Financial Incentives for Smoking Cessation

Volpp, K. G., Troxel, A. B., Pauly, M. V., Glick, H. A., Puig, A., Asch, D. A., et al. (2009). A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation. N Engl J Med, 360(7), 699-709.

Volpp et al. (2009) compared the effectiveness of providing a financial incentive for smoking cessation with solely providing information about smoking cessation. Potential participants were identified through a survey distributed to employees of a company. Participants were randomized into an information-only and an information plus financial incentive group. All participants received information about local smoking cessation programs and smoking cessation methods (e.g. bupropion) covered by their health insurance. The financial incentive group also received financial incentives for completion of a smoking-cessation program ($100), for smoking cessation within 6 months after study enrollment ($250), and for continued abstinence from smoking for an additional 6 months after smoking cessation ($400). Participants could receive a total of $750. Abstinence from smoking was confirmed using a cotinine test, a biochemical test of saliva or urine samples.

Participants in the financial incentive group had significantly higher rates of smoking cessation than did the information-only group. 9.4% of the financial incentive group abstained from smoking 15 to 18 months after enrollment, compared with only 3.6% of the information-only group. Participants in the financial incentive group were also more likely to enroll and complete a smoking cessation program, and quit smoking within 6 months of enrollment in the study.

It is estimated that smoking costs employers $3400 per year because of decreased productivity, increased absenteeism, and an increased rate of illness. Therefore, this may be cost-effective for employers. However, long-term relapse rates were higher in both groups than that which is reported in the literature. Individuals volunteering to participate in this study may be more driven to quit than the average smoker. Lastly, study participants were mainly white with high income and education levels (i.e. the results may not be generalizable to other populations).