HealthDay News — Paying smokers to quit may be more effective than offering them free counseling and nicotine replacement therapy, according to research published in the New England Journal of Medicine.

“Although incentive programs are increasingly used by governments, employers, and insurers to motivate changes in health behavior, their design is usually based on the traditional economic assumption that the size of the incentive determines its effectiveness,” explained Scott Halpern, MD, PhD, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues.

“In contrast, behavioral economic theory suggests that incentives of similar size may have very different effects depending on how they are designed.”

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To evaluate incentive programs for smoking cessation that are based on rewards or deposit contracts and that are delivered at the individual or group level, the investigators randomly assigned 2,538 CVS Caremark employees across the United States to either receive a financial reward if they quit or earn back more than their $150 deposit if they quit.

Patients who put up their deposit could also lose it if they weren’t successful with quitting. Although fewer people opted for putting their own money at risk, those who did were more likely to quit than those who chose the reward challenge.

“We found that reward-based programs were more effective overall because many people didn’t want to sign up for the programs requiring deposits,” Halpern told HealthDay. However, for the approximately 14% of smokers who would have accepted any program, the deposit programs were twice as effective as the rewards programs, and five times more effective than simply receiving free smoking aids, he said.

People in reward-based programs could get $800 if they quit, and those in deposit-based programs could get back their $150 deposit plus $650 if they quit, explained the investigators. Employers and insurers could do a lot more to curb smoking and to reduce costs by designing programs that account for human psychology, noted Halpern.

“[The fact] that people seek to minimize loss is one of several psychological insights that can help supercharge incentive programs without increasing their costs to employers or insurers.”


  1. Halpern SD et al. NEJM. 2015; doi: 10.1056/NEJMoa1414293.