Financial incentives to promote colorectal cancer screening: A longitudinal randomized control trial

Alicea Lieberman, Ayelet Gneezy, Emily Berry, Stacie Miller, Mark Koch, Chul Ahn, Bijal A. Balasubramanian, Keith E. Argenbright, Samir Gupta

Research output: Contribution to journalArticle

Abstract

Background: Financial incentives may improve health behaviors. We tested the impact of offering financial incentives for mailed fecal immunochemical test (FIT) completion annually for 3 years. Methods: Patients, ages 50 to 64 years, not up-to-date with screening were randomized to receive either a mailed FIT outreach (n ¼ 6,565), outreach plus $5 (n ¼ 1,000), or $10 (n ¼ 1,000) incentive for completion. Patients who completed the test were reinvited using the same incentive the following year, for 3 years. In year 4, patients who returned the kit in all preceding 3 years were reinvited without incentives. Primary outcome was FIT completion among patients offered any incentive versus outreach alone each year. Secondary outcomes were FIT completion for groups offered $5 versus outreach alone, $10 versus outreach alone, and $5 versus $10. Results: Year 1 FIT completion was 36.9% with incentives versus 36.2% outreach alone (P ¼ 0.59) and was not statistically different for $10 (34.6%; P ¼ 0.31) or $5 (39.2%; P ¼ 0.070) versus outreach alone. Year 2 completion was 61.6% with incentives versus 60.8% outreach alone (P ¼ 0.75) and not statistically different for $10 or $5 versus outreach alone. Year 3 completion was 79.4% with incentives versus 74.8% outreach alone (P ¼ 0.080), and was higher for $10 (82.4%) versus outreach alone (P ¼ 0.033), but not for $5 versus outreach alone. Completion was similar across conditions in year 4 (no incentives). Conclusions: Offering small incentives did not increase FIT completion relative to standard outreach. Impact: This was the first longitudinal study testing the impact of repeated financial incentives, and their withdrawal, on FIT completion.

Original languageEnglish (US)
Pages (from-to)1902-1908
Number of pages7
JournalCancer Epidemiology Biomarkers and Prevention
Volume28
Issue number11
DOIs
StatePublished - Jan 1 2019

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Early Detection of Cancer
Motivation
Colorectal Neoplasms
Health Behavior
Longitudinal Studies

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

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Financial incentives to promote colorectal cancer screening : A longitudinal randomized control trial. / Lieberman, Alicea; Gneezy, Ayelet; Berry, Emily; Miller, Stacie; Koch, Mark; Ahn, Chul; Balasubramanian, Bijal A.; Argenbright, Keith E.; Gupta, Samir.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 28, No. 11, 01.01.2019, p. 1902-1908.

Research output: Contribution to journalArticle

Lieberman, Alicea ; Gneezy, Ayelet ; Berry, Emily ; Miller, Stacie ; Koch, Mark ; Ahn, Chul ; Balasubramanian, Bijal A. ; Argenbright, Keith E. ; Gupta, Samir. / Financial incentives to promote colorectal cancer screening : A longitudinal randomized control trial. In: Cancer Epidemiology Biomarkers and Prevention. 2019 ; Vol. 28, No. 11. pp. 1902-1908.
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abstract = "Background: Financial incentives may improve health behaviors. We tested the impact of offering financial incentives for mailed fecal immunochemical test (FIT) completion annually for 3 years. Methods: Patients, ages 50 to 64 years, not up-to-date with screening were randomized to receive either a mailed FIT outreach (n ¼ 6,565), outreach plus $5 (n ¼ 1,000), or $10 (n ¼ 1,000) incentive for completion. Patients who completed the test were reinvited using the same incentive the following year, for 3 years. In year 4, patients who returned the kit in all preceding 3 years were reinvited without incentives. Primary outcome was FIT completion among patients offered any incentive versus outreach alone each year. Secondary outcomes were FIT completion for groups offered $5 versus outreach alone, $10 versus outreach alone, and $5 versus $10. Results: Year 1 FIT completion was 36.9{\%} with incentives versus 36.2{\%} outreach alone (P ¼ 0.59) and was not statistically different for $10 (34.6{\%}; P ¼ 0.31) or $5 (39.2{\%}; P ¼ 0.070) versus outreach alone. Year 2 completion was 61.6{\%} with incentives versus 60.8{\%} outreach alone (P ¼ 0.75) and not statistically different for $10 or $5 versus outreach alone. Year 3 completion was 79.4{\%} with incentives versus 74.8{\%} outreach alone (P ¼ 0.080), and was higher for $10 (82.4{\%}) versus outreach alone (P ¼ 0.033), but not for $5 versus outreach alone. Completion was similar across conditions in year 4 (no incentives). Conclusions: Offering small incentives did not increase FIT completion relative to standard outreach. Impact: This was the first longitudinal study testing the impact of repeated financial incentives, and their withdrawal, on FIT completion.",
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T1 - Financial incentives to promote colorectal cancer screening

