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Financial incentives fail to improve colorectal cancer screening
Offering $5 or $10 as an incentive for responding to a mailed invitation to undergo a fecal immunochemical test had no effect on colorectal cancer screening rates, according to a study published in “The Negative Issue” of the American Journal of Gastroenterology, a special edition focusing on what physicians should not do in clinical practice.
“Recently, there has been a significant interest in utilizing principles of behavioral economics, such as offering financial incentives, to ‘nudge’ behavior change, including participation in cancer screening,” Samir Gupta, MD, MSCS, of the San Diego VA Healthcare System and University of California San Diego, and colleagues wrote. “Despite interest in these strategies, financial incentives have undergone limited study for promoting cancer screening and, to our knowledge, have not been tested rigorously in safety net health settings caring for low-income populations, where incentives might be hypothesized to be particularly effective.”
Samir Gupta
Aiming to find out if small financial incentives would increase CRC screening in such a population, Gupta and colleagues performed a randomized, comparative effectiveness trial involving 8,565 primary care patients at safety net health system in Fort Worth, Texas. Patients were aged between 50 and 64 years, and were not insured or up to date with CRC screening.
The investigators randomly assigned 6,565 of the patients to receive a mailed invitation to undergo FIT, 1,000 to receive an invitation plus a $5 incentive, and another 1,000 to receive an invitation plus a $10 incentive.
Overall, 36.9% of those with a financial incentive completed FIT screening within 1 year, compared with 36.2% of those without a financial incentive. There was also no significant difference in completion rates between the $10 (34.6%) and $5 groups (39.2%). Median time to completion was also comparable between groups, and completion rates were similar across age, sex, race and ethnicity, or neighborhood poverty rate.
The researchers concluded that small financial incentives do not increase FIT completion rates.
In light of these negative results, Jeffrey Adler, MD, of Dartmouth-Hitchcock Medical Center in New Hampshire, and Jason A. Dominitz, MD, MHS, of the VA Puget Sound Health Care System, University of Washington School of Medicine in Seattle, recommend investments in systematic screening approaches that include patient navigation.
“This is a valuable negative study,” they wrote in a related editorial. While small financial incentives did not increase CRC screening, “adherence in all arms was actually considerably higher than expected. ... This is a very interesting finding, and may be related to the fact that all participants received co-interventions beyond what is offered in many screening settings. This included a letter, two automated phone calls, and up to two live reminders in English or Spanish to complete the FIT.”
While investments in such strategies could be expensive, they added, it “should not be prohibitive because CRC screening is clearly cost-effective and may even be cost saving. In the long-term, comprehensive CRC screening programs (including patient navigation) may even pay for themselves, which is really the kind of financial incentive we could use in today’s healthcare environment.” – by Adam Leitenberger
Disclosures: The researchers and editorial authors report no relevant financial disclosures.