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Financial incentives boosted HBV vaccination completion 12-fold among IDUs
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Injection drug users who were offered small financial incentives to complete the hepatitis B virus vaccination schedule were 12 times more likely to do so, according to new data published in The Lancet.
“That monetary incentives increase compliance is unremarkable, but the size of the increase we observed was striking,” John Strang, MBBS, FRCPsych, MD, of the National Addiction Centre at King’s College London, said in a press release. “[Injection] drug users are at high risk of infection and transmission of hepatitis B. This is a potentially life-saving vaccine, and increasing its uptake among this group has important benefits to public health, as well as to the individual.”
John Strang
In a cluster-randomized trial, 210 patients enrolled in 12 drug addiction treatment facilities in the United Kingdom were offered supermarket vouchers worth about $50.25 either in fixed or graduated installments, or they received zero incentives, for attending vaccination appointments on time and complying with the vaccination schedule over a 28-day period. The researchers compared completion rates for each group.
Nine percent of participants who received no financial incentive completed all three doses of the HBV vaccine within 28 days vs. 45% of those who received a fixed payment (OR=12.1; 95% CI, 3.7-39.9) and 49% who were paid in graduated installments that increased in value for each kept appointment (OR=14; 95% CI, 4.2-46.2).
In addition, at least 80% of participants who received cash incentives in one form or another attended their appointments on time vs. 50% to 65% of participants who received treatment as usual.
“Our research finds that offering financial incentives improves people’s completion of HBV vaccination and can be achieved in routine clinical practice,” Strang said. “However, even with these improvements, only about half of the participants completed the vaccination schedule in the contingency management groups: More work is needed to refine the reward and scheme to increase further the uptake and completion of vaccination.”
In a related editorial, A. Thomas McLellan, PhD, of the Treatment Research Institute in Philadelphia, wrote that incentivizing HBV vaccination is not much different than offering incentives to customers who are indecisive about purchasing a product.
“It might be lamentable to think of health care in this crass, commercial manner, but it could also be relevant to the ultimate goal of getting broad acceptance and use of cost-effective prevention initiatives,” he wrote. “Health care policymakers might be wise to consider traditional market forces when designing and delivering prevention strategies. The findings from Weaver and colleagues’ study suggest that contingent financial incentives might be as or more important in the disease prevention marketplace as they are in commercial markets.”
For more information:
McLellan T. Lancet. 2014;doi:10.1016/S0140-6736(14)60196-3 .
Weaver T. Lancet. 2014;doi:10.1016/S0140-6736(14)60196-3.
Disclosure: See the study for a full list of financial disclosures.