Cost-Effectiveness Analysis of E-cigarettes Compared to Nicotine Replacement Therapy for Smoking Cessation Among Medicaid Users in California.

This article evaluates the cost-effectiveness of e-cigarettes compared to nicotine replacement therapy (NRT), both combined with behavioral counseling, as smoking cessation aids for Medicaid smokers in California. Using a Markov model and a lifetime horizon, the study found that e-cigarettes are more effective and cost-effective than NRT, with an incremental cost-effectiveness ratio (ICER) of $11,454 per quality-adjusted life year (QALY) gained, well below conventional U.S. willingness-to-pay thresholds. Sensitivity analyses confirmed the robustness of these findings, though results were influenced by factors such as healthcare costs and model assumptions. Despite e-cigarettes not being FDA-approved for cessation and thus not covered by insurance, the study suggests policymakers consider their inclusion as a harm reduction strategy, particularly for low-income smokers disproportionately affected by tobacco use.