While early evidence for e-cigarettes is promising, there is not enough evidence yet to recommend them to people attempting to quit smoking, the Minister for Health has been advised.

However, pharmacological interventions, including nicotine replacement therapy (NRT) products, are effective and good value for money, the Health Information and Quality Authority (HIQA) has said.

It has carried out a health technology assessment (HTA) of smoking cessation interventions. This marks the first analysis ever undertaken to compare the cost effectiveness of different mixes of interventions, and the first assessment in the EU to assess the cost effectiveness of e-cigarettes as a smoking cessation intervention.

There are currently around 820,000 smokers in Ireland and half of these make at least one quit attempt every year. Smoking causes one in five deaths here annually.

The HTA found that all smoking cessation interventions are effective at helping people to quit smoking and all are cost effective when compared with unassisted quitting.

"Yearly expenditure on smoking cessation activity (by the HSE) is estimated to be over €40 million. This HTA has found that providing these interventions to help people quit smoking not only works, but is good value for money," said HIQA's director of HTAs, Dr Mairin Ryan.

For those who wanted some type of pharmacological support to quit smoking, the most effective therapy was found to be the prescription-only medication, varenicline, either alone or in combination with NRT.

"Using varenicline alongside NRT is more than three-and-a-half times as effective as using no active medication. However, this is a relatively new combination of interventions, and any potential implications of widespread uptake need to be considered as part of the development of clinical practice guidelines and national health policy," Dr Ryan commented.

She said that the HSE should seek to increase the uptake of varenicline, either alone or in combination with NRT, among smokers who need pharmacological support to quit.

When it came to e-cigarettes, the HTA found that while there were some promising results, there was not enough current evidence to ‘reliably demonstrate their effectiveness as an aid to smoking cessation'.

"HIQA advises the Minister for Health to await the results of ongoing trials before deciding whether to recommend e-cigarettes. A decision to advocate their use should take into consideration any additional information on the long-term safety of e-cigarettes use, and any emerging data in relation to concerns about the social normalisation of e-cigarettes leading to increased uptake among people who have never smoked, or later migration to tobacco cigarettes," Dr Ryan said.

The HTA noted that six ongoing trials on e-cigarettes, which are due to be completed between 2017 and 2022, should provide further evidence in this area.

Meanwhile, the report also found that behavioural interventions, such as counseling and group behaviour therapy, can be effective in helping smokers to quit compared to unassisted quitting.

HIQA pointed out that as pharmacological interventions may not be acceptable to everyone, it is important that behavioural interventions are provided.

The HTA also noted that pharmacological interventions can be further improved when provided in combination with a behavioural intervention.

"The HTA also found that pregnant women who smoke should be offered a psychosocial intervention in the first instance. There is substantial evidence to support the effectiveness of counselling for this cohort of the population," Dr Ryan said.

A report on this HTA can be viewed here