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Financial incentive increases colonoscopy screening
Adding a financial incentive of $100 to an offer of colonoscopy screening by email increased the screening rate by more than twofold in a randomized control trial.
“Colonoscopy is challenging for patients, requiring a day off from work, a bowel cleansing preparation, and transportation, in addition to non-financial costs of anxiety and discomfort,” Shivan J. Mehta, MD, assistant professor of medicine at the Perelman School of Medicine and associate chief innovation officer at Penn Medicine, said in a press release. “The improvement we saw in the rate of screening colonoscopies was statistically significant, and shows for the first time that a financial incentive can at least modestly boost that rate.”
To determine if a behavioral economics strategy called “active choice” with or without a financial incentive would increase participation in screening colonoscopy, Mehta and colleagues randomly sent 2,245 individuals aged 50 to 64 years one of three prompts. One group received an email requesting that they actively opt in or out of having a screening colonoscopy, another received the same email with a $100 cash incentive for having a colonoscopy within the next 3 months, and a third control group received an email with just a phone number for scheduling their colonoscopy.
A greater proportion of those who received a financial incentive chose to have a screening colonoscopy (3.7%) compared with both controls (1.6%; P = .01) and those who received an active choice email without a financial incentive (1.5%; P < .01).
“The additional 16 screened individuals in the financial incentive arm (as compared to control) cost $2,800 in incentives, which translates to an incremental cost of $175 each,” Mehta and colleagues wrote.
Further, those who received a financial incentive scheduled appointments more than twice as often (4.8%) as controls (2.1%) and those who received the active choice email without a financial incentive (2%), but the difference was not statistically significant.
Insurers and employers are increasingly using financial incentives to encourage healthy behaviors like weight loss, medication adherence and reducing cigarette smoking, but persuading people to undergo colorectal cancer screening has been more challenging, according to the press release. “For example, the Affordable Care Act of 2009 eliminated patient cost sharing for colonoscopies and other colorectal cancer screening procedures — up to a $500 value for some people — but did not lead to a wider adoption of these procedures,” the release said.
Mehta suggested that the financial incentive in this study may have been effective due to the large amount of cash offered and easy access to scheduling an appointment.
“Although a $100 incentive seems relatively large, this amount is comparable to what employers already offer for completion of health risk assessments or biometric screening activities,” he said in the press release. “Based on the results, the approach could be applied by employers or insurers to improve existing efforts to reduce the burden of colorectal cancer.” – by Adam Leitenberger
Disclosures: Two of the researchers report they are principals and owners of VAL Health, one of whom also reports he has served as a consultant for CVS Caremark and received grants from CVS Caremark, Hawaii Medical Services Association, Humana, Merck, Weight Watchers and Discovery (South Africa).