Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation

Abstract

BACKGROUND Financial incentives promote many health behaviors, but effective ways to deliver health incentives remain uncertain. METHODS We randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants. One of the individual-oriented programs and one of the group-oriented programs entailed rewards of approximately $800 for smoking cessation; the others entailed refundable deposits of $150 plus $650 in reward payments for successful participants. Usual care included informational resources and free smoking-cessation aids. RESULTS Overall, 2538 participants were enrolled. Of those assigned to reward-based programs, 90.0% accepted the assignment, as compared with 13.7% of those assigned to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained abstinence from smoking through 6 months were higher with each of the four incentive programs (range, 9.4 to 16.0%) than with usual care (6.0%) (P<0.05 for all comparisons); the superiority of reward-based programs was sustained through 12 months. Group-oriented and individual-oriented programs were associated with similar 6-month abstinence rates (13.7% and 12.1%, respectively; P = 0.29). Reward-based programs were associated with higher abstinence rates than deposit-based programs (15.7% vs. 10.2%, P<0.001). However, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2 percentage points (95% confidence interval, 3.1 to 22.8) higher in the deposit-based programs than in the reward-based programs among the estimated 13.7% of the participants who would accept participation in either type of program. CONCLUSIONS Reward-based programs were much more commonly accepted than deposit-based programs, leading to higher rates of sustained abstinence from smoking. Group-oriented incentive programs were no more effective than individual-oriented programs. (Funded by the National Institutes of Health and CVS Caremark; ClinicalTrials.gov number, NCT01526265.)

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

“…Deposit‐based financial incentive programmes are even more cost‐effective than reward‐based programmes 25, but patients generally refrain from putting their own money at risk. Hence, proposed reach can often not be achieved for deposit‐based financial incentive programmes.…”

“…Incentive programmes, a subgroup of behavioural support, have been shown to be effective for smoking cessation 25, 26, 27. Financial incentive programmes promote smoking cessation by providing financial incentives to quit.…”

“…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.…”

“…Costs of the financial incentive programme, which required biochemical confirmation of smoking status, were calculated based on supplementary data from Halpern et al . 2015 25. Average costs were calculated to be $235 or €176 [gross domestic product (GDP)‐based purchasing power parity (PPP)‐adjusted, currency year 2015] per participant of the individual reward group, including a lump sum cost of €10 per participant for biochemical testing and laboratory costs.…”

“…The RR for group‐based behavioural support is 1.98 [95% confidence interval (CI) = 1.60, 2.46] 34, the RR for varenicline is 2.27 (95% CI = 2.02, 2.55) 35 and the RR for the individual reward‐based financial incentive programme (using biochemical testing) after 12 months is 2.17 (95% CI = 1.226, 3.851) 25. We excluded effectiveness data of cessation studies that were based solely on self‐report and lacked biochemical testing to reduce possible bias 36.…”