Cost-Effectiveness of Four Financial-Incentive Programs for Smoking Cessation.

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 A decision model built with trial data, supplemented by data from the literature. Life expectancy gains for quitters were projected based on 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 $150. RESULTS Life-years, quality-adjusted life-years, costs (2012$), and cost-effectiveness ratios. From the healthcare sector perspective, costs ranged from $3,200/life-year ($2,500/quality-adjusted life-year) for the competitive deposit program, compared with usual care, to $6,500/life-year ($5,100/quality-adjusted life-year) for individual reward. From the employer perspective, costs ranged from $256,600/life-year gained for the individual deposit program to $1,711,100/life-year for individual reward; cost/quality-adjusted life-year ranged from $65,300 for competitive deposit to $128,800 for individual reward. 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.