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Money doesn’t talk for FIT incentive
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Results from a randomized clinical trial suggest that $10 is not enough to motivate people to return their fecal immunochemical tests for colorectal cancer screening.
Shivan J. Mehta, MD, MBA, MSHP, of the department of medicine at the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote that FIT completion remains low despite the success of tests mailed directly to patients.
“Mailing stool testing kits to patients’ homes can boost colorectal cancer screening rates and be complementary to existing clinic efforts that offer colonoscopy to patients,” Mehta told Healio Gastroenterology and Liver Disease. “Financial incentives informed by behavioral economic principles did not increase participation in screening.”
Researchers recruited 897 patients (median age 57 years; 56% women) who were eligible for CRC screening and at least two visits to their primary care clinician for their four-parallel-arm trial. They randomly assigned patients to receive a mailed FIT kit with either no additional incentive (n = 223), an unconditional $10 incentive (n = 224), $10 conditional on completion (n = 224) or a conditional lottery with a 1-in-10 chance of winning $100 (n = 226). They measured success of the different incentives based on FIT completion within 2 and 6 months of initial outreach.
The completion rate was 23.5% across all arms of the study. After two months, the completion rate was 26% (95% CI, 20.4%–32.3%) in the no incentive arm, 27.2% (95% CI, 21.5%–33.6%) in the unconditional incentive arm, 23.2% (95% CI, 17.9%–29.3%) in the conditional incentive arm, and 17.7% (95% CI, 13.0%–23.3%) in the lottery incentive arm. None of the three groups with a financial incentive were statistically superior to the arm without an incentive.
After 6 months, researchers found that the completion rate was 32.7% (95% CI, 26.6%–39.3%) in the no incentive arm, 31.7% (95% CI, 25.7%–38.2%) in the unconditional incentive arm, 26.8% (95% CI, 21.1%–33.1%) in the conditional incentive arm, and 24.3% (95% CI, 18.9%–30.5%) in the lottery incentive arm.
Mehta and colleagues wrote that the incentive value might have been too small.
“This highlights that while financial incentives can be effective at health promotion, how they are designed can influence response,” Mehta said. “It is important to rigorously evaluate the effectiveness of health outreach interventions.” – by Alex Young
Disclosures: Mehta reports receiving grants from the Commonwealth of Pennsylvania and from the National Cancer Institute. Please see the full study for all other authors’ relevant financial disclosures.
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Mehta SJ, et al. JAMA Netw Open. 2019;doi:10.1001/jamanetworkopen.2019.1156.
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