A cost-utility analysis of the impact of electronic nicotine inhalers on health care costs and outcomes in Canada

Introduction: We determined the impact of electronic nicotine delivery systems (ENDS) on health outcomes and costs in Canada, based on their effect on smoking cessation and smoking initiation rates. Methods: We used gender-specific Markov models to estimate lifetime discounted life years, quality-adjusted life years (QALYs) and smoking-related health care costs for cohorts of males and females aged 15 to 19 years, in scenarios in which (1) ENDS are available (status quo); (2) ENDS are completely unavailable; and (3) ENDS are available for smoking cessation through health care provider prescription, in addition to currently recognized smoking cessation tools. Analysis was from the perspective of a publicly funded health care system. Results: Outcomes are expressed per 1000 individuals and based on expected values obtained through a Monte Carlo simulation of 10 000 replications. For males aged 15 to 19 years, life years, QALYs and smoking-related health care costs were 41 553, 35 871 and CAD 79 645 964, respectively, when ENDS were available; 41 568, 35 894 and CAD 79 645 960 when ENDS were unavailable; and 41 570, 35 897 and CAD 79 605 869 when ENDS were available through prescription only. For females, life years, QALYs and smoking-related health care costs were 43 596, 37 416 and CAD 69 242 856, respectively, when ENDS were available; 43 610, 37 438 and CAD 69 085 926 when ENDS were unavailable; and 43 611, 37 438 and CAD 69 076 034 when ENDS were available through prescription only. Thus, situations in which ENDS are unavailable or available through prescription only are dominant over the status quo. Conclusion: These results show that a policy change whereby ENDS were unavailable to the Canadian population or available through prescription only would likely increase population health and reduce health care costs.