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

Journal article

Li, J., Hajek, P., Pesola, F., Wu, Q., Phillips-Waller, A., Przuli, D., Myers Smith, K., Bisal, N., Sasieni, P., Dawkins, L., Ross, L., Goniewicz, M., McRobbie, H. and Parrott, S. (2019). Cost-effectiveness of e-cigarettes compared with nicotine replacement therapy in stop smoking services in England (TEC study): a randomised controlled trial. Addiction. 115 (3), pp. 507-517. https://doi.org/10.1111/add.14829
AuthorsLi, J., Hajek, P., Pesola, F., Wu, Q., Phillips-Waller, A., Przuli, D., Myers Smith, K., Bisal, N., Sasieni, P., Dawkins, L., Ross, L., Goniewicz, M., McRobbie, H. and Parrott, S.
Abstract

Aim
To evaluate the cost-effectiveness of e-cigarettes as a smoking cessation aid used in routine stop smoking service.
Design
Cost-effectiveness analysis was performed from the National Health Service (NHS) and Personal Social Services (PSS) perspective for 12 months period and lifetime. Costs, including that of both treatments, other smoking cessation help and healthcare 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 randomised controlled trial. Lifetime 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 English Stop-Smoking Service sites in England
Participants
Adult smokers 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 three months, both with standard behavioural support. A total of 886 participants were randomised (439 in EC arm, 447 in NRT arm). Excluding one death in each arm, the one-year quit rate was 18.0% and 9.9%, respectively.
Measurements
Cost of treatments was estimated from treatment log. Costs of other smoking cessation help and healthcare services, and EQ-5D-5L were collected at baseline, six- 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 £1,100 per QALY gained at the 12 months after quit date (87% - 90% probability of cost-effective between £20,000/QALY and £30,000/QALY). Markov model estimated the lifetime ICER of EC to be £65 per QALY (around 85% probability of cost-effective between £20,000/QALY and £30,000/QALY).
Conclusion
Using e-cigarette as a smoking cessation aid with standard behavioural support in an English Stop-Smoking Service is more cost-effective than using nicotine replacement therapy in the same setting.

Year2019
JournalAddiction
Journal citation115 (3), pp. 507-517
PublisherWiley
ISSN0965-2140
Digital Object Identifier (DOI)https://doi.org/10.1111/add.14829
Publication dates
Online11 Feb 2020
Publication process dates
Accepted13 Sep 2019
Deposited28 Oct 2019
Accepted author manuscript
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Open
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Correction: Global and local perspectives on tobacco harm reduction: What are the issues and where do we go from here? [Harm Reduct J., 15, (2018) (32)] DOI: 10.1186/s12954-018-0239-5
Cox, S and Dawkins, L (2018). Correction: Global and local perspectives on tobacco harm reduction: What are the issues and where do we go from here? [Harm Reduct J., 15, (2018) (32)] DOI: 10.1186/s12954-018-0239-5. Harm Reduction Journal. 15 (1), p. 37. https://doi.org/doi.org/10.1186/s12954-018-0242-x
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Dawkins, LE, Kosmider, L, Kimber, C., Kurek, J and Corcoran, O (2017). Compensatory puffing with lower nicotine concentration e-liquids increases carbonyl exposure in e-cigarette aerosols. Nicotine and Tobacco Research (OUP). 20 (8), p. 998=1003. https://doi.org/10.1093/ntr/ntx162
Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack
Heidebrecht, F, MacLeod, MB and Dawkins, LE (2017). Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack. Addictive Behaviors. https://doi.org/https://doi.org/10.1016/j.addbeh.2017.10.013
E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure
Cox, S., Kośmider, L., McRobbie, H., Goniewicz, M., Kimber, C., Doig, M. and Dawkins, L. (2016). E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure. BMC Public Health. 16 (1). https://doi.org/DOI:10.1186/s12889-016-3653-1
Alcohol Gel Ingestion Among Homeless Eastern and Central Europeans in London: Assessing the Effects on Cognitive Functioning and Psychological Health
