Effect of Financial Incentives on Patient Use of Mailed Colorectal Cancer Screening Tests

Abstract

Key Points Question Can different forms of financial incentives (unconditional, conditional, or lottery) boost response rates to mailed colorectal cancer screening outreach? Findings In this randomized clinical trial of 897 patients, there was no statistically significant difference in screening response rates at 2 and 6 months between the incentive arms and mailed outreach without incentive. Meaning Different forms of financial incentives of the same expected value ($10) did not increase fecal immunochemical test completion rates, as the incentive value have been too small or financial incentives may not be effective in this context.

Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis

“…Tailored materials, such as culturally sensitive brochures or videos, and education, whether in person or in a group setting, also had positive outcomes, but not to the extent of patient navigation or free screening kits. Interestingly, Mehta and colleagues approached CRC screening uptake by providing financial incentives via 3 arms: unconditional, conditional, and lottery [ 81 ]. The unconditional arm was given a $10 gift card along with the FIT kit, while those in the conditional arm received the $10 gift card after completion of the FIT testing if within 2 months.…”

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

“…Yet, this would still allow for the possibility that once individuals decided to do the screening, they would finish it for reasons unrelated to monetary incentives. However, this reciprocity motive would also contradict evidence showing that noncontingent incentives underperform compared with contingent incentives in promoting compliance with health procedures . If noncontingent incentives elicited reciprocity to a significant extent, these would produce similar completion rates compared with contingent incentives.…”

“…There is consistent evidence that noncontingent (versus contingent) incentives are less effective in promoting healthcare compliance . In fact, Mehta et al . have shown that a single initial contingent $10 incentive did not increase colorectal cancer screening, by comparison with a control group.…”

“…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.…”

“…recently reported that a $100 incentive increased colonoscopy rates by only 2% ( n = 2245). Recently, Mehta et al . ( n = 897) also showed that neither a single initial contingent $10 incentive, nor a single final $10 incentive, increased colorectal screening rates, by comparison with a control group.…”