An official state assessment of how best to help citizens give up smoking conducted by Ireland’s Health Information and Quality Authority (Hiqa) recently revealed that a greater uptake of electronic cigarettes by smokers is likely to increase the number of successful quit attempts and lower the overall costs of smoking cessation.
The health technology assessment was requested by Dr. Fenton Howell, the national tobacco control adviser at Ireland’s Department of Health, and was the first in Europe to examine the cost effectiveness of electronic cigarettes, as well as other traditional quit-smoking aids. Dublin’s Health Information and Quality Authority, which has yet to publish its final report after a public consultation, found that e-cigs could help more people successfully kick their smoking habit while lowering healthcare costs by millions of euros.
“Hiqa’s analysis shows that increased uptake of e-cigarettes as an aid to quitting would increase the number of people who successfully quit compared with the existing situation in Ireland and would be cost-effective, provided that the currently available evidence on their effectiveness is confirmed by further studies,” said Dr. Mairin Ryan, Hiqa’s director of health technology assessment.
Ryan did however mention a “high level of uncertainty” regarding electronic cigarettes, stating that “while the long-term effects of using e-cigarettes have not yet been established, data from Healthy Ireland reveals that 29% of smokers currently use e-cigarettes as an aid to quitting smoking.”
“This analysis examines the safety, effectiveness and cost-effectiveness of the smoking cessation interventions available in Ireland that can be used to help smokers quit for good,” Dr. Ryan said. “These include medicines such as nicotine replacement therapy, varenicline and antidepressants, as well as e-cigarettes and behavioural interventions, such as counselling and telephone support. HIQA also specifically examined the clinical effectiveness of therapies in pregnant women, and those attending secondary mental health services.”
The report cites data from 2013 which shows that the cost to the Irish healthcare system of smoking was over €460 million while the cost of lost productivity was over €1 billion. At the moment the overall cost of smoking cessation to the State is estimated to be over €40 million per year. Taking this fact into consideration, Hiqa concludes that “that all publicly funded smoking cessation interventions can be considered clinically effective when compared with doing nothing, and cost-effective when compared with unassisted quitting.”
The 700-page assessment found that varenicline – a controversial prescription-only medication which helps people to stop smoking by reducing withdrawal symptoms and reducing the satisfaction that can be gained from smoking – was over two and a half times as effective in helping people quit smoking as using no drugs. But the most effective way was using varenicline alongside nicotine replacement therapy – more than three and a half times as effective as no medication.
Electronic cigarettes were found to be twice as effective as using no other therapy (based on only two trials with a small number of participants) but were considerably more cost effective than the other two forms of intervention. While Hiqa considers varenicline alongside nicotine replacement therapy “good value for money” due to its high effectiveness, it is estimated that its greater uptake could add around eight million euros to health care costs, every year. A rise in the use of e-cigarettes by smokers trying to quit, is expected to lower healthcare costs by 2.6 million euros per year.
And, I might add, e-cigarettes don’t carry the serious, albeit rare, side-effects of varenicline drugs like Chantix, including neuropsychiatric symptoms and suicidality. I’m not saying that e-cigarettes are completely safe, but so far researchers have not identified any serious side-effects of vaping. Long-term use is a completely different question to which we are unable to provide answers right now.