Rady School of Management, University of California San Diego, La Jolla, California.
University of Texas Southwestern Medical Center, Moncrief Cancer Institute, Fort Worth, Texas.
Cancer Epidemiol Biomarkers Prev. 2019 Nov;28(11):1902-1908. doi: 10.1158/1055-9965.EPI-19-0039. Epub 2019 Aug 6.
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.
Patients, ages 50 to 64 years, not up-to-date with screening were randomized to receive either a mailed FIT outreach ( = 6,565), outreach plus $5 ( = 1,000), or $10 ( = 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.
Year 1 FIT completion was 36.9% with incentives versus 36.2% outreach alone ( = 0.59) and was not statistically different for $10 (34.6%; = 0.31) or $5 (39.2%; = 0.070) versus outreach alone. Year 2 completion was 61.6% with incentives versus 60.8% outreach alone ( = 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 ( = 0.080), and was higher for $10 (82.4%) versus outreach alone ( = 0.033), but not for $5 versus outreach alone. Completion was similar across conditions in year 4 (no incentives).
Offering small incentives did not increase FIT completion relative to standard outreach.
This was the first longitudinal study testing the impact of repeated financial incentives, and their withdrawal, on FIT completion.
经济激励可能改善健康行为。我们测试了提供经济激励以促进邮寄粪便免疫化学测试（FIT）完成的效果，连续 3 年每年提供一次。
年龄在 50 至 64 岁之间、未及时进行筛查的患者被随机分配到接受邮寄 FIT 外展（=6565）、外展加 5 美元（=1000）或 10 美元（=1000）激励以完成测试。完成测试的患者在次年使用相同的激励措施再次受邀，为期 3 年。在第 4 年，在前 3 年返回试剂盒的患者没有激励措施再次受邀。主要结果是每年提供任何激励措施的患者与单独外展相比完成 FIT 的情况。次要结果是与单独外展相比，提供 5 美元、10 美元的组完成 FIT 的情况，以及提供 5 美元与 10 美元的组完成 FIT 的情况。
第 1 年的 FIT 完成率为 36.9%，有激励措施的患者与单独外展的患者相比（=0.59），差异无统计学意义，而 10 美元（34.6%；=0.31）或 5 美元（39.2%；=0.070）与单独外展的患者相比，差异也无统计学意义。第 2 年的完成率为 61.6%，有激励措施的患者与单独外展的患者相比（=0.75），差异也无统计学意义，而 10 美元或 5 美元与单独外展的患者相比，差异也无统计学意义。第 3 年的完成率为 79.4%，有激励措施的患者与单独外展的患者相比（=0.080），差异有统计学意义，而 10 美元（82.4%）与单独外展的患者相比（=0.033），差异有统计学意义，但 5 美元与单独外展的患者相比，差异无统计学意义。第 4 年（无激励措施）各条件下的完成情况相似。
与标准外展相比，提供小额激励并不能提高 FIT 完成率。
这是第一项测试重复经济激励及其撤销对 FIT 完成影响的纵向研究。
