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Valentelyte G, Sheridan A, Kavanagh P, Doyle F, Sorensen J. Financial incentives to stop smoking: Potential financial consequences of different reward schedules. Tob Prev Cessat 2024; 10:TPC-10-30. [PMID: 39006097 PMCID: PMC11241474 DOI: 10.18332/tpc/190617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/24/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Financial incentives to stop smoking (FISS) programs have been implemented internationally to encourage people who smoke to quit smoking. However, such programs require that the financial reward structure and its resulting effects on smoking quit rates are considered. We analyzed a number of scenarios for FISS reward schedules for current smoking individuals in Ireland, with a view to identify the potential implications in terms of financial consequences and expected effects. METHODS Using national QuitManager services data 2021-2023, we defined smoking quit rates for smokers currently using the national Health Services Executive stop smoking services in Ireland. Smoking quit rates at 4, 12 and 52 weeks were defined, and additionally defined by sex, age and education level. Using scenarios assuming different FISS reward sizes, structures and targeted population sub-groups, we estimated the number of additional quitters, budget impact, and incremental cost-effectiveness ratio. RESULTS A FISS program, if implemented for a cohort of 3500 smokers can result in a budget impact ranging €250000 - €870000. The cost-effectiveness trade-off between different payment schedules and the expected effect size suggested that FISS are cost-effective even at a moderate effect size. A FISS program implemented to approximately 20000 smokers nationally would cost between €2.0 million and €4.8 million, subject to the chosen reward schedule. Across social groups, FISS is more cost-effective for females, individuals in the youngest age group, and individuals with a medium level of education. CONCLUSIONS This analysis highlights the importance of considering different FISS schedules and potential quit effects, when designing such programs. We highlight that FISS programs should be targeted at certain social groups to achieve highest long-term smoking cessation rates. We also identified important challenges that decision-makers face when designing the reward structure of FISS programs. The acceptability or otherwise of the FISS structures may differ among stakeholders and should be explored.
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Affiliation(s)
- Gintare Valentelyte
- Converge: Centre for Chronic disease and Population Health Research, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Healthcare Outcome Research Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aishling Sheridan
- Tobacco Free Ireland Programme, Health Services Executive (HSE), Ireland
| | - Paul Kavanagh
- Tobacco Free Ireland Programme, Health Services Executive (HSE), Ireland
- Department of Epidemiology and Public Health, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcome Research Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Krotter A, García-Fernández G, García-Pérez Á, Aonso-Diego G, Weidberg S. Contingency management for smoking cessation for individuals with overweight or obesity: A randomized controlled trial. Drug Alcohol Depend 2024; 258:111269. [PMID: 38547787 DOI: 10.1016/j.drugalcdep.2024.111269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/09/2024] [Accepted: 03/10/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Interventions for quitting smoking and weight control among individuals with excess weight are scarce. Our study evaluated the effectiveness of cognitive behavioral therapy (CBT) plus contingency management (CM) in this population, and examined whether CM for smoking cessation improved CBT treatment outcomes at end of treatment (EOT) and at 1-, 3-, 6-, and 12-month follow-ups (FU). METHODS In an 8-week randomized clinical trial, 120 adults who smoke with overweight or obesity (54.16% females; MBMI = 31.75 ± 4.31) were randomly assigned to CBT for both quitting smoking and weight control (n = 60) or the same treatment plus CM for smoking cessation (n = 60). Outcome variables were compared (i.e., treatment completion, smoking abstinence, weight change and secondary outcomes). RESULTS At EOT, the CBT + CM group achieved 78.33% 7-day point-prevalence abstinence rates compared to 61.67% in the CBT group (p = .073), and rates declined over time (12-month FU: 18% vs 12%). Participants who attained abstinence weighed more compared to baseline at EOT (Mkg = 1.07; SD = 1.88) and over time (12-month FU: Mkg = 4.19; SD = 4.31). No differences were found between the two groups in outcome variables. CONCLUSIONS Both interventions were effective in promoting abstinence and reducing tobacco use over time. Combining CBT with CM for smoking cessation did not improve treatment outcomes in individuals with overweight or obesity compared to CBT only. Future studies should evaluate whether implementing CM for weight maintenance helps control post-cessation weight gain in this population.
