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Rewarding smokers for quitting was a more popular option for smoking cessation compared to sanctions-based treatment, but about the same number of participants in either group had quit smoking after 1 year.
Reward-based smoking cessation programs were accepted by 90% of those randomized, compared with 13.7% acceptance of deposit-based programs, and at 6 months, significantly more reward-based participants had ceased smoking, compared with deposit-based participants (15.2% vs. 10.2%). However, as with most such studies, at 1 year, nearly 50% of those who had achieved abstinence at 6 months had returned to smoking in all groups, according to a randomized controlled study of 2,538 CVS Caremark employees and their friends and relatives (ClinicalTrials.gov number, NCT01526265).
Participants were assigned to one of five groups: 468 to usual care only as the control, reported Dr. Scott D. Halpern of the University of Pennsylvania and his colleagues (N. Engl. J. Med. 2015;372:2108-17). They and all participants received information about local smoking cessation resources, cessation guides produced by the American Cancer Society, and, the 41% of the participants receiving health benefits through CVS Caremark had free access to a behavioral-modification program and nicotine-replacement therapy.
In addition, 498 were assigned to individual reward (eligible to receive $200 if they had biochemically confirmed abstinence at each of three times: 14 days, 30 days, and 6 months after quitting, with an additional $200 bonus at 6 months, for a total of $800); 519 to collaborative reward (in addition to the $800, patients were grouped into cohorts of six individuals who would receive an additional $100 per time point if one participant quit smoking to $600 per time point per participant if all six quit); 582 to individual deposit (the $800 dollars included a $150 deposit that would be refunded to participants who quit smoking), and 471 to competitive deposit (included the $150 deposit with the addition of a $450 matching reward per member ($3,600 total), which was redistributed among members who quit at each time point).
In intention-to-treat analyses, all four programs yielded greater rates of sustained cessation through 6 months (range, 9.4%-16.0%) than did usual care (6.0%) (P < .05 for all comparisons).
At 6 months, sustained abstinence was greater with reward-based incentives (15.7%) than with deposit-based (10.2%) (P < .001) and was similar between individual-incentive programs and group-incentive ones (12.1% vs. 13.7%, P = 0.29).
In addition, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2% higher in the deposit-based programs than in the reward-based programs among those who would accept participation in either type of program, the authors stated, indicating that the use of such a program might be of great cost-effectiveness to a health care provider.
Dr. Halpern reported having no relevant conflicts of interest. The National Cancer Institute, the National Institute on Aging, and CVS Caremark supported the study.
Smoking remains the leading cause of preventable deaths in America. It is estimated that employing a smoker costs nearly $6,000 more per year than employing nonsmokers. The article cited, in the New England Journal of Medicine, describes a randomized controlled trial of CVS Caremark employees, their families, and friends who smoke more than five cigarettes per day. The trial compared usual care to four different interventions designed to assess whether a financial incentive would entice greater quitting and abstinence rates.
The researchers looked at whether group participation with potential peer pressure would improve quitting rates. The group-oriented arms were not more effective than individual incentive arms. The psychology of loss aversion versus cash incentive was addressed by asking participants in one group to deposit money and get it back after 6 months of being smoking free. Requiring deposits resulted in decreased participation overall but in those who committed to this arm higher abstinence rates were seen. Overall, incentive rewards over 6 months of participation nearly tripled the rate of smoking cessation compared to usual care.
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Dr. Michael Liptay |
The severity of cigarette smoking addiction was highlighted by a maximum success rate of around 15% in the best arm as well as a 50% return to smoking rate in those original quitters at 1 year after trial inception. Future innovations in employee benefit design must address the need for shared participation in health maintenance and some form of lifelong risk/reward system that engages people to be responsible for their own health choices.
Dr. Michael Liptay is the medical editor for Thoracic Surgery News.