Dawkins, LE, Soar, K and Papaioannou, G (2016). Alcohol Gel Ingestion Among Homeless Eastern and Central Europeans in London: Assessing the Effects on Cognitive Functioning and Psychological Health. Substance Use and Misuse. https://doi.org/10.3109/10826084.2016.1168441
Self-titration by experienced e-cigarette users: blood nicotine delivery and subjective effects
Dawkins, LE, Kimber, C., Doig, M, Feyerabend, C and Corcoran, O (2016). Self-titration by experienced e-cigarette users: blood nicotine delivery and subjective effects. Psychopharmacology. 233 (15), pp. 2933-2941. https://doi.org/10.1007/s00213-016-4338-2
E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure (study protocol)
Dawkins, LE, Cox, SA, Kosmider, L, McRobbie, H, Goniewicz, M, Kimber, CF and Doig, M (2016). E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure (study protocol). BMC Public Health. 16. https://doi.org/10.1186/s12889-016-3653-1
Adolescent awareness and use of electronic cigarettes: A review of emerging trends and findings
Dawkins, LE, Greenhill, R, Notley, C, Finn, M and Turner, J (2016). Adolescent awareness and use of electronic cigarettes: A review of emerging trends and findings. Journal of Adolescent Health. 59 (6), pp. 612-619. https://doi.org/10.1016/j.jadohealth.2016.08.005
Recreational cocaine use is associated with attenuated latent inhibition
Soar, K., Dawkins, L., Page, F. and Woolridge, J. (2015). Recreational cocaine use is associated with attenuated latent inhibition. Addictive Behaviors. 50 (34-39). https://doi.org/10.1016/j.addbeh.2015.06.010
The effects of e-cigarette visual appearance on craving and withdrawal symptoms in abstinent smokers
Dawkins, L., Munafo, M., Christoforou, G., Olumegbon, N. and Soar, K. (2015). The effects of e-cigarette visual appearance on craving and withdrawal symptoms in abstinent smokers. Psychology of Addictive Behaviors. 30 (1), pp. 101-105. https://doi.org/10.1037/adb0000112
Acute electronic cigarette use: nicotine delivery and subjective effects in regular users
Dawkins, L. and Corcoran, O. (2014). Acute electronic cigarette use: nicotine delivery and subjective effects in regular users. Psychopharmacology. 231 (2), pp. 401-407. https://doi.org/10.1007/s00213-013-3249-8
First‐ versus second‐generation electronic cigarettes: predictors of choice and effects on urge to smoke and withdrawal symptoms
Dawkins, L., Kimber, C., Puwanesarasa, Y. and Soar, K. (2014). First‐ versus second‐generation electronic cigarettes: predictors of choice and effects on urge to smoke and withdrawal symptoms. Addiction. 110 (4), pp. 669-677. https://doi.org/10.1111/add.12807
Water consumption, not expectancies about water consumption, affects cognitive performance in adults
Edmonds, C.J., Crombie, R., Baillieux, H., Gardner, M.R. and Dawkins, L. (2013). Water consumption, not expectancies about water consumption, affects cognitive performance in adults. Appetite. 60, pp. 148-153. https://doi.org/10.1016/j.appet.2012.10.016
Vaping? profiles and preferences: an online survey of electronic cigarette users
Dawkins, L. (2013). Vaping? profiles and preferences: an online survey of electronic cigarette users. UEL Research and Knowledge Exchange Conference 2013. London 26 Jun 2013 University of East London.
Neuropsychological effects associated with recreational cocaine use
Soar, K., Mason, C., Potton, A. and Dawkins, L. (2012). Neuropsychological effects associated with recreational cocaine use. Psychopharmacology. 222, pp. 633-643. https://doi.org/10.1007/s00213-012-2666-4
The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition
Dawkins, L., Turner, J.J.D., Hasna, S. and Soar, K. (2012). The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition. Addictive Behaviors. 37, pp. 970-973. https://doi.org/10.1016/j.addbeh.2012.03.004
Investigating the impact of nicotine on executive functions using a novel virtual reality assessment
Jansari, A.S., Froggatt, D., Edginton, T. and Dawkins, L. (2012). Investigating the impact of nicotine on executive functions using a novel virtual reality assessment. Addiction. 108, pp. 977-984.
