Cost-effectiveness of e-cigarettes for smoking cessation at homeless support centres: SCeTCH cRCT

Li, Jinshuo, Wu, Qi, Parrott, Steve, Cox, Sharon, Pesola, Francesca, Soar, Kirstie, Brown, Rachel ORCID: https://orcid.org/0000-0002-4475-1733, Ford, Allison, Hajek, Peter, Notley, Caitlin, Robson, Deborah, Ward, Emma, Varley, Anna, Mair, Charlotte, McMillan, Lauren, Lennon, Jessica, Brierley, Janine, Edwards, Amy, Gardner, Bethany, Tyler, Allan, Bauld, Linda and Dawkins, Lynne 2025. Cost-effectiveness of e-cigarettes for smoking cessation at homeless support centres: SCeTCH cRCT. Public Health Research 10.3310/GJLD2428

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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.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Social Sciences (Includes Criminology and Education) Research Institutes & Centres > Centre For Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)
Publisher:	NIHR Journals Library
ISSN:	2050-439X
Date of First Compliant Deposit:	18 November 2025
Date of Acceptance:	30 April 2025
Last Modified:	18 Nov 2025 16:00
URI:	https://orca.cardiff.ac.uk/id/eprint/182491

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