Defense Date


Document Type


Degree Name

Doctor of Philosophy


Pharmaceutical Sciences

First Advisor

Dr. David Holdford



Awareness and usage of Electronic cigarettes (e-cigs) among smokers have increased rapidly over the past few years, majorly in quitting smoking. The main objectives for this study were: 1) To estimate the prevalence and study sociodemographic predictors for e-cigs use among individuals with Chronic Obstructive Pulmonary Disease (COPD) 2) To examine the predictors and estimate the total healthcare costs among current smokers with COPD 3) To estimate the economic impact of adopting e-cigs as a smoking cessation tool among current smokers with COPD.


The National Health Interview Survey data from the year 2014 was utilized to estimate the prevalence and identify sociodemographic predictors associated with e-cigs use among COPD adult population. Total healthcare costs and sociodemographic and clinical predictors among current smokers with COPD were estimated using the Medical Expenditure Panel Survey data from the year 2012-2013.

Economic impact for adoption of e-cigs was obtained by developing an epidemiological cohort-Markov model from a societal perspective over the period of 5-year. The targeted population was current smokers with COPD and willing to quit smoking. Smoking abstinence for e-cigs was compared with Varenicline, Bupropion, and Nicotine Replacement therapy. Outcomes evaluated were the 1-year and accumulated 5-year total healthcare costs savings associated with e-cigs over other options.


Among individuals with COPD, 8.65% and 24.37% were current and ever e-cig users respectively. Current e-cigs use was found to be associated with individuals who have tried quitting smoking in the past (OR: 2.0; 95%CI: 1.05, 3.97). Adjusted total healthcare costs per patient per year among current smokers with COPD were found to be higher by $1,811 in comparison to non-smokers with COPD. The adoption of e-cigs among COPD current smokers can have a positive impact on the healthcare budget and can lead to healthcare cost savings of $37.71 million over the period of 5-year. Furthermore, a positive impact on budget were found among women and individuals with age 65 & above.


E-cigs may be beneficial to the current US healthcare system if adopted as a smoking cessation tool among COPD individuals. However, uncertainty associated with product safety, efficacy and adherence for cessation warrants further studies and evaluation.


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