What percentage of smokers can quit for $750?
However, a large trial has just been published in the New England Journal of Medicine today, which examined this issue. The team of researchers, led by Dr Kevin Volpp of the Philadelphia VA Medical Center, recruited 878 smokers at a large multinational company and randomly allocated each one to either (a) information about smoking cessation programs available within 20 miles or (b) the same information, plus a $100 incentive for completing a program, $250 incentive for quitting during the first 6 months, and $400 incentive to remain quit 6 months later (i.e. total potential incentive = $750).
What proportion of smokers do you think would be quit 9-12 months after receiving the incentive offer?
In this study 5% of the no-incentive group attended the smoking cessation programs, but 15% of the incentive group did. 21% of the incentive group quit in the first 6 months, compared with 12% of those with no incentives. And 15% of the incentive group remained quit 9-12 months after receiving the offer, compared with 5% of those just receiving the information about quit smoking programs (but no incentives).
Among the very heavy smokers (2 packs/day or more) in the study none of those with no incentives succeeded in quitting (0/27), and 2/22 (9%) of those offered the incentives succeeded in quitting.
Among those who participated in smoking cessation programs those who had incentives had higher quit rates (46% vs 21%).
This study therefore shows that if smokers are offered access to smoking cessation programs and a $750 incentive to quit, they are more likely to succeed (15%), than those with no incentive (5%).
The study participants were all employees and 90% were white. It remains to be seen if this effect would generalize to other groups. The authors point out the estimated financial benefit of having employees stop smoking is $3400 per year (savings in healthcare costs, absenteeism etc), and that it may therefore be cost effective to provide employees with incentives to quit. The effectiveness of such incentives also requires that smoking cessation programs be available, which they often are not.
It is worth highlighting what this study did NOT show. It did not show that all you have to do to get smokers to quit is offer them $750. In fact 85% of the smokers offered that incentive were unable to quit. Secondly, the findings from this study do not imply that we don’t need treatment services for smokers, we just need to pay them to quit. On the contrary, all the smokers in this study had treatment services available to them.
So it looks like an extra 10% of smokers can quit when offered $750 incentive, and when some treatment services are available. This is a worthwhile increase. The more complicated challenge is turning that finding from a research study into something that could be implemented on a wider scale. I dont believe there will be general acceptance of the principle of paying people to change their unhealthy behaviors. I also suspect that there may be more problems of implementation outside a thorough research study. Whats to stop a non-smoker claiming to be a smoker so they will be eligible for the bonus when they are (still) not smoking a year later? Can the average employer arrange the biochemical verifications necessary for the research study?
Ultimately I believe money may be better spent making sure all smokers have easy access to quality treatment services at no cost, and making sure they are fully aware of the personal benefits that will come to them from succeeding in quitting (cost savings from not buying cigarettes, improved health, lower health insurance premium etc).
Ref: Volpp K et al. A randomized, controlled trial of financial incentives for smoking cessation. N Eng J Med, 2009, 360:699-709