A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation

Volpp, Kevin G.; Troxel, Andrea B.; Pauly, Mark V.; Glick, Henry A.; Puig, Andrea; Asch, David A.; Galvin, Robert; Zhu, Jingsan; Wan, Fei; DeGuzman, Jill; Corbett, Elizabeth L.; Weiner, Janet; Audrain-McGovern, Janet

doi:10.1056/nejmsa0806819

Cited by 767 publications

(517 citation statements)

References 18 publications

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“…However, we feel that their subsequent discussion, citing the research of Volpp et al [12] and Higgins et al [13], diminishes this statement and provides a misleading view of the value of PFIs in promoting health behaviour once the incentive has ceased. While Volpp et al's [12] randomized controlled trial of PFIs for smoking cessation found significant differences in smoking cessation after the incentive had been removed, the study has three issues that limit its impact. First, there is little detail of the content of the other components of the intervention.…”

Section: Evidence For Long-term Effects Of Incentives On Health Behavmentioning

confidence: 94%

The Goose Is (Half) Cooked: a Consideration of the Mechanisms and Interpersonal Context Is Needed to Elucidate the Effects of Personal Financial Incentives on Health Behaviour

et al. 2013

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While we agree that personal financial incentives (PFIs) may have some utility in public health interventions to motivate people in the uptake and persistence of health behaviour, we disagree with some of the sentiments outlined by Lynagh and colleagues [Lynagh, M. C., Sanson-Fisher, R. W., & Bonevski, B. (2013). What's good for the goose is good for the gander. Guiding principles for the use of financial incentives in health-behaviour change. Medicine,20,[114][115][116][117][118][119][120]. Specifically, we feel that the article gives a much stronger impression that PFIs will likely lead to long-term behaviour change once the incentive has been removed than is warranted by current research. This claim has not received strong empirical support nor is it grounded in psychological theory on the role of incentives and motivation. We also feel that the presentation of some of the tenets of self-determination theory by the authors is misleading. Based on self-determination theory, we propose that PFIs, without sufficient consideration of the mechanisms by which external incentives affect motivation and the interpersonal context in which they are presented, are unlikely to lead to persistence in health behaviour once the incentive is removed. We argue that interventions that adopt PFIs as a strategy to promote health-behaviour change, should incorporate strategies in the interpersonal context to minimize the undermining effect of the incentives on intrinsic motivation. Interventions should present incentives as informational regarding individuals' competence rather than as purely contingent on behavioural engagement and emphasise self-determined reasons for pursuing the behaviour. International Journal of Behavioural

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Section: Evidence For Long-term Effects Of Incentives On Health Behavmentioning

confidence: 94%

The Goose Is (Half) Cooked: a Consideration of the Mechanisms and Interpersonal Context Is Needed to Elucidate the Effects of Personal Financial Incentives on Health Behaviour

et al. 2013

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“…Financial incentive programmes promote smoking cessation by providing financial incentives to quit. Certain financial incentive programmes have demonstrated their effectiveness over a 1 year horizon 25, 28. The advantage of financial incentive programmes include their ease of implementation by companies and insurance companies.…”

Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

Huber¹,

Präger²,

Coyle

et al. 2017

Addiction

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AimsTo evaluate costs, effects and cost‐effectiveness of increased reach of specific smoking cessation interventions in Germany.DesignA Markov‐based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health‐care perspective (extended to include out‐of‐pocket payments) with life‐time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates.SettingGermany.ParticipantsCohort of current smoking population (18+ years) in Germany.InterventionsInterventions included group‐based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group‐based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England.MeasurementsEQUIPTMOD considered reach, intervention cost, number of quitters, quality‐of‐life years (QALYs) gained, cost‐effectiveness and return on investment.FindingsThe highest returns through reduction in smoking‐related health‐care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group‐based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost‐savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return‐on‐investment estimates. At a hypothetical willingness‐to‐pay threshold of only €5000, the probability of being cost‐effective is approximately 75% for prospective scenario 1.ConclusionsIncreasing the reach of group‐based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost‐effective.

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“…14 Patient financial incentives have been used successfully to promote other health behaviors influenced by present-biased preferences, 15 such as smoking cessation 16 and weight loss. 17 Financial incentives may be particularly salient for Medicaid beneficiaries.…”

Section: Introductionmentioning

confidence: 99%

Financial Incentives to Increase Advance Care Planning Among Medicaid Beneficiaries: Lessons Learned From Two Pragmatic Randomized Trials

Barnato

Moore

et al. 2017

Journal of Pain and Symptom Management

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Context. Medicaid populations have low rates of advance care planning (ACP). Potential policy interventions include financial incentives.Objective. To test the effectiveness of patient plus provider financial incentive compared with provider financial incentive alone for increasing ACP discussions among Medicaid patients.Methods. Between April 2014 and July 2015, we conducted two sequential assessor-blinded pragmatic randomized trials in a health plan that pays primary care providers (PCPs) $100 to discuss ACP: 1) a parallel cluster trial ( provider-delivered patient incentive) and 2) an individual-level trial (mail-delivered patient incentive). Control and intervention arms included encouragement to complete ACP, instructions for using an online ACP tool, and (in the intervention arm) $50 for completing the online ACP tool and a small probability of $1000 (i.e., lottery) for discussing ACP with their PCP. The primary outcome was provider-reported ACP discussion within three months.Results. In the provider-delivered patient incentive study, 38 PCPs were randomized to the intervention (n ¼ 18) or control (n ¼ 20) and given 10 patient packets each to distribute. Using an intention-to-treat analysis, there were 27 of 180 ACP discussions (15%) in the intervention group and 5 of 200 (2.5%) in the control group (P ¼ .0391). In the mail-delivered patient incentive study, there were 5 of 187 ACP discussions (2.7%) in the intervention group and 5 of 189 (2.6%) in the control group (P ¼ .99).Conclusion. ACP rates were low despite an existing provider financial incentive. Adding a provider-delivered patient financial incentive, but not a mail-delivered patient incentive, modestly increased ACP discussions. PCP encouragement combined with a patient incentive may be more powerful than either encouragement or incentive alone. J Pain Symptom Manage 2017;-:-e-. Ó

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A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation

Cited by 767 publications

References 18 publications

The Goose Is (Half) Cooked: a Consideration of the Mechanisms and Interpersonal Context Is Needed to Elucidate the Effects of Personal Financial Incentives on Health Behaviour

The Goose Is (Half) Cooked: a Consideration of the Mechanisms and Interpersonal Context Is Needed to Elucidate the Effects of Personal Financial Incentives on Health Behaviour

Cost‐effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD

Financial Incentives to Increase Advance Care Planning Among Medicaid Beneficiaries: Lessons Learned From Two Pragmatic Randomized Trials

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