Original ArticleAlimentary TractEffect of Behavioral Economic Incentives for Colorectal Cancer Screening in a Randomized Trial
Section snippets
Study Design
This was a 2-arm pragmatic randomized controlled trial comparing the following interventions: (1) a web-based risk assessment for CRC screening and direct access colonoscopy scheduling for eligible participants (control) or (2) the control approach along with a $10 loss-framed incentive to complete risk assessment and additional $25 unconditional incentive for colonoscopy completion (incentive). Approval for this study was obtained from the University of Pennsylvania Institutional Review Board.
Patient Characteristics
A total of 2276 potentially eligible employees were initially identified; 2000 were randomly selected for inclusion in the study and then randomly assigned to 2 study arms (Supplementary Figure 1). Twenty-three potential participants had undeliverable emails. Among the 1977 participants included in the analysis, 70.0% were women, and median income was $73,231 (interquartile range, $47,287–$94,920) (Table 1). The intervention was conducted from May to August 2017, when 3-month follow-up was
Discussion
In this study, we find that the loss-framed financial incentives increased CRC risk assessment completion, but the financial incentives did not result in a greater completion of screening colonoscopy.
Many employers use health risk assessments to gauge health behaviors, and financial incentives have increased participation.10,20 Our results confirm those findings: the loss-framed incentive increased response to the risk assessment questionnaire. The high response rate of 19.5% in the control arm
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Conflicts of Interest These authors disclose the following: David A. Asch and Kevin G. Volpp are principals at the behavioral economics consulting firm VAL Health. Kevin G. Volpp has received consulting income from CVS Caremark and research funding from Humana, CVS Caremark, Discovery (South Africa), Hawaii Medical Services Association, Oscar, and Weight Watchers. The remaining authors disclose no conflicts.
Funding This trial was supported in part by Grant No. UL1TR001878 from the National Center for Advancing Translational Science; the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania; and Grant No. K08CA234326 from the National Cancer Institute of the National Institutes of Health (to Shivan J. Mehta). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Science or the National Institutes of Health. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.