Successful smoking cessation is fundamental to reducing the worldwide healthcare burden of chronic disease. This randomised controlled trial investigated the impact of financial incentives on smoking cessation among employees of a multinational company in the USA.

The study randomised 878 employees to receive information on available smoking cessation programmes (n = 442) or the same information with financial incentives (n = 436). These included $100 for completing a cessation programme, $250 for smoking cessation within 6 months of study enrolment and $400 for abstinence for a further 6 months from initial cessation. Smoking cessation was confirmed biochemically using a cotinine test.

The financial incentive group had higher rates of enrolment and completion of a smoking cessation programme. The smoking cessation rate was significantly higher in the financial incentive group at the primary end point, which was 9 or 12 months after enrolment depending on whether initial cessation was reported at 3 or 6 months. A significantly higher cessation rate was also found at 15 or 18 months after enrolment in the financial incentive group. However, relapse rates in both groups were higher at the 9- or 12- and 15- or 18-month visits than in other studies and were higher in the incentive group than the control group.

This large trial highlights the potential benefits of financial incentives in increasing smoking cessation rates. It remains unclear if the effectiveness of this company-based strategy would translate into a wider population, and it appears the success may be limited to the duration of the financial incentive. Targeting behaviour change through financial incentives, although controversial, may deliver public health objectives more effectively than current incentives in place for healthcare providers.

▸ Volpp KG, Troxel AB, Pauly MV, et al. A randomized controlled trial of financial incentives for smoking cessation. N Engl J Med 2009;360:699–709.