{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T10:15:27Z","timestamp":1780049727392,"version":"3.53.1"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["T32HS013853"],"award-info":[{"award-number":["T32HS013853"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Smoking is the leading preventable cause of death and disability in the United States. A 2019 randomized controlled trial found e-cigarettes are more effective than nicotine replacement therapy (NRT) in achieving abstinence when both are combined with behavioral counseling. Few cost-effectiveness studies have been performed regarding e-cigarettes as an adjunct to cessation efforts, and none in a U.S. context. This study evaluated the cost-effectiveness of e-cigarettes compared to NRT, both with counseling, and as cessation aids for Medicaid smokers in California.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims and Methods<\/jats:title>\n                  <jats:p>A cost-effectiveness analysis from a U.S. societal perspective comparing e-cigarettes with NRT was constructed. Using a lifetime horizon, smokers were followed to different health states to their expected lifespan. Costs were expressed in 2020 U.S. dollars and health outcomes in quality-adjusted life years (QALY). All costs and outcomes were discounted at a 3% annual rate and model findings were assessed with a series of sensitivity analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Using U.S. willingness-to-pay thresholds, e-cigarettes were more cost-effective than NRT, with an incremental cost-effectiveness ratio of $11 454 per additional QALY gained over smokers\u2019 lifetimes. Results were sensitive to smokers\u2019 healthcare costs, model start ages, discount rates, and QALY weights.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>E-cigarettes used as a cessation treatment by smokers are more cost-effective relative to NRT. However, e-cigarettes as a treatment are currently unapproved by the Food and Drug Administration (FDA). Despite the lack of FDA approval, e-cigarettes are a popular choice among smokers trying to quit. Policymakers should consider whether providing financial support for e-cigarettes as a harm reduction strategy is worth pursuing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>As e-cigarettes grow in popularity and are an increasingly preferred choice of smoking cessation aid among smokers attempting to quit, it is important to examine the inclusion of these products in tobacco policy, research, and practice. Several countries have now adopted or are in the process of adopting e-cigarettes as a medically licensed and regulated smoking cessation aid. Future smoking cessation strategies by U.S. policymakers may consider the adoption of e-cigarettes as a cost-effective harm reduction tool for use by current smokers seeking to quit.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntae219","type":"journal-article","created":{"date-parts":[[2024,9,14]],"date-time":"2024-09-14T08:33:11Z","timestamp":1726302791000},"page":"466-474","source":"Crossref","is-referenced-by-count":1,"title":["Cost-Effectiveness Analysis of E-cigarettes Compared to Nicotine Replacement Therapy for Smoking Cessation Among Medicaid Users in California"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6656-128X","authenticated-orcid":false,"given":"Angela W","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Health Systems and Population Health, University of Washington School of Public Health , Seattle, WA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3419-4539","authenticated-orcid":false,"given":"Paul A","family":"Fishman","sequence":"additional","affiliation":[{"name":"Department of Health Systems and Population Health, University of Washington School of Public Health , Seattle, WA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"issue":"5","key":"2025022405530604300_CIT0001","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1093\/NTR\/NTV237","article-title":"Patterns of electronic cigarette use among adults in the United States","volume":"18","author":"Delnevo","year":"2016","journal-title":"Nicotine Tob Res."},{"issue":"e2","key":"2025022405530604300_CIT0002","doi-asserted-by":"publisher","first-page":"e145","DOI":"10.1136\/TOBACCOCONTROL-2021-056901","article-title":"Effectiveness of e-cigarettes as aids for smoking cessation: evidence from the PATH Study cohort, 2017\u20132019","volume":"32","author":"Chen","year":"2022","journal-title":"Tob Control."},{"key":"2025022405530604300_CIT0003","doi-asserted-by":"publisher","first-page":"i90","DOI":"10.1136\/TOBACCOCONTROL-2016-053096","article-title":"Long-term e-cigarette use and smoking cessation: a longitudinal study with US population","volume":"25","author":"Zhuang","year":"2016","journal-title":"Tob Control."