Department of Medical Ethics and Health Policy.
Center for Health Incentives and Behavioral Economics.
Ann Am Thorac Soc. 2021 Dec;18(12):1997-2006. doi: 10.1513/AnnalsATS.202012-1473OC.
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. To determine the cost-effectiveness of these incentives from the healthcare sector and employer perspectives. This study examines a decision model built with trial data, supplemented by data from the literature. Life-expectancy gains for quitters were projected on the basis of 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. Life-years, quality-adjusted life-years (QALYs), costs (2012 dollars), and cost-effectiveness ratios are described. From the healthcare sector perspective, costs ranged from $3,200 per life-year ($2,500 per QALY) for the competitive deposit program, compared with usual care, to $6,500 per life-year ($5,100 per QALY) for the individual reward program. From the employer perspective, costs ranged from $256,600 per life-year gained for the individual deposit program to $1,711,100 per life-year gained for the individual reward program; the cost per QALY ranged from $65,300 for the competitive deposit program to $128,800 for the individual reward program. Cost-effectiveness from the employer perspective improved with longer decision horizons. Including future medical costs reduced cost-effectiveness from both perspectives. 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.
四项财务激励计划的试验在大型雇主 CVS Caremark 进行，记录了它们在促进持续戒烟方面的有效性，但它们的成本效益尚不清楚，而且激励措施的前期成本高昂，这阻碍了它们的采用。为了从医疗保健部门和雇主的角度确定这些激励措施的成本效益。本研究使用试验数据构建决策模型，并辅之以文献数据。根据美国生命表，预计戒烟者的预期寿命会增加。两个面向个人的计划在 6 个月时为戒烟支付 800 美元；其中一个要求参与者在基线时存入 150 美元。两个面向群体的计划的支付金额随群体的成功而变化；同样，其中一个要求参与者存入 150 美元。描述了生命年、质量调整生命年 (QALY)、成本（2012 年美元）和成本效益比。从医疗保健部门的角度来看，与常规护理相比，竞争存款计划的成本为每生命年 3200 美元（每 QALY 2500 美元），个人奖励计划的成本为每生命年 6500 美元（每 QALY 5100 美元）。从雇主的角度来看，个人存款计划每获得一个生命年的成本为 256600 美元，个人奖励计划每获得一个生命年的成本为 1711100 美元；每获得一个 QALY 的成本从竞争存款计划的 65300 美元到个人奖励计划的 128800 美元不等。从雇主的角度来看，随着决策时间的延长，成本效益得到改善。包括未来的医疗成本降低了从两个角度来看的成本效益。向吸烟者支付戒烟费用的四项财务激励计划从医疗保健部门的角度来看非常具有成本效益。从雇主的角度来看，它们的成本更高，但对于决策时间更长的雇主来说，它们可能具有成本效益。
