Commitment contracts and team incentives: a randomized controlled trial for smoking cessation in Thailand.

BackgroundTreatment for tobacco dependence is not available in many low-resource settings, especially in developing countries.PurposeTo test the impact of a novel mix of monetary and social incentives on smoking abstinence in rural communities of Thailand.DesignAn RCT of commitment contracts and team incentives for rural smokers to quit smoking. Smokers were not blinded to treatment status, although the assessor of the biochemical urine test was.Setting/participantsAll adult smokers living in the study area were eligible to participate; 215 adult smokers from 42 villages in Nakhon Nayok province, Thailand, participated. Fourteen smokers who lacked teammates were dropped.InterventionA total of 201 smokers were assigned to a two-person team, and then randomly assigned by team (in a 2:1 ratio) with computer-generated random numbers to receive smoking-cessation counseling (control group) or counseling plus offer of a commitment contract, team incentives, and text message reminders for smoking cessation at 3 months (intervention group).Main outcome measuresThe primary outcome was biochemically verified 7-day abstinence at 6 months, assessed on an intention-to-treat basis. Secondary outcomes include study participation, biochemically verified abstinence at 3 months, self-reported abstinence at 14 months, and the incremental cost per quitter of the intervention, nicotine gum, and varenicline in Thailand. Data were collected in 2010-2011 and analyzed in 2012.ResultsThe trial enrolled 215 (10.5%) of 2055 smokers. The abstinence rate was 46.2% (61/132) in the intervention group and 14.5% (10/69) in the control group (adjusted OR 7.5 [3.0-18.6]) at 3 months; 44.3% (58/131) and 18.8% (13/69) at the primary end point of 6 months (adjusted OR 4.2 [1.8-9.7]); and 42.0% (55/131) and 24.6% (17/69) at 14 months (adjusted OR 2.2 [1.0-4.8]). The purchasing power parity-adjusted incremental cost per quitter from the intervention is $281 (95$187, $562), less than for nicotine gum ($1780, 95% CI=$1414,$2401) or varenicline ($2073, 95$1357, $4388) in Thailand.ConclusionsThe intervention enhanced abstinence by 91%-136% at 6 months, relative to the control group, although self-reports at 14 months suggest tapering of the treatment effect. The intervention may offer a viable, cost-effective alternative to current smoking-cessation approaches in low-resource settings.Trial registrationThis study is registered at ClinicalTrials.gov NCT01311115

Fiscal Impact of Smoking Cessation in Thailand: A Government Perspective Cost-Benefit Analysis

We evaluate the broader public economic consequences of investments in smoking cessation that change lifetime productivity, which can influence future government tax revenue and social transfer costs and health care spending. The analysis applies a government perspective framework for assessing the intergenerational relationships between morbidity and mortality and lifetime tax revenue and social transfers received. Applying smoking prevalence in Thailand, a cohort model was developed for smoker and former smokers to estimate impact on lifetime direct taxes and tobacco taxes paid. Age-specific earnings for males and wage appropriate tax rates were applied to estimate net taxes for smokers and former smokers. Introducing smoking cessation leads to lifetime public economic benefits of THB13 998 to THB43 356 per person depending on the age of introducing smoking cessation. Factoring in the costs of smoking cessation therapy, an average return on investment of 1.35 was obtained indicating fiscal surplus generated for government from the combined effect of increased tax revenues and of averting smoking-attributable health care costs. </jats:p

Commitment contracts and team incentives: a randomized controlled trial for smoking cessation in Thailand.

BackgroundTreatment for tobacco dependence is not available in many low-resource settings, especially in developing countries.PurposeTo test the impact of a novel mix of monetary and social incentives on smoking abstinence in rural communities of Thailand.DesignAn RCT of commitment contracts and team incentives for rural smokers to quit smoking. Smokers were not blinded to treatment status, although the assessor of the biochemical urine test was.Setting/participantsAll adult smokers living in the study area were eligible to participate; 215 adult smokers from 42 villages in Nakhon Nayok province, Thailand, participated. Fourteen smokers who lacked teammates were dropped.InterventionA total of 201 smokers were assigned to a two-person team, and then randomly assigned by team (in a 2:1 ratio) with computer-generated random numbers to receive smoking-cessation counseling (control group) or counseling plus offer of a commitment contract, team incentives, and text message reminders for smoking cessation at 3 months (intervention group).Main outcome measuresThe primary outcome was biochemically verified 7-day abstinence at 6 months, assessed on an intention-to-treat basis. Secondary outcomes include study participation, biochemically verified abstinence at 3 months, self-reported abstinence at 14 months, and the incremental cost per quitter of the intervention, nicotine gum, and varenicline in Thailand. Data were collected in 2010-2011 and analyzed in 2012.ResultsThe trial enrolled 215 (10.5%) of 2055 smokers. The abstinence rate was 46.2% (61/132) in the intervention group and 14.5% (10/69) in the control group (adjusted OR 7.5 [3.0-18.6]) at 3 months; 44.3% (58/131) and 18.8% (13/69) at the primary end point of 6 months (adjusted OR 4.2 [1.8-9.7]); and 42.0% (55/131) and 24.6% (17/69) at 14 months (adjusted OR 2.2 [1.0-4.8]). The purchasing power parity-adjusted incremental cost per quitter from the intervention is $281 (95$187, $562), less than for nicotine gum ($1780, 95% CI=$1414,$2401) or varenicline ($2073, 95$1357, $4388) in Thailand.ConclusionsThe intervention enhanced abstinence by 91%-136% at 6 months, relative to the control group, although self-reports at 14 months suggest tapering of the treatment effect. The intervention may offer a viable, cost-effective alternative to current smoking-cessation approaches in low-resource settings.Trial registrationThis study is registered at ClinicalTrials.gov NCT01311115

Supplementary Material, Table_3_Supplement – Fiscal Impact of Smoking Cessation in Thailand: A Government Perspective Cost-Benefit Analysis

<p>Supplementary Material, Table_3_Supplement for Fiscal Impact of Smoking Cessation in Thailand: A Government Perspective Cost-Benefit Analysis by Mark P. Connolly, Nikolaos Kotsopoulos, Pichaya Suthipinijtham and Suthat Rungruanghiranya in Asia Pacific Journal of Public Health</p