Louise B Russell1,2,3, Kevin G Volpp1,4,2,3,5, Pui L Kwong6,2, Benjamin S Cosgriff7, Michael O Harhay6,2, Jingsan Zhu1,2, Scott D Halpern1,4,6,2,3. 1. Department of Medical Ethics and Health Policy. 2. Center for Health Incentives and Behavioral Economics. 3. Leonard Davis Institute of Health Economics, and. 4. Department of Medicine, and. 5. Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania; and. 6. Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 7. Independent Consultant, Westfield, New Jersey.
Abstract
Rationale: A trial of four financial incentive programs, conducted at CVS Caremark, a large employer, documented their effectiveness in promoting sustained abstinence from smoking, but their cost-effectiveness is unknown, and the significant up-front cost of the incentives is a deterrent to their adoption. Objectives: To determine the cost-effectiveness of these incentives from the healthcare sector and employer perspectives. Methods: This study examines a decision model built with trial data, supplemented by data from the literature. Life-expectancy gains for quitters were projected on the basis of U.S. life tables. The two individual-oriented programs paid $800 for smoking cessation at 6 months; one required participants to deposit $150 at baseline. Payments in the two group-oriented programs varied with the group's success; again, one required participants to deposit $150. Results: Life-years, quality-adjusted life-years (QALYs), costs (2012 dollars), and cost-effectiveness ratios are described. From the healthcare sector perspective, costs ranged from $3,200 per life-year ($2,500 per QALY) for the competitive deposit program, compared with usual care, to $6,500 per life-year ($5,100 per QALY) for the individual reward program. From the employer perspective, costs ranged from $256,600 per life-year gained for the individual deposit program to $1,711,100 per life-year gained for the individual reward program; the cost per QALY ranged from $65,300 for the competitive deposit program to $128,800 for the individual reward program. Cost-effectiveness from the employer perspective improved with longer decision horizons. Including future medical costs reduced cost-effectiveness from both perspectives. Conclusions: Four financial incentive programs that paid smokers to quit are very cost-effective from the healthcare sector perspective. They are more expensive from the employer perspective but may be cost-effective for employers with longer decision horizons.
Rationale: A trial of four financial incentive programs, conducted at CVS Caremark, a large employer, documented their effectiveness in promoting sustained abstinence from smoking, but their cost-effectiveness is unknown, and the significant up-front cost of the incentives is a deterrent to their adoption. Objectives: To determine the cost-effectiveness of these incentives from the healthcare sector and employer perspectives. Methods: This study examines a decision model built with trial data, supplemented by data from the literature. Life-expectancy gains for quitters were projected on the basis of U.S. life tables. The two individual-oriented programs paid $800 for smoking cessation at 6 months; one required participants to deposit $150 at baseline. Payments in the two group-oriented programs varied with the group's success; again, one required participants to deposit $150. Results: Life-years, quality-adjusted life-years (QALYs), costs (2012 dollars), and cost-effectiveness ratios are described. From the healthcare sector perspective, costs ranged from $3,200 per life-year ($2,500 per QALY) for the competitive deposit program, compared with usual care, to $6,500 per life-year ($5,100 per QALY) for the individual reward program. From the employer perspective, costs ranged from $256,600 per life-year gained for the individual deposit program to $1,711,100 per life-year gained for the individual reward program; the cost per QALY ranged from $65,300 for the competitive deposit program to $128,800 for the individual reward program. Cost-effectiveness from the employer perspective improved with longer decision horizons. Including future medical costs reduced cost-effectiveness from both perspectives. Conclusions: Four financial incentive programs that paid smokers to quit are very cost-effective from the healthcare sector perspective. They are more expensive from the employer perspective but may be cost-effective for employers with longer decision horizons.
Authors: Scott D Halpern; Benjamin French; Dylan S Small; Kathryn Saulsgiver; Michael O Harhay; Janet Audrain-McGovern; George Loewenstein; Troyen A Brennan; David A Asch; Kevin G Volpp Journal: N Engl J Med Date: 2015-05-13 Impact factor: 91.245
Authors: William C Black; Ilana F Gareen; Samir S Soneji; JoRean D Sicks; Emmett B Keeler; Denise R Aberle; Arash Naeim; Timothy R Church; Gerard A Silvestri; Jeremy Gorelick; Constantine Gatsonis Journal: N Engl J Med Date: 2014-11-06 Impact factor: 91.245
Authors: Louise B Russell; Laurie A Norton; David Pagnotti; Christianne Sevinc; Sophia Anderson; Darra Finnerty Bigelow; Lauren G Iannotte; Michael Josephs; Ryan McGilloway; Iwan Barankay; Mary E Putt; Peter P Reese; David A Asch; Lee R Goldberg; Shivan J Mehta; Monique S Tanna; Andrea B Troxel; Kevin G Volpp Journal: Med Decis Making Date: 2020-11-20 Impact factor: 2.583
Authors: Prabhat Jha; Chinthanie Ramasundarahettige; Victoria Landsman; Brian Rostron; Michael Thun; Robert N Anderson; Tim McAfee; Richard Peto Journal: N Engl J Med Date: 2013-01-24 Impact factor: 91.245
Authors: Rachel Kohn; Anil Vachani; Dylan Small; Alisa J Stephens-Shields; Dorothy Sheu; Vanessa L Madden; Brian A Bayes; Marzana Chowdhury; Sadie Friday; Jannie Kim; Michael K Gould; Mohamed H Ismail; Beth Creekmur; Matthew A Facktor; Charlotte Collins; Kristina K Blessing; Christine M Neslund-Dudas; Michael J Simoff; Elizabeth R Alleman; Leonard H Epstein; Michael A Horst; Michael E Scott; Kevin G Volpp; Scott D Halpern; Joanna L Hart Journal: Ann Am Thorac Soc Date: 2022-02