Dollars and Sense – Will Smokers Bet on Quitting?

Vaper’s Vortex

May 27, 2015

“With such unprecedented rates of success, the trick now is to figure out how to get more people to sign up — to feel like they have skin in the game.”

Results from a unique study conducted over an eight month period in 2012 by the University of Pennsylvania’s Perelman School of Medicine, were recently published in the New England Journal of Medicine.

The Study

2,568 participants from across the U.S., all employees of CVS Caremark (now CVS Health) who funded the study, were offered a financial incentive of roughly $800 to quit smoking. Participants were broken into five groups.

Reward Programs

  • Individual reward (reward based on individual performance)
  • Collaborative reward (reward based on group performance)

Deposit Programs

  • Individual deposit (requiring an upfront deposit of $150 with subsequent matching funds)
  • Competitive deposit (competing for other participants’ deposits and matching funds)

Counseling and Nicotine Replacement Therapy

  • Usual care including informational resources and free smoking cessation aids.

The Results

  • 90% of participants assigned to reward based programs, individual or group, accepted the assignment.
  • Only 14% of participants assigned to deposit-based programs accepted.
  • Of those assigned to reward programs (no deposit required), 16% remained smoke-free at the six month point.
  • Of those assigned to deposit programs, 10% were smoke-free at six months.
  • And among the usual care participants, 6% were smoke-free at six months.
  • There was not a statistically significant difference in the quitting success of group-oriented programs vs. individual-oriented programs – 14% vs. 12%.

All four programs offering a financial incentive were substantially more successful at helping smokers quit than the traditional counseling and nicotine replacement therapy option (provided at no cost to participants). There was, however, one surprise.

Of the 14% who accepted deposit based programs, 55% were smoke-free at six months – the highest success rate, by far, of any of the five groups. Lead author Scott Halpern, MD, PhD:

“However, among people who would have accepted any program we offered them, the deposit contracts were twice as effective as rewards, and five times more effective than free information and nicotine replacement therapy, likely because they leveraged people’s natural aversion to losing money. With such unprecedented rates of success, the trick now is to figure out how to get more people to sign up — to feel like they have skin in the game.”

What If We Up the Bet?

What if we scaled the Penn State study results up to a national level?

  • There are 45 million adult smokers in the U.S.
  • The CDC estimates that annual direct medical care costs for U.S. smokers is $170 billion.

How do we get more people, with “skin in the game”, to sign up?

  • What if the federal government offered a financial, deposit based, reward for smokers to stop smoking combustible tobacco cigarettes? By any means. The name of the game is just stop smoking.
  • Smokers would be required to pay $50 to enter the “Kick Butts Program” – skin in the game.
  • Smokers who are smoke free at the end of 12 months would receive a $500 check.

I won’t bore everyone with all of the math but:

  • Let’s assume just one percent, 450,000, of all 45 million smokers accepted the open enrollment option in first year of “Kick Butts”.
  • $22.5 million ($50 each) would be collected from all enrollees.
  • Based on the Penn State’s results, 55%, or 247,000 of those enrolled, would be successful quitters at the end of 12 months.
  • Net payout by the government would be just over – $100 million.
  • Savings in healthcare costs – $329 million.

There are a ton of variables not accounted for in this greatly simplified example. A number of assumptions are made based on the Penn State study. Assumptions that might, or might not, materialize in an experiment with nearly one hundred times the number of participants.

Then again, the concept would not have to be tested on a national level. It could easily be done in a single state. Or a single city. For now, it will be tested in a single company.

The potential to save lives, improve public health and at the same time dramatically reduce healthcare costs deserves serious consideration. Billions are being spent every year to treat the disease. For a fraction of that cost, we could focus on treating the cause.

Apparently CVS Health agrees. They are preparing to launch a new program – “700 Good Reasons”. CVS employees willing to bet on success will quit smoking, and put down a $50 bet (aka deposit). If at the end of one year they are still not smoking, they will receive their $50 back – and a $700 bonus. CVS sees that as a good investment. They typically spend $4,000 to $6,000 more per year on a smoking employee.

Will smokers bet on quitting? I’m betting they will. And many will win the bet. And the winners – they’ll be winning much more than just money.


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Dave Coggin has a Master’s Degree in business and spent 35 years in corporate America. He is a co-founder and partner in DIYELS. He has spent the last five years actively researching and following the evolution of the e-cigarette industry. He is a strong proponent of e-cigarettes as the most promising option currently known for tobacco harm reduction. He may be contacted directly at .

The opinions presented here are exclusively those of the author. Vaper’s Vortex is offered as a service to our customers and followers. Anyone considering e-cigarettes as an alternative to tobacco cigarettes should seek qualified advice from a medical professional.

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