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Affiliation(s)
| | | | - Ángel García-Pérez
- Department of Psychology, Sociology and Philosophy, University of Leon, Spain
| | | | - Sara Weidberg
- Department of Psychology, University of Oviedo, Spain
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Webb A, Coward L, Yousef M, Karamesinis A, Leong S. Does offering small financial incentives to smokers at the time of being wait-listed for surgery increase smoking cessation by the day of surgery? A randomised feasibility trial. BMJ Open 2023; 13:e080693. [PMID: 38154905 PMCID: PMC10759110 DOI: 10.1136/bmjopen-2023-080693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/04/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE This study aims to assess whether offering small financial incentives to smokers on elective surgery wait-lists is feasible and increases quitting before surgery. DESIGN Randomised controlled trial, prospective, double-blinded. SETTING Single-centre, Australian metropolitan public hospital. PARTICIPANTS 620 adult smokers (≥10 cigarettes per day) were randomised on being wait-listed for elective surgery and 404 underwent operations (28 January 2021-31 July 2022) at the hospital (65.2%) by trial's end. INTERVENTION Intervention participants were offered at wait-listing an $A70 supermarket voucher for verified abstinence on the day of surgery, provided they registered an intention to quit before surgery. Registrants intending to quit were also referred to Quitline. Neither intervention was offered to control participants (usual care). Smokers wait-listed from 17 May 2021 were offered an increased incentive of $A140. MAIN OUTCOME MEASURES Primary outcome, quitting at least 24 hours before surgery, verified by exhaled carbon monoxide testing. Feasibility outcomes were the proportion taking up offers, ease of patient contact and disputes about quit status. RESULTS Of 620 randomised participants (control 312, intervention 308), 404 had surgery at the hospital during the trial (control 214, intervention 190), which was lower than expected (for COVID-19 reasons). Offering $A70 resulted in 21.9% registering to quit, increasing to 32.6% with $A140. Telephone calls were the most effective means to gain registrations. The proportion of intervention group patients verified quit at least 24 hours before surgery was similar to controls (9.5% vs 8.9%, OR 1.1, 95% CI 0.5 to 2.2). Quitline contact was higher in the intervention group (13.2% vs 2.3%, OR 6.3, 95% CI 2.3 to 21.6). Disputes over test results did not occur, but 17.4% of intervention participants claiming quit failed verification. CONCLUSION A single offer of financial rewards for perioperative cessation was feasible, without achieving clinically important quit differences. TRIAL REGISTRATION NUMBER ACTRN12620000130965.
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Affiliation(s)
- Ashley Webb
- Department of Anaesthesia, Monash University Central and Eastern Clinical School, Melbourne, Victoria, Australia
- Department of Anaesthesia, Peninsula Health, Frankston, Victoria, Australia
| | - Lisa Coward
- Department of Anaesthesia, Peninsula Health, Frankston, Victoria, Australia
| | - Michael Yousef
- Department of Anaesthesia, Peninsula Health, Frankston, Victoria, Australia
| | | | - Samuel Leong
- Department of Anaesthesia, Monash University Central and Eastern Clinical School, Melbourne, Victoria, Australia
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Jackson MA, Brown AL, Baker AL, Bonevski B, Haber P, Bonomo Y, Blandthorn J, Attia J, Perry N, Barker D, Gould GS, Dunlop AJ. Tobacco treatment incorporating contingency management, nicotine replacement therapy, and behavioral counseling for pregnant women who use substances: a feasibility trial. Front Psychiatry 2023; 14:1207955. [PMID: 37654991 PMCID: PMC10467262 DOI: 10.3389/fpsyt.2023.1207955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Most pregnant women with substance use problems smoke, and few will quit during their pregnancy. Tobacco treatment is often overlooked, with the focus usually placed on other substance use. Additionally, few targeted effective treatments for this group exist. To address this, the feasibility of an intensive tobacco treatment incorporating contingency management (CM) that featured non-face-to-face delivery was examined. Methods A single-arm pre-post design feasibility trial was conducted in three antenatal services that support women who use substances in metropolitan Australia. Participants were over the age of 15, had <33-week gestation, and smoked tobacco daily. They received financial incentives for daily carbon monoxide-verified smoking abstinence or reduction through an internet-based CM programme, nicotine replacement therapy (NRT) posted to women and partners or household members who smoked and telephone-delivered behavioral counseling from study enrolment to birth. Results Of the 101 referrals, 46 women (46%) consented. The mean (SD) age was 31(±6) years, and the gestation period was 22(±6) weeks. Nineteen (41%) of those enrolled were retained for 12-week postpartum. Of 46 women, 32 (70%) utilized CM; 32 (70%) used NRT for ≥2 weeks; 23 (50%) attended ≥1 counseling session; and 15 (22%) received NRT for partners/household members. Fifteen (33%) were verified abstinent from tobacco at delivery after a median (IQR) period of abstinence of 65(36-128) days. All non-smokers at birth utilized NRT and financial incentives, and 9/15 (60%) utilized counseling. Four (9%) were abstinent at 12-week postpartum. Median cigarettes smoked/day reduced from baseline to delivery (10(6-20) to 1(0-6) p =< 0.001). Women who quit smoking had more education (72% vs. 33% p =< 0.02), completed more CO samples (median (IQR) 101(59-157) vs. 2(0-20) p =< 0.001), and received more incentives (median (IQR) $909($225-$1980) vs. $34($3-$64) p =< 0.001). Intervention acceptability was rated favorably by participants (9 items rated 0-10 with scores >5 considered favorable). Discussion This study demonstrated the feasibility and acceptability of a consumer-informed, non-face-to-face intensive tobacco treatment, highlighting the potential of remotely delivered technology-based CM to reduce the health impact of tobacco smoking in high-priority populations. The intervention demonstrates scale-up potential. Future studies should extend treatment into the postpartum period, utilizing new technologies to enhance CM delivery and improve counseling provision and partner support. Clinical trial registration https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374196, ACTRN1261800056224.
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Affiliation(s)
- Melissa A. Jackson
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
| | - Amanda L. Brown
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Billie Bonevski
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Paul Haber
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
- Edith Collins Centre, Sydney Local Health District, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Yvonne Bonomo
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
- Women's Alcohol and Drug Service, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Julie Blandthorn
- Women's Alcohol and Drug Service, The Royal Women's Hospital, Parkville, VIC, Australia
| | - John Attia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Natasha Perry
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
| | - Daniel Barker
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Gillian S. Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Adrian J. Dunlop
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
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McMeekin N, Sinclair L, Robinson‐Smith L, Mitchell A, Bauld L, Tappin DM, Boyd KA. Financial incentives for quitting smoking in pregnancy: Are they cost-effective? Addiction 2023; 118:1445-1456. [PMID: 36843417 PMCID: PMC10952957 DOI: 10.1111/add.16176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/04/2023] [Indexed: 02/28/2023]
Abstract
AIMS To evaluate whether adding financial incentives to usual care is cost-effective in encouraging pregnant women to quit tobacco smoking, compared with usual care alone. DESIGN Cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a health-care provider's perspective, embedded in the Smoking Cessation in Pregnancy Incentives Trial (CPIT III). Long-term analyses were conducted from the same perspective, using an existing Markov model over a life-time horizon. SETTING Seven maternity smoking cessation sites in Scotland, England and Northern Ireland in the United Kingdom. PARTICIPANTS In the short-term analysis, CPIT III participants were assessed: women 16 years or older, self-reporting as smokers, fewer than 24 weeks pregnant and English-speaking (n = 944). The same population was used for the life-time analysis, plus their infants. MEASUREMENTS Costs included financial incentive vouchers and postage, cessation support and nicotine replacement therapy and neonatal stays. The outcome measure was a biochemically verified quit rate for the CEA and quality-adjusted life-years (QALYs) for CUA. Costs are presented in 2020 GBP sterling (£). Data for the life-time analysis came from the trial and were combined with data from published literature embedded in the model, reporting incremental cost per quitter and QALY. A 3.5% discount rate was applied. FINDINGS The short-term incremental cost per quitter was £4400 and cost per QALY was £150 000. Results of sensitivity analyses confirmed these results. The long-term analysis combined costs and outcomes for mother and infants; results showed a cost saving of £37 [95% confidence interval (CI]) = £35-106] and increase in QALYs of 0.171 (95% CI = 0.124-0.229). These findings indicate that, over a life-time, financial incentives are cost-saving and improve health outcomes. CONCLUSIONS In the United Kingdom, offering up to £400 financial incentives, in addition to usual care, to support pregnant women to stop smoking appears to be highly cost-effective over a life-time for mother and infants.