Smoking remains the leading cause of preventable deaths in America. It is estimated that employing a smoker costs nearly $6,000 more per year than employing nonsmokers. The article cited, in the New England Journal of Medicine, describes a randomized controlled trial of CVS Caremark employees, their families, and friends who smoke more than five cigarettes per day. The trial compared usual care to four different interventions designed to assess whether a financial incentive would entice greater quitting and abstinence rates.
The researchers looked at whether group participation with potential peer pressure would improve quitting rates. The group-oriented arms were not more effective than individual incentive arms. The psychology of loss aversion versus cash incentive was addressed by asking participants in one group to deposit money and get it back after 6 months of being smoking free. Requiring deposits resulted in decreased participation overall but in those who committed to this arm higher abstinence rates were seen. Overall, incentive rewards over 6 months of participation nearly tripled the rate of smoking cessation compared to usual care.
|
Dr. Michael Liptay |
The severity of cigarette smoking addiction was highlighted by a maximum success rate of around 15% in the best arm as well as a 50% return to smoking rate in those original quitters at 1 year after trial inception. Future innovations in employee benefit design must address the need for shared participation in health maintenance and some form of lifelong risk/reward system that engages people to be responsible for their own health choices.
Dr. Michael Liptay is the medical editor for Thoracic Surgery News.
Smoking remains the leading cause of preventable deaths in America. It is estimated that employing a smoker costs nearly $6,000 more per year than employing nonsmokers. The article cited, in the New England Journal of Medicine, describes a randomized controlled trial of CVS Caremark employees, their families, and friends who smoke more than five cigarettes per day. The trial compared usual care to four different interventions designed to assess whether a financial incentive would entice greater quitting and abstinence rates.
The researchers looked at whether group participation with potential peer pressure would improve quitting rates. The group-oriented arms were not more effective than individual incentive arms. The psychology of loss aversion versus cash incentive was addressed by asking participants in one group to deposit money and get it back after 6 months of being smoking free. Requiring deposits resulted in decreased participation overall but in those who committed to this arm higher abstinence rates were seen. Overall, incentive rewards over 6 months of participation nearly tripled the rate of smoking cessation compared to usual care.
|
Dr. Michael Liptay |
The severity of cigarette smoking addiction was highlighted by a maximum success rate of around 15% in the best arm as well as a 50% return to smoking rate in those original quitters at 1 year after trial inception. Future innovations in employee benefit design must address the need for shared participation in health maintenance and some form of lifelong risk/reward system that engages people to be responsible for their own health choices.
Dr. Michael Liptay is the medical editor for Thoracic Surgery News.
Rewarding smokers for quitting was a more popular option for smoking cessation compared to sanctions-based treatment, but about the same number of participants in either group had quit smoking after 1 year.
Reward-based smoking cessation programs were accepted by 90% of those randomized, compared with 13.7% acceptance of deposit-based programs, and at 6 months, significantly more reward-based participants had ceased smoking, compared with deposit-based participants (15.2% vs. 10.2%). However, as with most such studies, at 1 year, nearly 50% of those who had achieved abstinence at 6 months had returned to smoking in all groups, according to a randomized controlled study of 2,538 CVS Caremark employees and their friends and relatives (ClinicalTrials.gov number, NCT01526265).
Participants were assigned to one of five groups: 468 to usual care only as the control, reported Dr. Scott D. Halpern of the University of Pennsylvania and his colleagues (N. Engl. J. Med. 2015;372:2108-17). They and all participants received information about local smoking cessation resources, cessation guides produced by the American Cancer Society, and, the 41% of the participants receiving health benefits through CVS Caremark had free access to a behavioral-modification program and nicotine-replacement therapy.
In addition, 498 were assigned to individual reward (eligible to receive $200 if they had biochemically confirmed abstinence at each of three times: 14 days, 30 days, and 6 months after quitting, with an additional $200 bonus at 6 months, for a total of $800); 519 to collaborative reward (in addition to the $800, patients were grouped into cohorts of six individuals who would receive an additional $100 per time point if one participant quit smoking to $600 per time point per participant if all six quit); 582 to individual deposit (the $800 dollars included a $150 deposit that would be refunded to participants who quit smoking), and 471 to competitive deposit (included the $150 deposit with the addition of a $450 matching reward per member ($3,600 total), which was redistributed among members who quit at each time point).
