Wisconsin Tobacco Quit Line Medicaid Incentive Evaluation

• ClinicalTrials.gov Identifier: NCT02713594
• Recruitment Status: Completed
• First Posted: March 18, 2016
• Results First Posted: April 21, 2017
• Last Update Posted: April 21, 2017
• Sponsor: University of Wisconsin, Madison
• Information provided by (Responsible Party): University of Wisconsin, Madison

Study Description

Brief Summary:

The study is designed to test the hypotheses that financial incentives can increase both participation in smoking cessation treatment and resulting cessation rates, when they are offered to BadgerCare Plus (Medicaid) smokers as part of their health care.

Condition or disease	Intervention/treatment	Phase
Smoking; Smoking Cessation; Nicotine Dependence	Behavioral: Counseling from WTQL; Other: Financial incentive to participate	Not Applicable

Detailed Description:

Previous research on providing incentives for healthy behaviors has shown that financial incentives can increase treatment participation and boost outcomes when they are tied to participation in evidence based treatments. However, most of this research has been done in laboratory settings and in relatively small clinical trials. This study is designed to test the hypotheses that incentives can increase both participation in smoking cessation treatment and resulting cessation rates, when they are offered to Wisconsin BadgerCare Plus (Medicaid) smokers as part of their health care. If successful, this treatment approach could be used more broadly to reduce the considerable financial and personal costs associated with smoking-related disease.

In this study, Medicaid-eligible smokers were recruited from primary care clinics and from callers to the Wisconsin Tobacco Quit Line (WTQL) with randomization a Control condition and an Incentive condition. All participants were offered five cessation calls from the WTQL and participants were encouraged by WTQL coaches to obtain cessation medication from their primary care providers. All participants received payment for completing a baseline assessment ($40) and a 6-month smoking test ($40). Only Incentive condition participants received additional compensation for taking counseling calls ($30 per completed call) and for biochemically-verified abstinence at the 6-month visit ($40).

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 1900 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Health Services Research
• Official Title: Wisconsin Tobacco Quit Line Centers for Medicaid Services Striving To Quit Evaluation Project
• Study Start Date: April 2013
• Actual Primary Completion Date: March 2016
• Actual Study Completion Date: March 2017

Arms and Interventions

Arm	Intervention/treatment
Placebo Comparator: Control; Counseling from WTQL	Behavioral: Counseling from WTQL; Counseling from the Wisconsin Tobacco Quit Line (WTQL) consisted of 5 proactive calls to the participant to help them successfully quit tobacco use, plus ad hoc calls at the participant's initiation; also, WTQL coaches encouraged participants to see their health care provider to obtain Medicaid-approved smoking cessation medications to help them quit smoking.
Experimental: Incentive; Counseling from WTQL; Financial incentive to participate	Behavioral: Counseling from WTQL; Counseling from the Wisconsin Tobacco Quit Line (WTQL) consisted of 5 proactive calls to the participant to help them successfully quit tobacco use, plus ad hoc calls at the participant's initiation; also, WTQL coaches encouraged participants to see their health care provider to obtain Medicaid-approved smoking cessation medications to help them quit smoking.; Other: Financial incentive to participate; Participants in the Incentive condition received $30 per call for up to five WTQL calls taken; in addition, Incentive condition participants received $40 for producing biochemical evidence of abstinence at the 6-month follow-up visit. (Note that participants in both the Control condition and the Incentive condition received $40 for completing the baseline biochemical smoking status assessment visit and $40 for completing the 6-month follow-up biochemical smoking status assessment visit.) Compensation was in the form of prepaid Visa gift cards mailed approximately 2-4 weeks after the point of contact.

Outcome Measures

Primary Outcome Measures :

1. Abstinence From Smoking [ Time Frame: Measured 6 months after enrollment at follow-up assessment ]
   The primary outcome data will be the biochemically confirmed abstinence using urine (measured cotinine) or exhaled (breath) carbon monoxide (CO).

Secondary Outcome Measures :

1. Engagement in Treatment [ Time Frame: Measured 6 months after enrollment at follow-up assessment ]
   This analysis will compare number of calls completed
2. Cost-effectiveness [ Time Frame: Measured 6 months after enrollment ]
   This analysis will quantify the costs of treatment for Control and Incentive conditions with regard to attaining 6-month abstinence. Project costs were allocated to three categories: 1) Service costs, including billed staff time for counseling and testing, as well as all incidentals connected with services; 2) Incentives and distribution costs; and 3) Service-related administrative costs, including promotion/marketing and staff time for administering the intervention. Costs of planning the project, grant administration, and research within the project are not included in the analysis.The outcome is the cost per quit in each treatment group. Cost per quit in each group was calculated by: 1) computing the grand total of costs for all participants in a given group; and 2) dividing the grand total for a given group by the number of successful quitters. As such, the cost per quit is a single value with no measure of dispersion.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 99 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

• enrollment in Wisconsin Medicaid (BadgerCare Plus)
• resides in study area (one of 25 counties)
• 18 or older
• English or Spanish speaking
• has smoked daily (at least 5 cigarettes each day) over the last week
• willingness to attend visits at his/her PCC (primary care clinic) or go to a testing site at baseline and 6 months (2 times over a 6 month period), provide urine samples or participate in exhaled carbon monoxide testing, and complete follow-up phone calls from the WTQL
• willingness to inform the WTQL as to any change in address, phone number, clinic attended, or health plan.

Exclusion Criteria:

• not enrolled in Wisconsin Medicaid (BadgerCare Plus)
• not reside in study area
• less than 18 years of age
• not English or Spanish speaking
• does not smoke daily (at least 5 cigarettes each day) over the last week
• not willing to attend visits at his/her PCC (primary care clinic) or alternative testing site at baseline and 6 months (2 times over a 6 month period), provide urine or exhaled carbon monoxide samples, and complete follow-up phone calls.
• not willing to inform the WTQL as to any change in address, phone number, clinic attended, or health plan.

Contacts and Locations

Sponsors and Collaborators

University of Wisconsin, Madison

Investigators

• Principal Investigator: Timothy b Baker, PhD; University of Wisconsin--CTRI

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Fraser DL, Fiore MC, Kobinsky K, Adsit R, Smith SS, Johnson ML, Baker TB. A Randomized Trial of Incentives for Smoking Treatment in Medicaid Members. Am J Prev Med. 2017 Dec;53(6):754-763. doi: 10.1016/j.amepre.2017.08.027. Epub 2017 Nov 2.

• Responsible Party: University of Wisconsin, Madison
• ClinicalTrials.gov Identifier: NCT02713594
• Other Study ID Numbers: 2013-0056 (400025710)
• First Posted: March 18, 2016
• Results First Posted: April 21, 2017
• Last Update Posted: April 21, 2017
• Last Verified: April 2017

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

Additional relevant MeSH terms:

Tobacco Use Disorder; Substance-Related Disorders; Chemically-Induced Disorders; Mental Disorders