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Affiliation(s)
- Nicola McMeekin
- Health Economics and Health Technology Assessment, Institute of Health and WellbeingUniversity of GlasgowGlasgowG12 8RZUK
| | - Lesley Sinclair
- York Trials Unit, Department of Health Sciences, Faculty of ScienceUniversity of YorkYO10 5DDYorkUK
| | - Lyn Robinson‐Smith
- York Trials Unit, Department of Health Sciences, Faculty of ScienceUniversity of YorkYO10 5DDYorkUK
| | - Alex Mitchell
- York Trials Unit, Department of Health Sciences, Faculty of ScienceUniversity of YorkYO10 5DDYorkUK
| | - Linda Bauld
- Usher Institute and SPECTRUM ConsortiumUniversity of EdinburghEdinburghEH8 9AGUK
| | - David M. Tappin
- Child Health, School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
| | - Kathleen A. Boyd
- Health Economics and Health Technology Assessment, Institute of Health and WellbeingUniversity of GlasgowGlasgowG12 8RZUK
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van der Swaluw K, Hiemstra M, Lambooij M, Roordink E, van der Vliet N, Zantinge E, Proper K, Zeelenberg M, Prast HM. Lottery incentives for smoking cessation at the workplace: design and protocol of the smoke-free lottery - a cluster randomized trial. BMC Public Health 2023; 23:76. [PMID: 36627613 PMCID: PMC9831882 DOI: 10.1186/s12889-022-14915-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Smoking is the leading behavioral risk factor for the loss of healthy life years. Many smokers want to quit, but have trouble doing so. Financial incentives in workplace settings have shown promising results in supporting smokers and their design influences their impact. Lotteries that leverage behavioral economic insights might improve the effectiveness of workplace cessation support. METHODS AND DESIGN We examine in a cluster randomized trial if a workplace cessation group training paired with lottery deadlines will increase continuous abstinence rates over and above the cessation training alone. Organizations are randomized to either the control arm or lottery arm. The lotteries capitalize regret aversion by always informing winners at the deadline, but withholding prizes if they smoked. In the lottery-arm, winners are drawn out of all participants within a training group, regardless of their smoking status. In weeks 1-13 there are weekly lotteries. Winners are informed about their prize (€50), but can only claim it if they did not smoke that week, validated biochemically. After 26 weeks, there is a long-term lottery where the winners are informed about their prize (vacation voucher worth €400), but can only claim it if they were abstinent between weeks 13 and 26. The primary outcome is continuous abstinence 52 weeks after the quit date. DISCUSSION There is a quest for incentives to support smoking cessation that are considered fair, affordable and effective across different socioeconomic groups. Previous use of behavioral economics in the design of lotteries have shown promising results in changing health behavior. This cluster randomized trial aims to demonstrate if these lotteries are also effective for supporting smoking cessation. Therefore the study design and protocol are described in detail in this paper. Findings might contribute to the application and development of effective cessation support at the workplace. TRIAL REGISTRATION Netherlands Trial Register Identifier: NL8463 . Date of registration: 17-03-2020.
