Active Choice and Financial Incentives to Increase Rates of Screening Colonoscopy–A Randomized Controlled Trial

Abstract

Behavioral economic approaches could increase uptake for colorectal cancer screening. We performed a randomized controlled trial of 2245 employees to determine whether an email containing a phone number for scheduling (control), an email with the active choice to opt in or opt out (active choice), or the active choice email plus a $100 incentive (financial incentive) increased colonoscopy completion within 3 months. Higher proportions of participants in the financial incentive group underwent screening (3.7%) than in the control (1.6%) or active choice groups (1.5%) (P=.01 and P <.01). We found no difference in uptake of screening between the active choice and control groups (P=.88). The $100 conditional incentive modestly but significantly increased colonoscopy use. ClinicalTrials.gov no: NCT02660671.

Colorectal Cancer Screening: Money Isn’t Everything . . . But It Helps!

“…12 Organizational and leadership alignment on our CRC screening goal has contributed to our ability to double CRC screening rates in the first 5 years of our program. 12 In this issue of Gastroenterology, Mehta et al 13 at the University of Pennsylvania performed a randomized trial among 2245 employees of their institution comparing an email outreach reminder for colonoscopy screening (control), with an email with active choice to opt in or opt out of screening (active choice), or an active choice email plus a $100 incentive (financial incentive). Colonoscopy completion was evaluated at 3 months.…”

“…There was with no difference between the active choice and control arms. 13 The literature on financial incentives in CRC screening has been mixed. Modest $5 or $10 incentives have not shown a significant effect on improving CRC screening rates, but a 1 in 10 chance of winning $50 increased participation by nearly 20%.…”

“…The authors argue that the $100 expense is within the range of what is paid for completing health risk assessments and biometric screening activities. 13 For an employer like the University of Pennsylvania, the expense of the colonoscopy incentive will be partially offset by the fees paid by the insurer for colonoscopy. Conversely, small businesses and organizations that are not fee-forservice providers may be less likely to spend an additional $100 for their employees to have a colonoscopy.…”

Parts greater than their sum: randomized controlled trial testing partitioned incentives to increase cancer screening

“…Patients were randomly allocated to one of two groups, according to the incentive offer in their invitation letters: either (1) a single €10 ($12) incentive upon completion of screening, or (2) two €5 ($6) incentives offered at the beginning and at the end of screening. The former is the standard method employed in previous research, with a single incentive, offered conditional with completing the health procedure, whereas the latter tests the hypothesis of partitioned incentives.…”

“…Screening rates ranged between 34% and 37%, with no statistical differences between the groups. Mehta et al . recently reported that a $100 incentive increased colonoscopy rates by only 2% ( n = 2245).…”