},{"issue":"1","key":"2025022405530604300_CIT0004","first-page":"1","article-title":"Electronic cigarettes for smoking cessation","volume":"2024","author":"Lindson","year":"2024","journal-title":"Cochrane Database Syst"},{"key":"2025022405530604300_CIT0005","doi-asserted-by":"publisher","first-page":"j3262","DOI":"10.1136\/BMJ.J3262","article-title":"E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys","volume":"358","author":"Zhu","year":"2017","journal-title":"BMJ"},{"key":"2025022405530604300_CIT0006","doi-asserted-by":"publisher","first-page":"106230","DOI":"10.1016\/J.ADDBEH.2019.106230","article-title":"Associations between dual use of e-cigarettes and smoking cessation: a prospective study of smokers in England","volume":"103","author":"Jackson","year":"2020","journal-title":"Addict Behav."},{"issue":"11","key":"2025022405530604300_CIT0007","doi-asserted-by":"publisher","first-page":"11220","DOI":"10.3390\/ijerph111111220","article-title":"Effectiveness of the electronic cigarette: an eight-week flemish study with six-month follow-up on smoking reduction, craving and experienced benefits and complaints","volume":"11","author":"Adriaens","year":"2014","journal-title":"Int J Environ Res Public Health."},{"issue":"7","key":"2025022405530604300_CIT0008","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1056\/NEJMoa1808779","article-title":"A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy","volume":"380","author":"Hajek","year":"2019","journal-title":"N Engl J Med."},{"issue":"8","key":"2025022405530604300_CIT0009","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1093\/NTR\/NTX166","article-title":"The relationship of E-cigarette use to cigarette quit attempts and cessation: insights from a large, Nationally Representative U.S. Survey","volume":"20","author":"Levy","year":"2018","journal-title":"Nicotine Tob Res."},{"issue":"7","key":"2025022405530604300_CIT0010","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1056\/NEJMoa2308815","article-title":"Electronic nicotine-delivery systems for smoking cessation","volume":"390","author":"Auer","year":"2024","journal-title":"N Engl J Med."},{"issue":"3","key":"2025022405530604300_CIT0011","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1111\/ADD.16063","article-title":"Biomarkers of potential harm in people switching from smoking tobacco to exclusive e-cigarette use, dual use or abstinence: secondary analysis of Cochrane systematic review of trials of e-cigarettes for smoking cessation","volume":"118","author":"Hartmann-Boyce","year":"2023","journal-title":"Addiction."},{"key":"2025022405530604300_CIT0012","author":"National Health Service","journal-title":"Using e-cigarettes to stop smoking - NHS"},{"key":"2025022405530604300_CIT0013","author":"Medicines and Healthcare products Regulatory Agency","journal-title":"MHRA publishes clear guidance to support bringing e-cigarettes to market as licensed therapies - GOV.UK"},{"key":"2025022405530604300_CIT0014","doi-asserted-by":"publisher","first-page":"p1014","DOI":"10.1136\/BMJ.P1014","article-title":"Australia bans all vapes except on prescription to stem use in children","volume":"381","author":"Nogrady","year":"2023","journal-title":"BMJ"},{"key":"2025022405530604300_CIT0015","volume-title":"Premarket Tobacco Product Marketing Granted Orders | FDA","year":"2024"},{"issue":"6","key":"2025022405530604300_CIT0016","doi-asserted-by":"publisher","first-page":"155","DOI":"10.15585\/MMWR.MM6906A2","article-title":"State medicaid coverage for tobacco cessation treatments and barriers to accessing treatments \u2014 United States, 2008\u20132018","volume":"69","author":"DiGiulio","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"5","key":"2025022405530604300_CIT0017","doi-asserted-by":"publisher","first-page":"e0178279","DOI":"10.1371\/journal.pone.0178279","article-title":"Smoking prevalence in Medicaid has been declining at a negligible rate","volume":"12","author":"Zhu","year":"2017","journal-title":"PLoS One."},{"issue":"3","key":"2025022405530604300_CIT0018","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1111\/add.14829","article-title":"Cost-effectiveness of e-cigarettes compared with nicotine replacement therapy in stop smoking services in England (TEC study): a randomized controlled trial","volume":"115","author":"Li","year":"2019","journal-title":"Addiction."},{"issue":"59","key":"2025022405530604300_CIT0019","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/HTA25590","article-title":"Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis","volume":"25","author":"Thomas","year":"2021","journal-title":"Health Technol Assess."