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Affiliation(s)
- Koen van der Swaluw
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, 3720 BA Bilthoven, The Netherlands ,grid.5590.90000000122931605Department of Economics and Business Economics, Nijmegen School of Management, Radboud University, 6500 HK Nijmegen, The Netherlands
| | - Marieke Hiemstra
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, 3720 BA Bilthoven, The Netherlands
| | - Mattijs Lambooij
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, 3720 BA Bilthoven, The Netherlands
| | - Eline Roordink
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, 3720 BA Bilthoven, The Netherlands
| | - Nina van der Vliet
- grid.31147.300000 0001 2208 0118National Institute for Public Health and the Environment (RIVM), Centre for Sustainability, Environment and Health, 3720 BA Bilthoven, The Netherlands ,grid.12295.3d0000 0001 0943 3265Tilburg University Graduate School, Tilburg School of Social and Behavioral Sciences, 5000 LE Tilburg, The Netherlands
| | - Else Zantinge
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Health and Society, 3720 BA Bilthoven, The Netherlands
| | - Karin Proper
- grid.31147.300000 0001 2208 0118National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, 3720 BA Bilthoven, The Netherlands ,grid.16872.3a0000 0004 0435 165XAmsterdam UMC, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marcel Zeelenberg
- grid.12295.3d0000 0001 0943 3265Tilburg University, Department of Social Psychology, Tilburg School of Social and Behavioral Sciences, 5000 LE Tilburg, the Netherlands ,grid.12380.380000 0004 1754 9227VU Amsterdam, Department of Marketing, School of Business and Economics, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| | - Henriette M. Prast
- grid.12295.3d0000 0001 0943 3265Tilburg University, 5000 LE Tilburg, the Netherlands ,grid.465164.40000 0004 0621 2610Dutch Senate, 2500 EA Den Haag, The Netherlands
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Crainich D. [Financial incentives to achieve health-related behavioral goals: State of play and unresolved questions]. Med Sci (Paris) 2022; 38:198-204. [PMID: 35179475 DOI: 10.1051/medsci/2022005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Programs providing monetary rewards to individuals who achieve a health-related goal (quitting smoking, losing weight, etc.) aim at promoting healthy behaviors. While these programs seem to achieve their objective in the short run, their ability to provoke lasting changes remains to be demonstrated. The identification of granting mechanisms likely to maximize the incentive effect of these rewards should be based on knowledge about individual attitudes evidenced by behavioral economics. As the latter has shown that preferences toward risk vary from one individual to another, these incentive mechanisms should be tailor-made according to individual preferences.
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Affiliation(s)
- David Crainich
- Univ. Lille, CNRS, IESEG School of management, UMR 9221 - LEM (Lille Économie Management), 3 rue de la Digue, F-59000 Lille, France
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Egede LE, Walker RJ, Dismuke-Greer CE, Pyzyk S, Dawson AZ, Williams JS, Campbell JA. Cost-effectiveness of financial incentives to improve glycemic control in adults with diabetes: A pilot randomized controlled trial. PLoS One 2021; 16:e0248762. [PMID: 33735275 PMCID: PMC7971847 DOI: 10.1371/journal.pone.0248762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/02/2021] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Determine the cost-effectiveness of three financial incentive structures in obtaining a 1% within group drop in HbA1c among adults with diabetes. METHODS 60 African Americans with type 2 diabetes were randomized to one of three financial incentive structures and followed for 3-months. Group 1 (low frequency) received a single incentive for absolute HbA1c reduction, Group 2 (moderate frequency) received a two-part incentive for home testing of glucose and absolute HbA1c reduction and Group 3 (high frequency) received a multiple component incentive for home testing, attendance of weekly telephone education classes and absolute HbA1c reduction. The primary clinical outcome was HbA1c reduction within each arm at 3-months. Cost for each arm was calculated based on the cost of the intervention, cost of health care visits during the 3-month time frame, and cost of workdays missed from illness. Incremental cost effectiveness ratios (ICER) were calculated based on achieving a 1% within group drop in HbA1c and were bootstrapped with 1,000 replications. RESULTS The ICER to decrease HbA1c by 1% was $1,100 for all three arms, however, bootstrapped standard errors differed with Group 1 having twice the variation around the ICER coefficient as Groups 2 and 3. ICERs were statistically significant for Groups 2 and 3 (p<0.001) indicating they are cost effective interventions. CONCLUSIONS Given ICERs of prior diabetes interventions range from $1,000-$4,000, a cost of $1,100 per 1% within group decrease in HbA1c is a promising intervention. Multi-component incentive structures seem to have the least variation in cost-effectiveness.
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Affiliation(s)
- Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Rebekah J. Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Clara E. Dismuke-Greer
- Health Economics Resource Center (HERC), Palo Alto VA Health Care System, Palo Alto, California, United States of America
| | - Sarah Pyzyk
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Aprill Z. Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Joni S. Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Jennifer A. Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
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