- Vapes help smokers quit more effectively and affordably than nicotine patches and other traditional nicotine replacement therapies (NRTs).
- Using vapes to quit smoking costs just $11,454 (€10,027) for each extra year of healthy life gained – well below what’s usually considered good value in U.S. healthcare.
- Vapes remain excluded from Medicaid (health coverage for low income people) and private insurance, despite their success in helping people quit deadly smoking.
- Researchers call for policy change to support vapes as a powerful harm reduction and smoking cessation tool.
Vapes outperform nicotine replacement therapies (NRT) in helping smokers quit – and at a lower long-term cost to society, a major new U.S. study has found.
The research, published in Nicotine and Tobacco Research, shows that vapes combined with behavioural counselling are significantly more effective than nicotine patches, gum, lozenges, nasal spray or an oral inhaler in supporting smokers to quit. They also offer far better value in public health spending.
“E-cigarettes used as a cessation treatment by smokers are more cost-effective relative to NRT,” the study concluded.
Stronger quit rates, bigger health gains
Researchers followed two hypothetical groups of 1,000 smokers – one using vapes, the other using FDA-approved NRT. Each group also received counselling support.
Smokers started at age 25 and were followed throughout their lifetimes. The analysis used quality-adjusted life years (QALYs) to measure the value of each intervention in terms of both longevity and quality of life.
It found that smokers who used vapes had better long-term health outcomes and, while the upfront costs were slightly higher (about $457 (€400) more per quitter), the health gains more than made up for it.
The ‘incremental cost-effectiveness ratio’ (ICER) of $11,454 (€10,027) per QALY gained is well below the U.S. benchmark of $150,000/QALY, making vapes a highly cost-effective intervention.
Conducted using California Medicaid (Medi-Cal) data and a lifetime modeling approach, the study found that even with cautious estimates, there was a 98 per cent probability that vapes were more cost-effective than NRT.
A missed opportunity in U.S. health policy
Despite their proven impact in helping smokers quit, vapes are not approved by the Food and Drug Administration (FDA) as cessation aids.
This regulatory gap means they are not covered by Medicaid or private insurers, leaving millions of smokers to pay out-of-pocket for the very tool that might help them quit for good.
The study notes: “Despite lack of FDA approval, e-cigarettes are a popular choice among smokers trying to quit.”
Lack of access to vapes to quit smoking hits the poorest the hardest. Low-income Americans are not only more likely to smoke – they’re also less able to afford cessation tools, according to the study.
Among Medicaid recipients, smoking prevalence is more than double that of privately insured people (23.9 per cent vs 10.5 per cent).
The researchers note that U.S. regulators are currently more focussed on concerns about youth vaping than on helping adult smokers quit. They point to a growing number of studie, including a 2024 Cochrane Review, that show higher quit rates and no increase in biomarkers of harm among dual users (people who vape while reducing cigarette use).
Time for a shift
The authors argue that vaping’s superior quit rates and cost-effectiveness should lead to FDA approval and insurance coverage, especially under Medicaid.
By formally recognising vaping as a cessation method, the U.S. could make meaningful progress in reducing smoking rates, cutting healthcare costs, and saving lives.
The study said: “Policymakers should consider whether providing financial support for e-cigarettes as a harm reduction strategy is worth pursuing.
“Ultimately, if medically licensed by the FDA as a tobacco cessation treatment, e-cigarettes could be covered by Medicaid as an official cessation aid. This would result in more smokers being reached and greater financial savings for smokers and the health system.
“Most importantly, it would save more lives from an extremely addictive and damaging behaviour that is the number one cause of preventable death and disability in the country.”
Currently, more than 480,000 Americans die each year from smoking-related illnesses. This latest research strengthens the case for including vapes in smoking cessation efforts.
