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Randomized Controlled Trial
. 2020 May;29(3):320-325.
doi: 10.1136/tobaccocontrol-2018-054811. Epub 2019 May 30.

Financial incentives to Medicaid smokers for engaging tobacco quit line treatment: maximising return on investment

Marlon P Mundt  1 , Timothy B Baker  2   3 , Megan E Piper  2   3 , Stevens S Smith  2   3 , David L Fraser  2 , Michael C Fiore  2   3
Affiliations
Randomized Controlled Trial

Financial incentives to Medicaid smokers for engaging tobacco quit line treatment: maximising return on investment

Marlon P Mundt et al. Tob Control. 2020 May.

Abstract

Background: Low-income smokers experience greater difficulty in quitting smoking than do other smokers. Providing financial incentives for treatment engagement increases smoking cessation success. This study models the cost-effectiveness of varying levels of financial incentives to maximise return on investment (ROI) for engaging low-income Medicaid recipients who smoke to take calls from a tobacco quit line.

Methods: Participants (N=1900) were recruited from May 2013 to June 2015 through quit line-based (n=980), clinic-based (n=444) or community-based referrals (n=476) into the Wisconsin Medicaid Quit Line Incentive project. Incentive (n=948) and control group participants (n=952) received $30 versus $0 per call, respectively, for taking up to five Wisconsin Tobacco Quit Line (WTQL) calls. Cost-effectiveness analyses estimated the incremental cost-effectiveness ratio for alternative financial incentives for engagement with WTQL calls. Probabilistic sensitivity analysis was employed to determine an optimal strategy for financial incentives to minimise the cost per individual who quit smoking.

Results: Using fixed payments, the incremental cost-effectiveness ratio of $2316 per smoker who quit in the randomised trial decreased to $2150 per smoker who quit when the incentives were modelled at $20 per each of five WTQL calls taken. Using variable payments, the minimal cost per additional smoker who quit was $2125 when incentives for the first four WTQL calls were set at $20, and the financial payment for the fifth WTQL call was set at $70.

Conclusions: Modelling suggests that financial incentives in the amount of $20 per call for taking the first four quit line calls and $70 for taking a fifth quit line call maximise ROI to engage low-income smokers with evidence-based smoking cessation treatment.

Keywords: cessation; economics; socioeconomic status.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1:
Figure 1:
Incremental Cost-Effectiveness Based on Equal Incentive per WTQL Call
Figure 2:
Figure 2:
Incremental cost-effectiveness at various financial incentives for the final 5th WQTL call and $20 for the first 4 WTQL calls
See this image and copyright information in PMC

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