Controlled Trial
. 2020 Mar;115(3):507-517.
doi: 10.1111/add.14829. Epub 2019 Dec 4.

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

Jinshuo Li  1 , Peter Hajek  2 , Francesca Pesola  3 , Qi Wu  1 , Anna Phillips-Waller  2 , Dunja Przulj  2 , Katie Myers Smith  2 , Natalie Bisal  2 , Peter Sasieni  3 , Lynne Dawkins  4 , Louise Ross  5 , Maciej Lukasz Goniewicz  6 , Hayden McRobbie  2 , Steve Parrott  1
Affiliations
Randomized Controlled Trial

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

Jinshuo Li et al. Addiction. 2020 Mar.

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-5 L 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.

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Figures

Figure 1
Figure 1
Schematic representation of Markov model [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Cost‐effectiveness plane and cost‐effectiveness acceptability curve for the primary analysis (upper) and complete case analysis (lower), QALY=, quality‐adjusted life‐years [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Life‐time cost‐effectiveness plane and cost‐effectiveness acceptability curve. QALY=, quality‐adjuested life‐years [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

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