title: Would vaccination against nicotine be a cost-effective way to prevent smoking uptake in adolescents?
abstract: OBJECTIVE
  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; 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.
  
  
  RESULTS
  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.
authors.affiliation: UQ Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia. c.gartner@uq.edu.au
authors.forename: Coral E
authors.initials: CE
authors.lastname: Gartner
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Barendregt
authors.forename: Angela
authors.initials: A
authors.lastname: Wallace
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000191:economics / Q000453:epidemiology; D000074606:Smoking Prevention; D014029:Tobacco Use Disorder / Q000517:prevention & control*; D014611:Vaccination / Q000191:economics*; D055815:Young Adult