Mundt Crunches Cost Effectiveness Data for Tobacco Treatment

Dr. Marlon Mundt, PhD, MS, MA

UW Assistant Professor Dr. Marlon Mundt, health economist from the Department of Family Medicine and Community Health, is collaborating with UW-CTRI to evaluate the cost-effectiveness of financial incentives for Medicaid smokers to take Wisconsin Tobacco Quit Line calls. He has penned a new paper ready for submission on Striving to Quit for Medicaid recipients.

“The study results are very promising,” Mundt said, adding that low-income individuals who received modest financial incentives to engage with counselors to quit smoking in Striving to Quit were 57% more likely to quit smoking. That is, 22% of those in the financial incentive group quit smoking, whereas only 14% in the control group quit. Mundt estimated that an additional $2,349 in staff time, medication costs, and financial incentives is needed to gain one additional Medicaid recipient who abstains from smoking at six-month follow-up after the intervention.

“These results show that incentivizing engagement (as opposed to solely incentivizing smoking abstinence) is cost-effective,” Mundt said, “because we are incentivizing compliance to a tobacco-cessation treatment regimen. This increases the chance of success for more smokers.”

Mundt examined the return on investment for incentivizing that engagement. “Prior research shows that a 55-to-64 year-old who quits smoking can gain an additional four years in life expectancy, and a 35-44 year-old can expect an additional nine years of life. Furthermore, if smoking abstinence alleviates suffering from future smoking-related diseases for more smokers and eases associated economic costs ($289 billion annually in the US alone), the $2,350 you’re spending to get someone to quit has a great return on investment.”

Mundt said that, in the future, he’d like to explore:

  • How varying levels of incentives affect quit rates and cost effectiveness.
  • Which smoker groups are best to incentivize.
  • How incentives to engage with a counselor to quit might be staggered over time to increase quit rates.

In his other research, Mundt has conducted economic evaluation of physician’s behavioral counseling of primary care patients designed to reduce alcohol misuse. These analyses were instrumental in the U.S. Preventive Services Task Force (USPSTF) making a “B” grade recommendation that all adult primary care patients receive screening and behavioral counseling for problem alcohol use. Grade “B” indicates that USPSTF views the benefit from universal alcohol screening as moderate to substantial.