In intention-to-treat analyses, all four programs yielded greater rates of sustained cessation through 6 months (range, 9.4%-16.0%) than did usual care (6.0%) (P < .05 for all comparisons).
At 6 months, sustained abstinence was greater with reward-based incentives (15.7%) than with deposit-based (10.2%) (P < .001) and was similar between individual-incentive programs and group-incentive ones (12.1% vs. 13.7%, P = 0.29).
In addition, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2% higher in the deposit-based programs than in the reward-based programs among those who would accept participation in either type of program, the authors stated, indicating that the use of such a program might be of great cost-effectiveness to a health care provider.
Dr. Halpern reported having no relevant conflicts of interest. The National Cancer Institute, the National Institute on Aging, and CVS Caremark supported the study.
Rewarding smokers for quitting was a more popular option for smoking cessation compared to sanctions-based treatment, but about the same number of participants in either group had quit smoking after 1 year.
Reward-based smoking cessation programs were accepted by 90% of those randomized, compared with 13.7% acceptance of deposit-based programs, and at 6 months, significantly more reward-based participants had ceased smoking, compared with deposit-based participants (15.2% vs. 10.2%). However, as with most such studies, at 1 year, nearly 50% of those who had achieved abstinence at 6 months had returned to smoking in all groups, according to a randomized controlled study of 2,538 CVS Caremark employees and their friends and relatives (ClinicalTrials.gov number, NCT01526265).
Participants were assigned to one of five groups: 468 to usual care only as the control, reported Dr. Scott D. Halpern of the University of Pennsylvania and his colleagues (N. Engl. J. Med. 2015;372:2108-17). They and all participants received information about local smoking cessation resources, cessation guides produced by the American Cancer Society, and, the 41% of the participants receiving health benefits through CVS Caremark had free access to a behavioral-modification program and nicotine-replacement therapy.
In addition, 498 were assigned to individual reward (eligible to receive $200 if they had biochemically confirmed abstinence at each of three times: 14 days, 30 days, and 6 months after quitting, with an additional $200 bonus at 6 months, for a total of $800); 519 to collaborative reward (in addition to the $800, patients were grouped into cohorts of six individuals who would receive an additional $100 per time point if one participant quit smoking to $600 per time point per participant if all six quit); 582 to individual deposit (the $800 dollars included a $150 deposit that would be refunded to participants who quit smoking), and 471 to competitive deposit (included the $150 deposit with the addition of a $450 matching reward per member ($3,600 total), which was redistributed among members who quit at each time point).
In intention-to-treat analyses, all four programs yielded greater rates of sustained cessation through 6 months (range, 9.4%-16.0%) than did usual care (6.0%) (P < .05 for all comparisons).
At 6 months, sustained abstinence was greater with reward-based incentives (15.7%) than with deposit-based (10.2%) (P < .001) and was similar between individual-incentive programs and group-incentive ones (12.1% vs. 13.7%, P = 0.29).
In addition, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2% higher in the deposit-based programs than in the reward-based programs among those who would accept participation in either type of program, the authors stated, indicating that the use of such a program might be of great cost-effectiveness to a health care provider.
Dr. Halpern reported having no relevant conflicts of interest. The National Cancer Institute, the National Institute on Aging, and CVS Caremark supported the study.
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Key clinical point: Reward-based smoking cessation incentive programs were more acceptable and effective than were reward plus penalty-based programs.
Major finding: At 6 months, significantly more reward-based participants had ceased smoking compared with deposit-based participants (15.2% vs. 10.2%).
Data source: A five-group randomized, controlled trial of 2,538 CVS-Caremark employees comparing usual care with four incentive programs aimed at sustained abstinence from smoking.
Disclosures: Dr. Halpern reported having no relevant conflicts of interest. The National Cancer Institute, the National Institute on Aging, and CVS Caremark supported the study.