},{"issue":"6","key":"2025022405530604300_CIT0020","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1016\/J.JVAL.2020.12.012","article-title":"Cost-effectiveness analysis of smoking cessation interventions in the United Kingdom accounting for major neuropsychiatric adverse events","volume":"24","author":"Keeney","year":"2021","journal-title":"Value Health."},{"issue":"1","key":"2025022405530604300_CIT0021","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1093\/NTR\/NTY062","article-title":"E-cigarettes: comparing the possible risks of increasing smoking initiation with the potential benefits of increasing smoking cessation","volume":"21","author":"Warner","year":"2019","journal-title":"Nicotine Tob Res."},{"issue":"2","key":"2025022405530604300_CIT0022","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/J.AMEPRE.2008.04.009","article-title":"A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report","volume":"35","author":"Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff","year":"2008","journal-title":"Am J Prev Med."},{"key":"2025022405530604300_CIT0023","author":"Centers for Medicare & Medicaid Services","journal-title":"California | Medicaid.gov"},{"issue":"6","key":"2025022405530604300_CIT0024","doi-asserted-by":"publisher","first-page":"S130","DOI":"10.1016\/j.amepre.2018.07.017","article-title":"The growing proportion of smokers in medicaid and implications for public policy","volume":"55","author":"Zhu","year":"2018","journal-title":"Am J Prev Med."},{"key":"2025022405530604300_CIT0025","author":"Centers for Disease Control and Prevention","journal-title":"State Tobacco Activities Tracking and Evaluation (STATE) System: State Highlights | OSH | CDC"},{"issue":"9","key":"2025022405530604300_CIT0026","doi-asserted-by":"publisher","first-page":"4765","DOI":"10.1002\/CAM4.1495","article-title":"Economic evaluation of smoking cessation in Ontario\u2019s regional cancer programs","volume":"7","author":"Djalalov","year":"2018","journal-title":"Cancer Med"},{"issue":"14","key":"2025022405530604300_CIT0027","doi-asserted-by":"publisher","first-page":"3684","DOI":"10.1007\/S11606-021-07335-X","article-title":"The cost-effectiveness of nicotine replacement therapy sampling in primary care: a markov cohort simulation model","volume":"37","author":"Chen","year":"2022","journal-title":"J Gen Intern Med."},{"issue":"9905","key":"2025022405530604300_CIT0028","doi-asserted-by":"publisher","first-page":"1629","DOI":"10.1016\/S0140-6736(13)61842-5","article-title":"Electronic cigarettes for smoking cessation: a randomised controlled trial","volume":"382","author":"Bullen","year":"2013","journal-title":"Lancet (London, England)"},{"issue":"6","key":"2025022405530604300_CIT0029","doi-asserted-by":"publisher","first-page":"S148","DOI":"10.1016\/J.AMEPRE.2018.08.007","article-title":"Economic impact of financial incentives and mailing nicotine patches to help medicaid smokers quit smoking: a cost\u2013benefit analysis","volume":"55","author":"Sung","year":"2018","journal-title":"Am J Prev Med."},{"issue":"10","key":"2025022405530604300_CIT0030","doi-asserted-by":"publisher","first-page":"1696","DOI":"10.1111\/J.1360-0443.2008.02320.X","article-title":"Smokers\u2019 use of nicotine replacement therapy for reasons other than stopping smoking: findings from the ITC Four Country Survey","volume":"103","author":"Hammond","year":"2008","journal-title":"Addiction."},{"issue":"6","key":"2025022405530604300_CIT0031","doi-asserted-by":"publisher","first-page":"969","DOI":"10.2105\/AJPH.2004.040667","article-title":"Free nicotine replacement therapy programs vs implementing smoke-free workplaces: a cost-effectiveness comparison estimation of Minnesota\u2019s smoking population","volume":"95","author":"Ong","year":"2005","journal-title":"Am J Public Health."},{"issue":"26","key":"2025022405530604300_CIT0032","first-page":"504","article-title":"Smoking cessation during previous year, adults -- U.S., 1990\/1991","volume":"42","author":"Centers for Disease Control and Prevention","year":"1993","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"2025022405530604300_CIT0033","author":"Congressional Budget Office","year":"2012","journal-title":"Raising the Excise Tax on Cigarettes: Effects on Health and the Federal Budget | Congressional Budget Office"},{"issue":"16","key":"2025022405530604300_CIT0034","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1001\/JAMA.1996.03530400035035","article-title":"Cost-effectiveness of the transdermal nicotine patch as an adjunct to physicians\u2019 smoking cessation counseling","volume":"275","author":"Fiscella","year":"1996","journal-title":"JAMA."