Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 26;11(1):15.
doi: 10.1186/s13561-021-00313-3.

Can financial payments incentivize short-term smoking cessation in orthopaedic trauma patients? Evidence from a discrete choice experiment

Dana Alkhoury  1 , Jared Atchison  2 , Antonio J Trujillo  3 , Kimberly Oslin  2 , Katherine P Frey  1 , Robert V O'Toole  2 , Renan C Castillo  1 , Nathan N O'Hara  4
Affiliations

Can financial payments incentivize short-term smoking cessation in orthopaedic trauma patients? Evidence from a discrete choice experiment

Dana Alkhoury et al. Health Econ Rev. .

Abstract

Background: Smoking increases the risk of complications and related costs after an orthopaedic fracture. Research in other populations suggests that a one-time payment may incentivize smoking cessation. However, little is known on fracture patients' willingness to accept financial incentives to stop smoking; and the level of incentive required to motivate smoking cessation in this population. This study aimed to estimate the financial threshold required to motivate fracture patients to stop smoking after injury.

Methods: This cross-sectional study utilized a discrete choice experiment (DCE) to elicit patient preferences towards financial incentives and reduced complications associated with smoking cessation. We presented participants with 12 hypothetical options with several attributes with varying levels. The respondents' data was used to determine the utility of each attribute level and the relative importance associated with each attribute.

Results: Of the 130 enrolled patients, 79% reported an interest in quitting smoking. We estimated the financial incentive to be of greater relative importance (ri) (45%) than any of the included clinical benefits of smoking cessations (deep infection (ri: 24%), bone healing complications (ri: 19%), and superficial infections (ri: 12%)). A one-time payment of $800 provided the greatest utility to the respondents (0.64, 95% CI: 0.36 to 0.93), surpassing the utility associated with a single $1000 financial incentive (0.36, 95% CI: 0.18 to 0.55).

Conclusions: Financial incentives may be an effective tool to promote smoking cessation in the orthopaedic trauma population. The findings of this study define optimal payment thresholds for smoking cessation programs.

PubMed Disclaimer

Conflict of interest statement

Dr. O’Toole reports consults not related to this study from Smith & Nephew, Lincotek, and Imagen; and stock options not related to this study from Imagen. No other authors have potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Sample choice set
Fig. 2
Fig. 2
The relative importance of the included attributes calculated with the full sample and with a reduced sample that excluded patients that were unwilling to stop smoking based on any of the presented options. SSI, surgical site infection
Fig. 3
Fig. 3
The mean utility with 95% confidence interval for each of the included attributes and levels. a Reports the full sample. b Reports both the full dataset and with a reduced sample that excluded patients that were unwilling to stop smoking based on any of the presented options. SSI, surgical site infection
See this image and copyright information in PMC

References

    1. Scolaro JA, Schenker ML, Yannascoli S, Baldwin K, Mehta S, Ahn J. Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am. 2014;96(8):674–681. doi: 10.2106/JBJS.M.00081. - DOI - PubMed
    1. Bedard NA, DeMik DE, Owens JM, Glass NA, DeBerg J, Callaghan JJ. Tobacco use and risk of wound complications and periprosthetic joint infection: a systematic review and meta-analysis of primary total joint arthroplasty procedures. J Arthroplasty. 2019;34(2):385–396.e4. doi: 10.1016/j.arth.2018.09.089. - DOI - PubMed
    1. Pearson RG, Clement RG, Edwards KL, Scammell BE. Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis. BMJ Open. 2016;6(11):e010303. doi: 10.1136/bmjopen-2015-010303. - DOI - PMC - PubMed
    1. Lee JJ, Patel R, Biermann JS, Dougherty PJ. The musculoskeletal effects of cigarette smoking. J Bone Joint Surg Am. 2013;95(9):850–859. doi: 10.2106/JBJS.L.00375. - DOI - PubMed
    1. Beahrs TR, Reagan J, Bettin CC, Grear BJ, Murphy GA, Richardson DR. Smoking effects in foot and ankle surgery: an evidence-based review. Foot Ankle Int. 2019;40(10):1226–1232. doi: 10.1177/1071100719867942. - DOI - PubMed

LinkOut - more resources