Li, Jinshuo;
Wu, Qi;
Parrott, Steve;
Cox, Sharon;
Pesola, Francesca;
Soar, Kirstie;
Brown, Rachel;
... Dawkins, Lynne; + view all
(2025)
Cost-effectiveness of e-cigarettes for smoking cessation at homeless support centres: SCeTCH cRCT.
Public Health Research
10.3310/GJLD2428.
(In press).
Preview |
Text
3049163.pdf - Published Version Download (1MB) | Preview |
Abstract
Background: While smoking is common among those experiencing homelessness, the effectiveness of an e-cigarette intervention to reduce smoking in this population is unclear. Objective: To determine the cost-effectiveness of providing an e-cigarette for smoking cessation in homeless support centres compared to usual care. Design and methods: A multicentre two-arm cluster randomised controlled trial, with data collection time points at baseline, 4, 12 and 24 weeks post baseline. Setting and participants: Adults (aged 18+) who smoked daily and accessed 32 homeless support centres across six areas of Great Britain received either e-cigarette intervention (n = 239 in 16 centres) or usual care (n = 236 in 16 centres) by centre (cluster) randomisation. Intervention: The intervention was the provision of an e-cigarette starter kit plus 4 weeks’ supply of e-liquids. The usual care comprised very brief advice for smoking cessation and signposting to local Stop Smoking Services. Main outcome measures: 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. Data sources: 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.Results: Mean intervention costs were estimated at £92 [standard error (SE) £0] per participant and mean usual care costs at £50 (SE £0) per participant. Mean total costs per participant were estimated at £3859 (SE £441) in the e-cigarette group and £2716 (SE £386) 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 £1267 (95% confidence interval £600 to £1938) more costly and yielded 0.007 (95% confidence interval −0.017 to 0.027) more quality-adjusted life-years than usual care. The incremental cost-effectiveness ratio was calculated at £181,000 per quality-adjusted life-year gain, with probability of intervention being cost-effective between the incremental cost-effectiveness ratio thresholds of £20,000–30,000 per quality-adjusted life-year gain at 0.9–3.5%. The lifetime model projected the incremental cost-effectiveness ratio at £38,360 per quality-adjusted life-year gained, with the probability of intervention being cost-effective between £20,000 and £30,000 from 47.6% to 49.6%. Limitations: 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. Conclusions: 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. Future work: Future work should aim to maximise quit rates while being cost-effective and therefore implementable. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR132158. A plain language summary of this research article is available on the NIHR Journals Library Website https://doi. org/10.3310/GJLD2428.
| Type: | Article |
|---|---|
| Title: | Cost-effectiveness of e-cigarettes for smoking cessation at homeless support centres: SCeTCH cRCT |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.3310/GJLD2428 |
| Publisher version: | https://doi.org/10.3310/GJLD2428 |
| Language: | English |
| Additional information: | Copyright © 2025 Li et al. This work was produced by Li et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10217089 |
Archive Staff Only
 |
View Item |