},{"issue":"8","key":"2025022405530604300_CIT0035","doi-asserted-by":"publisher","first-page":"E99","DOI":"10.5888\/PCD15.170555","article-title":"National and state-specific unit sales and prices for electronic cigarettes, United States, 2012\u20132016","volume":"15","author":"Wang","year":"2019","journal-title":"Prev Chronic Dis."},{"key":"2025022405530604300_CIT0036","volume-title":"Interventions for Smoking Cessation and Treatments for Nicotine Dependence","author":"Office of the Surgeon General","year":"2020"},{"issue":"10","key":"2025022405530604300_CIT0037","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1001\/JAMA.2016.12195","article-title":"Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine","volume":"316","author":"Sanders","year":"2016","journal-title":"JAMA."},{"key":"2025022405530604300_CIT0038","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1787\/16097491","article-title":"Estimating the structural rate of unemployment for the OECD countries","volume-title":"OECD Econ Stud.","author":"Boone","year":"2001"},{"key":"2025022405530604300_CIT0039","author":"US Bureau of Labor Statistics. California Economy at a Glance"},{"key":"2025022405530604300_CIT0040","volume-title":"Full Employment in A Free Society: A Report","author":"Beveridge","year":"1944"},{"key":"2025022405530604300_CIT0041","volume-title":"Understanding the Intersection of Medicaid & Work: A Look at What the Data Say | KFF","author":"Guth","year":"2023"},{"issue":"2","key":"2025022405530604300_CIT0042","doi-asserted-by":"publisher","first-page":"118","DOI":"10.2471\/BLT.14.138206","article-title":"Thresholds for the cost\u2013effectiveness of interventions: alternative approaches","volume":"93","author":"Marseille","year":"2015","journal-title":"Bull World Health Organ."},{"issue":"2","key":"2025022405530604300_CIT0043","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.jval.2013.02.010","article-title":"Consolidated Health Economic Evaluation","volume":"16","author":"Husereau","year":"2013","journal-title":"Value Health"},{"issue":"9","key":"2025022405530604300_CIT0044","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1002\/14651858.CD010216.pub3","article-title":"Electronic cigarettes for smoking cessation","volume":"2016","author":"Hartmann-Boyce","year":"2016","journal-title":"Cochrane Database Syst Rev."},{"issue":"12","key":"2025022405530604300_CIT0045","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1016\/J.ADDBEH.2008.05.012","article-title":"Relapse to smoking after 1 year of abstinence: a meta-analysis","volume":"33","author":"Hughes","year":"2008","journal-title":"Addict Behav."},{"issue":"12","key":"2025022405530604300_CIT0046","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1093\/ntr\/ntq175","article-title":"Long-Term smoking relapse: a study using the British Household Panel Survey","volume":"12","author":"Hawkins","year":"2010","journal-title":"Nicotine Tob Res."},{"key":"2025022405530604300_CIT0047","volume-title":"The Health Benefits of Smoking Cessation","author":"US Department of Health and Human Services","year":"1990"},{"issue":"11","key":"2025022405530604300_CIT0048","doi-asserted-by":"publisher","first-page":"2017","DOI":"10.1111\/J.1360-0443.2011.03505.X","article-title":"Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy","volume":"106","author":"Etter","year":"2011","journal-title":"Addiction."},{"issue":"2","key":"2025022405530604300_CIT0049","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1111\/1475-6773.00142","article-title":"Health care costs among smokers, former smokers, and never smokers in an HMO","volume":"38","author":"Fishman","year":"2003","journal-title":"Health Serv Res."},{"key":"2025022405530604300_CIT0050","doi-asserted-by":"publisher","first-page":"S186","DOI":"10.1016\/J.AMEPRE.2018.07.018","article-title":"Racial\/Ethnic differences in the response to incentives for quitline engagement","volume":"55","author":"Vijayaraghavan","year":"2018","journal-title":"Am J Prev Med."}],"container-title":["Nicotine and Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntae219\/59734867\/ntae219.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/27\/3\/466\/59734867\/ntae219.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/27\/3\/466\/59734867\/ntae219.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T05:54:45Z","timestamp":1740376485000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/27\/3\/466\/7756831"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,13]]},"references-count":50,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,9,13]]},"published-print":{"date-parts":[[2025,2,24]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntae219","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,3]]},"published":{"date-parts":[[2024,9,13]]}}}