Reward-Based Incentives for Smoking CessationHow a Carrot Became a Stick FREE ONLINE FIRST
Health care payers have an increasing interest in using financial incentives to change personal health behaviors, with an estimated 82% of employers using financial incentives for healthy behavior in 2013.1 Several factors are fueling this increased interest: steadily increasing costs that have been resistant to traditional forms of control, the realization that the majority of costs are driven by chronic conditions, which are themselves in large part a result of lifestyle choices, and emerging reports that incentives have successfully modified behaviors in a variety of contexts.2,3In addition, the Affordable Care Act allows employers to use up to 30% of total premiums (50% if programs include smoking) for outcomes-based rewards or penalties.4
Cigarette smoking is a habit that remains one of the leading causes of preventable mortality5 and thereby also has a large influence on health care costs. In a randomized controlled trial involving 878 employees, financial incentives worth a total of $750 increased long-term smoking cessation rates from 5.0% to 14.7% at the end of 9 to 12 months.6 The ratio of successful long-term cessation in this study was similar to that achieved among smokers given nicotine patches, sprays, bupropion, and varenicline. Six months after discontinuing the incentives, the initial quit rate ratio of 2.9 (14.7% with incentives vs 5.0% without incentives) remained at 2.6, providing reasonably good evidence of sustainability./.../
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