T2 - A longitudinal randomized control trial

AU - Lieberman, Alicea

AU - Gneezy, Ayelet

AU - Berry, Emily

AU - Miller, Stacie

AU - Koch, Mark

AU - Ahn, Chul

AU - Balasubramanian, Bijal A.

AU - Argenbright, Keith E.

AU - Gupta, Samir

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Financial incentives may improve health behaviors. We tested the impact of offering financial incentives for mailed fecal immunochemical test (FIT) completion annually for 3 years. Methods: Patients, ages 50 to 64 years, not up-to-date with screening were randomized to receive either a mailed FIT outreach (n ¼ 6,565), outreach plus $5 (n ¼ 1,000), or $10 (n ¼ 1,000) incentive for completion. Patients who completed the test were reinvited using the same incentive the following year, for 3 years. In year 4, patients who returned the kit in all preceding 3 years were reinvited without incentives. Primary outcome was FIT completion among patients offered any incentive versus outreach alone each year. Secondary outcomes were FIT completion for groups offered $5 versus outreach alone, $10 versus outreach alone, and $5 versus $10. Results: Year 1 FIT completion was 36.9% with incentives versus 36.2% outreach alone (P ¼ 0.59) and was not statistically different for $10 (34.6%; P ¼ 0.31) or $5 (39.2%; P ¼ 0.070) versus outreach alone. Year 2 completion was 61.6% with incentives versus 60.8% outreach alone (P ¼ 0.75) and not statistically different for $10 or $5 versus outreach alone. Year 3 completion was 79.4% with incentives versus 74.8% outreach alone (P ¼ 0.080), and was higher for $10 (82.4%) versus outreach alone (P ¼ 0.033), but not for $5 versus outreach alone. Completion was similar across conditions in year 4 (no incentives). Conclusions: Offering small incentives did not increase FIT completion relative to standard outreach. Impact: This was the first longitudinal study testing the impact of repeated financial incentives, and their withdrawal, on FIT completion.

AB - Background: Financial incentives may improve health behaviors. We tested the impact of offering financial incentives for mailed fecal immunochemical test (FIT) completion annually for 3 years. Methods: Patients, ages 50 to 64 years, not up-to-date with screening were randomized to receive either a mailed FIT outreach (n ¼ 6,565), outreach plus $5 (n ¼ 1,000), or $10 (n ¼ 1,000) incentive for completion. Patients who completed the test were reinvited using the same incentive the following year, for 3 years. In year 4, patients who returned the kit in all preceding 3 years were reinvited without incentives. Primary outcome was FIT completion among patients offered any incentive versus outreach alone each year. Secondary outcomes were FIT completion for groups offered $5 versus outreach alone, $10 versus outreach alone, and $5 versus $10. Results: Year 1 FIT completion was 36.9% with incentives versus 36.2% outreach alone (P ¼ 0.59) and was not statistically different for $10 (34.6%; P ¼ 0.31) or $5 (39.2%; P ¼ 0.070) versus outreach alone. Year 2 completion was 61.6% with incentives versus 60.8% outreach alone (P ¼ 0.75) and not statistically different for $10 or $5 versus outreach alone. Year 3 completion was 79.4% with incentives versus 74.8% outreach alone (P ¼ 0.080), and was higher for $10 (82.4%) versus outreach alone (P ¼ 0.033), but not for $5 versus outreach alone. Completion was similar across conditions in year 4 (no incentives). Conclusions: Offering small incentives did not increase FIT completion relative to standard outreach. Impact: This was the first longitudinal study testing the impact of repeated financial incentives, and their withdrawal, on FIT completion.

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