The net impact on population health and health system costs of vaporized nicotine products is uncertain. We modeled, with uncertainty, the health and cost impacts of liberalizing the vaporized nicotine market for a high-income country, New Zealand (NZ).
We used a multi-state life-table model of 16 tobacco-related diseases to simulate lifetime quality-adjusted life-years (QALYs) and health system costs at a 0% discount rate. We incorporated transitions from never, former, and current smoker states to, and from, regularly using vaporized nicotine and literature estimates for relative risk of disease incidence for vaping compared to smoking.
Compared to continuation of baseline trends in smoking uptake and cessation rates and negligible vaporized nicotine use, we projected liberalizing the market for these products to gain 236,000 QALYs (95% uncertainty interval (UI): 27,000 to 457,000) and save NZ$3.4 billion (2011 $) (95%UI: NZ$370m to NZ$7.1b) or US$2.5 billion (2017 $). However, estimates of net health gains for 0-14 year olds and 65+-year olds had 95%UIs including the null. Uncertainty around QALYs gained was mainly driven by uncertainty around the impact of vaporized nicotine products on population-wide cessation rates and the relative health risk of vaping compared to smoking.
This modeling suggested that a fairly permissive regulatory environment around vaporized nicotine products achieves net health gain and cost-savings, albeit with wide uncertainty.
Our results suggest that optimal strategies will also be influenced by targeted smoking cessation advice, regulations around chemical constituents of these products, and marketing and age limits to prevent youth uptake of vaping.
1 Burden of Disease Epidemiology, Equity, and Cost-Effectiveness (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
2 Centre for Applied Health Economics (CAHE), School of Medicine, Griffith University, Nathan, Queensland, Australia.
3 The University of Queensland, School of Public Health, Herston, Queensland, Australia
4 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
Data availability: Supporting information regarding the multi-state life-table model approach and data inputs can be found online in Blakely et al and Pearson et al. Data sharing with other researchers or official agencies of the precise data used in the modeling is potentially possible subject to agreement with the government agencies making it available to the researchers (the Ministry of Health).