{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:23:45Z","timestamp":1787775825337,"version":"build-2784847793"},"reference-count":51,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001921","name":"Public Health Research programme","doi-asserted-by":"publisher","award":["NIHR132158"],"award-info":[{"award-number":["NIHR132158"]}],"id":[{"id":"10.13039\/501100001921","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec id=\"abs1-1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While smoking is common among those experiencing homelessness, the effectiveness of an e-cigarette intervention to reduce smoking in this population is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-2\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the cost-effectiveness of providing an e-cigarette for smoking cessation in homeless support centres compared to usual care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-3\">\n                    <jats:title>Design and methods<\/jats:title>\n                    <jats:p>A multicentre two-arm cluster randomised controlled trial, with data collection time points at baseline, 4, 12 and 24 weeks post baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-4\">\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>\n                      Adults (aged 18+) who smoked daily and accessed 32 homeless support centres across six areas of Great Britain received either e-cigarette intervention (\n                      <jats:italic>n<\/jats:italic>\n                      \u2005=\u2005239 in 16 centres) or usual care (\n                      <jats:italic>n<\/jats:italic>\n                      \u2005=\u2005236 in 16 centres) by centre (cluster) randomisation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-5\">\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>The intervention was the provision of an e-cigarette starter kit plus 4 weeks\u2019 supply of e-liquids. The usual care comprised very brief advice for smoking cessation and signposting to local Stop Smoking Services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-6\">\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The total costs included costs of intervention\/usual care, costs of smoking cessation outside of the trial and costs of general healthcare services use over 24 weeks. Quality-adjusted life-years were derived from EuroQol-5 Dimensions, five-level version administered at each data collection point. An incremental cost-effectiveness ratio was calculated for 24 weeks using the difference between groups in total costs and quality-adjusted life-years, with cost-effectiveness acceptability curve constructed based on bootstrap to examine uncertainty. A long-term model was employed to project a lifetime incremental cost-effectiveness ratio with probabilistic sensitivity analysis to examine uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-7\">\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>The analysis over 24 weeks was based on research team records and data collected via self-reported questionnaires. Unit costs for valuation were extracted from published secondary sources. The parameters of the long-term model were based on the 24-week results and published secondary sources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean intervention costs were estimated at \u00a392 [standard error (SE) \u00a30] per participant and mean usual care costs at \u00a350 (SE \u00a30) per participant. Mean total costs per participant were estimated at \u00a33859 (SE \u00a3441) in the e-cigarette group and \u00a32716 (SE \u00a3386) in the usual care group. Mean quality-adjusted life-years were estimated at 0.303 (SE 0.008) in the e-cigarette group and 0.295 (SE 0.010) in the usual care group. Adjusting for baseline covariates and respective baseline values, e-cigarette group were \u00a31267 (95% confidence interval \u00a3600 to \u00a31938) more costly and yielded 0.007 (95% confidence interval \u22120.017 to 0.027) more quality-adjusted life-years than usual care. The incremental cost-effectiveness ratio was calculated at \u00a3181,000 per quality-adjusted life-year gain, with probability of intervention being cost-effective between the incremental cost-effectiveness ratio thresholds of \u00a320,000\u201330,000 per quality-adjusted life-year gain at 0.9\u20133.5%. The lifetime model projected the incremental cost-effectiveness ratio at \u00a338,360 per quality-adjusted life-year gained, with the probability of intervention being cost-effective between \u00a320,000 and \u00a330,000 from 47.6% to 49.6%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-9\">\n                    <jats:title>Limitations<\/jats:title>\n                    <jats:p>The imbalance in missing data led to some uncertainty in the results, and healthcare costs recorded in the trial may not reflect the health needs of this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-10\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Providing e-cigarettes for smoking cessation in homeless support centres was more costly than usual care, but the small increase in quality-adjusted life-years was not significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-11\">\n                    <jats:title>Future work<\/jats:title>\n                    <jats:p>Future work should aim to maximise quit rates while being cost-effective and therefore implementable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-12\">\n                    <jats:title>Funding<\/jats:title>\n                    <jats:p>This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR132158.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3310\/gjld2428","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T08:46:54Z","timestamp":1745830014000},"page":"1-45","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness of e-cigarettes for smoking cessation at homeless support centres: SCeTCH 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