The bottom line quit rate at 9-12 months was 14.7% in the group that was incented vs. 5.0% in the group that had no incentive. There were only two urine or saliva samples that were positive for cotinine.
The DMCB counted 47 persons completed the community resource (at $100 each or $4700), 91 had cotinine confirmed abstinence within 6 months (at $250 each or $22,750) and 64 remained abstinent at about 12 months ($400 each or $25,600), yielding a total outlay of $53,050 or $828 per smoker who quit.
Take away lessons from the Disease Management Care Blog:
Quit rates based in physician offices that are supplemented with the use of pharmacotherapy typically range from 11% to 30% at one year. The quit rate of about 15% in this program seems comparatively low. However, it has the advantage of offering more persons access to a tobacco program with a respectable outcome. As a result, while the relative number of quitters is lower, the absolute number is probably higher than what can be obtained in the traditional health care system.
While the number of persons trying to game the system seemed to be low (apparently saying they stopped and submitting a sample), that may have been helped by the sentinel effect of urine or saliva testing. This would seem to be an important part of any company-sponsored tobacco cessation program that involves cash incentives.
The cost of $9000 described in the scenario above is the direct cost to the company. Other costs, such as cotinine testing, physician services or drug use (for example, nicotine replacement therapy) represent other costs, especially in a self-insured company.
Last but not least, this appears to be another business opportunity for disease management organizations. This is not the first program to use incentives, but we now have a better idea on the role of cash in incenting persons to quit. DMOs can help recruit smokers, arrange for the community-based referrals, arrange the cotinine testing and adjudicate payment.