FROM THE NEW ENGLAND JOURNAL OF MEDICINE

Rewarding smokers for quitting was a more popular option for smoking cessation compared to sanctions-based treatment, but about the same number of participants in either group had quit smoking after 1 year.

Reward-based smoking cessation programs were accepted by 90% of those randomized, compared with 13.7% acceptance of deposit-based programs, and at 6 months, significantly more reward-based participants had ceased smoking, compared with deposit-based participants (15.2% vs. 10.2%). However, as with most such studies, at 1 year, nearly 50% of those who had achieved abstinence at 6 months had returned to smoking in all groups, according to a randomized controlled study of 2,538 CVS Caremark employees and their friends and relatives (ClinicalTrials.gov number, NCT01526265).

Participants were assigned to one of five groups: 468 to usual care only as the control, reported Dr. Scott D. Halpern of the University of Pennsylvania and his colleagues (N. Engl. J. Med. 2015;372:2108-17 ). They and all participants received information about local smoking cessation resources, cessation guides produced by the American Cancer Society, and, the 41% of the participants receiving health benefits through CVS Caremark had free access to a behavioral-modification program and nicotine-replacement therapy.

In addition, 498 were assigned to individual reward (eligible to receive $200 if they had biochemically confirmed abstinence at each of three times: 14 days, 30 days, and 6 months after quitting, with an additional $200 bonus at 6 months, for a total of $800); 519 to collaborative reward (in addition to the $800, patients were grouped into cohorts of six individuals who would receive an additional $100 per time point if one participant quit smoking to $600 per time point per participant if all six quit); 582 to individual deposit (the $800 dollars included a $150 deposit that would be refunded to participants who quit smoking), and 471 to competitive deposit (included the $150 deposit with the addition of a $450 matching reward per member ($3,600 total), which was redistributed among members who quit at each time point).

In intention-to-treat analyses, all four programs yielded greater rates of sustained cessation through 6 months (range, 9.4%-16.0%) than did usual care (6.0%) (P < .05 for all comparisons).

At 6 months, sustained abstinence was greater with reward-based incentives (15.7%) than with deposit-based (10.2%) (P < .001) and was similar between individual-incentive programs and group-incentive ones (12.1% vs. 13.7%, P = 0.29).

In addition, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2% higher in the deposit-based programs than in the reward-based programs among those who would accept participation in either type of program, the authors stated, indicating that the use of such a program might be of great cost-effectiveness to a health care provider.

Dr. Halpern reported having no relevant conflicts of interest. The National Cancer Institute, the National Institute on Aging, and CVS Caremark supported the study.

mlesney@frontlinemedcom.com

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