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.
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
ISSN0965-2140
Publication process dates
Accepted13 Sep 2019
Deposited28 Oct 2019
Accepted author manuscript
License
CC BY 4.0
File Access Level
Open
Supplemental file
License
CC BY 4.0
File Access Level
Open
Permalink -

https://openresearch.lsbu.ac.uk/item/88535

File access - Request a copy

Accepted author manuscript

Supplemental file

  • 7
    total views
  • 0
    total downloads
  • 1
    views this month
  • 0
    downloads this month

Related outputs

Effects of e-cigarettes versus nicotine replacement therapy on short-term smoking abstinence when delivered at a community pharmacy
Cox, S, Dawkins, L, Dosh, J and Cameron, J (2019). Effects of e-cigarettes versus nicotine replacement therapy on short-term smoking abstinence when delivered at a community pharmacy. Addictive Behaviors Reports. 10.
A cross sectional survey of smoking characteristics and quitting behaviour from a sample of homeless adults in Great Britain
Cox, S, Dawkins, L, Ford, A, Bauld, L, Balaban, S and Tyler, A (2019). A cross sectional survey of smoking characteristics and quitting behaviour from a sample of homeless adults in Great Britain. Addictive Behaviors. 95 (2019), pp. 35-40.
A systematic review of smoking, smoking cessation and the homeless: there is a will but is there a way?
Cox, S., Dawkins, L., Robson, D. and Soar, K. (2019). A systematic review of smoking, smoking cessation and the homeless: there is a will but is there a way? Lisbon Addictions Conference 2019. Lisbon 09 - 11 Oct 2019
Investigating within-person patterns and trajectories of dual e-cigarette and tobacco use: the TRAJECT mixed methods study protocol
Cox, S., Notley, C., Dawkins, L., Naughton, F., Beard, E., Kimber, C., Ward, E., Holland, R. and Kwasnicka, D. (2019). Investigating within-person patterns and trajectories of dual e-cigarette and tobacco use: the TRAJECT mixed methods study protocol. Society for Research on Nicotine and Tobacco. Oslo 17 - 21 Sep 2019
Communicating the Relative Health Risks of E-Cigarettes: An online experimental study exploring the Effects of a Comparative Health Message versus the EU Nicotine Addiction Warnings on Smokers’ and Non-Smokers’ Risk Perceptions and Behavioural Intentions.
Kimber, C., Frings, D., Cox, S., Albery, I. and Dawkins, L. (2019). Communicating the Relative Health Risks of E-Cigarettes: An online experimental study exploring the Effects of a Comparative Health Message versus the EU Nicotine Addiction Warnings on Smokers’ and Non-Smokers’ Risk Perceptions and Behavioural Intentions. Addictive Behaviors.
Data for 'Real-world’ compensatory behaviour with low nicotine concentration e-liquid: subjective effects and nicotine, acrolein and formaldehyde exposure
Dawkins, LE, Cox, S, Goniewicz, M, McRobbie, H, Kimber, CF, Doig, M and Kosmider, L (2019). Data for 'Real-world’ compensatory behaviour with low nicotine concentration e-liquid: subjective effects and nicotine, acrolein and formaldehyde exposure. John Wiley & Sons Ltd on behalf of Society for the Study of Addiction. doi:10.18744/LSBU.002952
A randomized trial of E-cigarettes versus nicotine-replacement therapy
Hajek, P, Phillips-Waller, A, Przulj, D, Pesola, F, Smith, KM, Bisal, N, Li, J, Parrott, S, Sasieni, P, Dawkins, L, Ross, L, Goniewicz, M, Wu, Q and McRobbie, HJ (2019). A randomized trial of E-cigarettes versus nicotine-replacement therapy. New England Journal of Medicine. 380 (7), pp. 629-637.
An exploration into “do-it-yourself” (DIY) e-liquid mixing: Users' motivations, practices and product laboratory analysis
Cox, S, Dawkins, L, Leigh, N, Choo, E, Vanderbush, T and Goniewicz, M (2018). An exploration into “do-it-yourself” (DIY) e-liquid mixing: Users' motivations, practices and product laboratory analysis. Addictive Behaviors Reports.
The effects of the European E-cigarette health warning and comparative health messages on non-smokers' and smokers' risk perceptions and behavioural intentions: study protocol
Kimber, C, Frings, D, Cox, S, Albery, I and Dawkins, L (2018). The effects of the European E-cigarette health warning and comparative health messages on non-smokers' and smokers' risk perceptions and behavioural intentions: study protocol. BMC Public Health. 18 (1259).
Vaping as an alternative to smoking relapse following brief lapse
Notley, C, Ward, E, Dawkins, L, Holland, R and Jakes, S (2018). Vaping as an alternative to smoking relapse following brief lapse. Drug and Alcohol Review.
Nicotine absorption from e-cigarettes over 12 months
Soar, K, Kimber, CF, McRobbie, H and Dawkins, LE (2018). Nicotine absorption from e-cigarettes over 12 months. Addictive Behaviors. 91, pp. 102-105.
Global and local perspectives on tobacco harm reduction: what are the issues and where do we go from here?
Cox, SA and Dawkins, LE (2018). Global and local perspectives on tobacco harm reduction: what are the issues and where do we go from here? Harm Reduction Journal. 15 (32).
A pre-post pilot study of electronic cigarettes to reduce smoking in people with severe mental illness
Hickling, L, Perez-Iglesias, R, McNeil, A, Dawkins, LE, Moxham, J, Ruffell, T, Sendt, K-V and McQuire, P (2018). A pre-post pilot study of electronic cigarettes to reduce smoking in people with severe mental illness. Psychological Medicine. 49 (6), pp. 1033-1040.
The unique contribution of e-cigarettes for tobacco harm reduction in supporting smoking relapse prevention
Notley, C, Ward, E, Dawkins, LE and Holland, R (2018). The unique contribution of e-cigarettes for tobacco harm reduction in supporting smoking relapse prevention. Harm Reduction Journal. 15 (1).
'Real-world' compensatory behaviour with low nicotine concentration e-liquid: subjective effects and nicotine, acrolein and formaldehyde exposure
Dawkins, LE, Cox, SA, Goniewicz, M, McRobbie, H, Kimber, CF, Doig, M and Kosmider, L (2018). 'Real-world' compensatory behaviour with low nicotine concentration e-liquid: subjective effects and nicotine, acrolein and formaldehyde exposure. Addiction.
A Qualitative Exploration of the Role of Vape Shop Environments in Supporting Smoking Abstinence
Ward, E, Cox, SA, Dawkins, LE, Jakes, S, Holland, R and Notley, C (2018). A Qualitative Exploration of the Role of Vape Shop Environments in Supporting Smoking Abstinence. International Journal of Environmental Research and Public Health. 15 (2), p. 297.
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.
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.
Changing Behaviour: Electronic Cigarettes
Dawkins, LE and McRobbie, H (2017). Changing Behaviour: Electronic Cigarettes. British Psychological Society.
Compensatory puffing with lower nicotine concentration e-liquids increases carbonyl exposure in e-cigarette aerosols
Dawkins, LE, Kosmider, L, Kimber, CF, 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).
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.
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.
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.
Self-titration by experienced e-cigarette users: blood nicotine delivery and subjective effects
Dawkins, LE, Kimber, CF, 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.