Abstract
Aims We used epidemiological modelling to assess whether nicotine vaccines would be a cost effective way of preventing smoking uptake in adolescents.
Methods We built an epidemiological model using Australian data on age-specific smoking prevalence; smoking cessation and relapse rates; lifetime 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 program 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 to 19. 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.
Results Under the most optimistic assumptions, the cost to avert a smoker at age 20 was $43,659 (95% Uncertainty Interval $39,871-$48,508). This increased to $296,019 (95% UI $252,307-$355,930) under more plausible scenarios. The vaccine program was not cost-effective under any scenario.
Conclusions A preventive nicotine vaccination program is unlikely to be cost-effective. The total cost of a universal vaccination program would be high and its impact on population smoking prevalence negligible. For these reasons, such a program is unlikely to be publicly funded in Australia or any other developed country.