Financial incentives to Medicaid smokers for engaging tobacco quit line treatment: maximising return on investment

Abstract

BackgroundLow-income smokers experience greater difficulty in quitting smoking than do other smokers. Providing financial incentives for treatment engagement increases smoking cessation success. This study models the cost-effectiveness of varying levels of financial incentives to maximise return on investment (ROI) for engaging low-income Medicaid recipients who smoke to take calls from a tobacco quit line.MethodsParticipants (N=1900) were recruited from May 2013 to June 2015 through quit line-based (n=980), clinic-based (n=444) or community-based referrals (n=476) into the Wisconsin Medicaid Quit Line Incentive project. Incentive (n=948) and control group participants (n=952) received $30 versus $0 per call, respectively, for taking up to five Wisconsin Tobacco Quit Line (WTQL) calls. Cost-effectiveness analyses estimated the incremental cost-effectiveness ratio for alternative financial incentives for engagement with WTQL calls. Probabilistic sensitivity analysis was employed to determine an optimal strategy for financial incentives to minimise the cost per individual who quit smoking.ResultsUsing fixed payments, the incremental cost-effectiveness ratio of $2316 per smoker who quit in the randomised trial decreased to $2150 per smoker who quit when the incentives were modelled at $20 per each of five WTQL calls taken. Using variable payments, the minimal cost per additional smoker who quit was $2125 when incentives for the first four WTQL calls were set at $20, and the financial payment for the fifth WTQL call was set at $70.ConclusionsModelling suggests that financial incentives in the amount of $20 per call for taking the first four quit line calls and $70 for taking a fifth quit line call maximise ROI to engage low-income smokers with evidence-based smoking cessation treatment.

Active referral plus a small financial incentive upon cessation services use on smoking abstinence: a community-based, cluster-randomised controlled trial

“… 12 Emerging evidence suggested the use of modest incentives (US$60–US$190) contingent upon treatment use 18 , 19 and small amount of monetary incentives are more sustainable for application in large community-based smoking cessation programs. 20 Our previous trial found a small, abstinence-contingent incentive (HK$500/US$64) effective in increasing quit attempt, but the effects on service use and abstinence was inconclusive. 17 By different design features, incentives of similar amount varied in type, frequency, condition, and delivery of payment produced various effectiveness.…”

Psychological Therapies Used for the Reduction of Habitual Cigarette Smoking Cigarette Consumption: A Systematic Review

“…Regarding the use of financial incentives, its efficacy is presented in decreasing the severity of withdrawal symptoms [ 37 ] in time no longer than one-year post-intervention [ 47 ]. Video-based interventions such as those conducted by Bloom et al [ 50 ] QuitBet platform, and Scholten et al [ 49 ] with the go/no-go training game for smoking cessation in young adults.…”

Smoking Cessation Programs Are Less Effective in Smokers with Low Socioeconomic Status Even When Financial Incentives for Quitting Smoking Are Offered—A Community-Randomized Smoking Cessation Trial in Denmark

“…On the other hand, denying smokers with high SES an effective treatment might be seen as discrimination. Financial incentives are not only an evidence-based and highly effective smoking cessation method, but the strategy also seems to be highly cost-effective (a good investment) [ 39 , 40 , 41 , 42 ]. Therefore, one could argue that it should be offered to as many smokers as possible.…”

“…Our study also found that neither the FIMs nor the CAMs succeeded in attracting more smokers with low SES during the intervention year than the year before. Previous studies indicated that financial incentives can be a good recruitment method to smoking cessation activities [ 43 , 44 ], even for disadvantaged smokers [ 39 ]. Evidence on interventions that are successful in attracting smokers with low SES to smoking cessation services is needed.…”