Cost-Effectiveness Analysis of E-cigarettes Compared to Nicotine Replacement Therapy for Smoking Cessation Among Medicaid Users in California

Introduction:
This text provides an analysis of the cost-effectiveness of e-cigarettes as a smoking cessation aid for Medicaid users in California. The study compares e-cigarettes with nicotine replacement therapy (NRT) and behavioral counseling. The analysis is conducted from a societal perspective and considers the lifetime costs and health outcomes of each treatment.

Key Points:

* The study is based on a hypothetical cohort of 1000 smokers per treatment arm, followed through four mutually exclusive and exhaustive health states: smoker, former smoker, smoking-attributable death, and death from unrelated causes.
* The model is based on the experience of California Medicaid recipients and assumes that individuals receive treatment once at the beginning of the first cycle with no subsequent treatment.
* The cohort is followed over their expected lifetime to fully capture all health outcomes and costs and to estimate the impact on life expectancy attributable to each treatment.
* The study found that e-cigarettes were more cost-effective than NRT, with an incremental cost-effectiveness ratio of $11,454 per additional QALY gained over smokers’ lifetimes.
* Results were sensitive to smokers’ healthcare costs, model start ages, discount rates, and QALY weights.
* Despite the lack of FDA approval, e-cigarettes are a popular choice among smokers trying to quit, and policymakers should consider whether providing financial support for e-cigarettes as a harm reduction strategy is worth pursuing.

Main Message:
The study highlights the potential cost-effectiveness of e-cigarettes as a smoking cessation aid for Medicaid users in California. The results suggest that e-cigarettes could provide a more cost-effective harm reduction strategy than NRT, despite the lack of FDA approval. Policymakers should consider the potential benefits of e-cigarettes as a smoking cessation aid and the economic implications of extending health insurance coverage for e-cigarettes as a cessation aid. However, further research is needed to inform the degree to which current policy in the United States regarding e-cigarettes exacerbates health disparities within a particularly disadvantaged population.

Angela W Chen, Paul A Fishman, Cost-Effectiveness Analysis of E-cigarettes Compared to Nicotine Replacement Therapy for Smoking Cessation Among Medicaid Users in California, Nicotine & Tobacco Research, Volume 27, Issue 3, March 2025, Pages 466–474, https://doi.org/10.1093/ntr/ntae219