Would vaccination against nicotine be a cost-effective way to prevent smoking uptake in adolescents?

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9304118 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1360-0443 (Electronic) Linking ISSN: 09652140 NLM ISO Abbreviation: Addiction Subsets: MEDLINE

Publication: Oxford : Wiley-Blackwell
Original Publication: Abingdon, Oxfordshire, UK : Carfax Pub. Co., c1993-

Smoking Prevention*; Tobacco Use Disorder/*prevention & control ; Vaccination/*economics; Adolescent ; Australia/epidemiology ; Cohort Studies ; Cost-Benefit Analysis ; Female ; Humans ; Male ; Prevalence ; Quality-Adjusted Life Years ; Smoking/economics ; Smoking/epidemiology ; Young Adult

Aims: We used epidemiological modelling to assess whether nicotine vaccines would be a cost-effective way of preventing smoking uptake in adolescents.
Design, Setting, Participants and Measurements: We built an epidemiological model using Australian data on age-specific smoking prevalence; smoking cessation and relapse rates; life-time sex-specific disability-adjusted life years lived for cohorts of 100,000 smokers and non-smokers; government data on the costs of delivering a vaccination programme by general practitioners; and a range of plausible and optimistic estimates of vaccine cost, efficacy and immune response rates based on clinical trial results. We first estimated the smoking uptake rates for Australians aged 12-19 years. We then used these estimates to predict the expected smoking prevalence in a birth cohort aged 12 in 2003 by age 20 under (i) current policy and (ii) different vaccination scenarios that varied in cost, initial vaccination uptake, yearly re-vaccination rates, efficacy and a favourable vaccine immune response rate.
Findings: Under the most optimistic assumptions, the cost to avert a smoker at age 20 was $44,431 [95% confidence interval (CI) $40,023-49,250]. This increased to $296,019 (95% CI $252,307-$355,930) under more plausible scenarios. The vaccine programme was not cost-effective under any scenario.
Conclusions: A preventive nicotine vaccination programme is unlikely to be cost-effective. The total cost of a universal vaccination programme would be high and its impact on population smoking prevalence negligible. For these reasons, such a programme is unlikely to be publicly funded in Australia or any other developed country.
(© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.)

Date Created: 20111117 Date Completed: 20120522 Latest Revision: 20171116

20231215

10.1111/j.1360-0443.2011.03718.x

22084967