Nicotine derived from the electronic cigarette improves time-based prospective memory in abstinent smokers
Dawkins, L., Turner, J.J.D. and Crowe, E. (2012). Nicotine derived from the electronic cigarette improves time-based prospective memory in abstinent smokers. Psychopharmacology. 227, pp. 377-384.
Effects of nicotine and alcohol on affective responses to emotionally toned film clips
Dawkins, L. and Powell, J (2011). Effects of nicotine and alcohol on affective responses to emotionally toned film clips. Psychopharmacology. 216, pp. 197-205. https://doi.org/10.1007/s00213-011-2197-4
Expectation of having consumed caffeine can improve performance and mood
Dawkins, L., Shahzad, F.-Z., Ahmed, S.S and Edmonds, C.J. (2011). Expectation of having consumed caffeine can improve performance and mood. Appetite. 57, pp. 597-600. https://doi.org/10.1016/j.appet.2011.07.011
Relapse to smoking during unaided cessation: clinical, cognitive, and motivational predictors
Powell, J.H., Dawkins, L., West, R., Powell, J.F. and Pickering, A. (2010). Relapse to smoking during unaided cessation: clinical, cognitive, and motivational predictors. Psychopharmacology. 212, pp. 537-549. https://doi.org/10.1007/s00213-010-1975-8
Patterns of change in withdrawal symptoms, desire to smoke, reward motivation and response inhibition across 3 months of smoking abstinence
Dawkins, L., Powell, J.H., Pickering, A., Powell, J. and West, R. (2009). Patterns of change in withdrawal symptoms, desire to smoke, reward motivation and response inhibition across 3 months of smoking abstinence. Addiction. 104, pp. 850-858. https://doi.org/10.1111/j.1360-0443.2009.02522.x
The effects of cigarette smoking and abstinence on auditory verbal learning
Soar, K., Dawkins, L., Begum, H. and Parrott, A.C. (2008). The effects of cigarette smoking and abstinence on auditory verbal learning. Human Psychopharmacology: Clinical and Experimental. 23, pp. 621-627. https://doi.org/10.1002/hup.968
The effects of smoking and abstinence on experience of happiness and sadness in response to positively valenced, negatively valenced, and neutral film clips
Dawkins, L., Acaster, S. and Powell, J.H. (2007). The effects of smoking and abstinence on experience of happiness and sadness in response to positively valenced, negatively valenced, and neutral film clips. Addictive Behaviors. 32, pp. 425-431. https://doi.org/10.1016/j.addbeh.2006.05.010
A double-blind placebo controlled experimental study of nicotine: II - Effects on response inhibition and executive functioning
Dawkins, L., Powell, J.H., West, R., Powell, J. and Pickering, A. (2007). A double-blind placebo controlled experimental study of nicotine: II - Effects on response inhibition and executive functioning. Psychopharmacology. 190, pp. 457-467. https://doi.org/10.1007/s00213-006-0634-6
A double-blind placebo controlled experimental study of nicotine: I - Effects on incentive motivation
Dawkins, L., Powell, J.H., West, R., Powell, J. and Pickering, A. (2006). A double-blind placebo controlled experimental study of nicotine: I - Effects on incentive motivation. Psychopharmacology. 189, pp. 355-367. https://doi.org/10.1007/s00213-006-0588-8
Cognitive and psychological correlates of smoking abstinence, and predictors of successful cessation
Powell, J.H., Pickering, A.D., Dawkins, L., West, R. and Powell, J.F. (2004). Cognitive and psychological correlates of smoking abstinence, and predictors of successful cessation. Addictive Behaviors. 29, pp. 1407-1426. https://doi.org/10.1016/j.addbeh.2004.06.006
Smoking, reward responsiveness, and response inhibition: tests of an incentive motivational model
Powell, J.H., Dawkins, L. and Davis, R.E. (2002). Smoking, reward responsiveness, and response inhibition: tests of an incentive motivational model. Biological Psychiatry. 51, pp. 151-163. https://doi.org/10.1016/S0006-3223(01)01208-2