HIQA announces public consultation on first EU HTA to include e-cigarettes as an intervention for quitting smoking

Date of publication:

The Health Information and Quality Authority (HIQA) has commenced a national public consultation on a health technology assessment of smoking cessation interventions.

This independent analysis by HIQA identifies what improvements could be made in the mix of interventions offered by the Health Service Executive (HSE) in Ireland to increase overall quit rates at an acceptable cost. The findings will inform the development of a national clinical guideline to guide healthcare professionals and smokers on how best to quit smoking successfully.

HIQA’s Director of Health Technology Assessment Dr Máirín Ryan said: “Quitting smoking substantially reduces the risk of disease in former smokers. This analysis examines the safety, effectiveness and cost-effectiveness of the smoking cessation interventions available in Ireland that can be used to help smokers quit for good. These include medicines such as nicotine replacement therapy, varenicline[1] and antidepressants, as well as e-cigarettes and behavioural interventions, such as counselling and telephone support. HIQA also specifically examined the clinical effectiveness of therapies in pregnant women, and those attending secondary mental health services.”

The HIQA assessment is the first of its kind in the EU to examine the cost-effectiveness of e-cigarettes.

Dr Máirín Ryan continued: “This report found that all publicly funded smoking cessation interventions can be considered clinically effective when compared with doing nothing, and cost-effective when compared with unassisted quitting. The most cost-effective strategy is to maximise the use of varenicline and nicotine replacement therapy (NRT) in combination.”

Significant changes have taken place in smokers’ choice of cessation support since the arrival of e-cigarettes on the market five years ago. This analysis looks at current uptake rates of e-cigarettes among those trying to stop smoking in Ireland, as well as trends in other countries, while acknowledging that research into e-cigarettes is only beginning.

Dr Máirín Ryan said: “This HTA found a high level of uncertainty surrounding both the clinical and cost-effectiveness of e-cigarettes. While the long-term effects of using e-cigarettes have not yet been established, data from Healthy Ireland reveals that 29% of smokers currently use e-cigarettes as an aid to quitting smoking. HIQA’s analysis shows that increased uptake of e-cigarettes as an aid to quitting would increase the number of people who successfully quit compared with the existing situation in Ireland and would be cost-effective, provided that the currently available evidence on their effectiveness is confirmed by further studies.”

A public consultation seeking feedback on this report is open until 3 February 2017. Following this, a final report will be prepared for consideration by the HIQA Board, before being submitted to the Minister for Health and the HSE.


[1] Varenicline is a prescription-only medication which helps people to stop smoking by reducing withdrawal symptoms and reducing the satisfaction that can be gained from smoking.

Further Information:

Marty Whelan, Head of Communications and Stakeholder Engagement
01 8147480 / 086 2447623 mwhelan@hiqa.ie

Notes to the Editor:

  • HIQA is the statutory organisation in Ireland with responsibility to carry out national health technology assessments (HTAs) and to develop guidelines for the conduct of HTAs across our healthcare system.
  • Following a request from the Department of Health, HIQA assessed the evidence for therapies that aid with quitting smoking to inform policy decisions about improving the provision of these services and to underpin a planned national clinical guideline on smoking cessation in Ireland.
  • The prevalence of smoking in Ireland is 22.7% in people aged 15 years and over. The prevalence is higher in men (24.3%) than women (21.2%), but has been in decline since 2008.
  • Approximately 20.5% of deaths each year can be attributed to smoking, including deaths due to second-hand smoke.
  • Smoking has a harmful effect on the health of smokers and is linked to diseases such as cancer, respiratory and cardiovascular disease. Quitting smoking substantially reduces the risk of disease over time.
  • In 2013 the estimated cost to the healthcare system of smoking was over €460 million while the cost of lost productivity was over €1 billion.
  • Currently, the overall cost of smoking cessation in Ireland is estimated to be over €40 million annually. This figure includes the cost to the HSE of providing smoking cessation support though the HSE Tobacco Control Programme, the costs of GP services and pharmacological treatment to those with a medical card, as well as out-of-pocket expenditure by smokers on various smoking cessation products.
  • According to data from the Healthy Ireland survey 2015, half of smokers attempting to quit smoking in Ireland do so unaided. A further 29% of smokers try to quit using e-cigarettes as a cessation aid. Approximately 16% of quit attempts are made using some form of pharmacotherapy (for example, NRT).
  • Nicotine replacement therapy (NRT) includes nicotine gum, patches, inhalers, intranasal and oral sprays, and tablets.
  • Varenicline was the most effective single pharmacotherapy; more than two and half times as effective as no pharmacotherapy. Varenicline with NRT was the most effective dual therapy; more than three and half times as effective as no pharmacotherapy. Combination NRT was more effective than a single form of NRT alone. E-cigarettes were twice as effective as no therapy; however, this estimate was based on only two trials including a relatively small number of participants.
  • The effectiveness of pharmacological interventions is improved by an average of 18% by adding behavioural therapy.
  • Group behaviour therapy was the most effective behavioural intervention; almost twice as effective as brief advice or written materials. Individual counselling, intensive advice and telephone support were all found to be more effective than brief advice or written materials.
  • If uptake of varenicline and NRT in combination increases to the highest likely level in Ireland, this would be considered good value for money compared to other interventions currently funded by the HSE, but it could lead to an average increase of up to €7.6 million in the cost of providing smoking cessation interventions annually.
  • If uptake rates of e-cigarettes increases to the current rate of 45% in England (while still not being reimbursed through the Primary Care Reimbursement Scheme), this would result in a decrease in expenditure on smoking cessation interventions of approximately €2.6 million per year.