利用推动理论和全额补贴提高日本工作场所的肝炎病毒筛查率。

Increasing hepatitis virus screening uptake at worksites in Japan using nudge theory and full subsidies.

机构信息

Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Shinanomachi, Tokyo, 160-8582, Japan.

Hepatitis Information Center, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Chiba, 272-8516, Japan.

出版信息

Environ Health Prev Med. 2021 Feb 1;26(1):18. doi: 10.1186/s12199-021-00940-6.

DOI:10.1186/s12199-021-00940-6

PMID:33522902

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7849075/

Abstract

BACKGROUND

Despite the importance of hepatitis screening for decreasing liver cancer mortality, screening rates remain low in Japan. Previous studies show that full subsidies increase screening uptake, but full subsidies are costly and difficult to implement in low-resource settings. Alternatively, applying nudge theory to the message design could increase screening at lower costs. This study examined the effects of both methods in increasing hepatitis virus screening rates at worksites.

METHODS

1496 employees from a Japanese transportation company received client reminders for an optional hepatitis virus screening before their general health checkups. Groups A and B received a client reminder designed based on the principles of "Easy" and "Attractive," while the control group received a client reminder not developed using nudge theory. Additionally, hepatitis virus screening was offered to the control group and group A for a co-payment of JPY 612, but was fully subsidized for group B. The hepatitis virus screening rates among the groups were compared using a Chi-square test with Bonferroni correction, and the risk ratios of group A and group B to the control group were also calculated. To adjust for unobservable heterogeneity per cluster, the regression analysis was performed using generalized linear mixed models.

RESULTS

The screening rate was 21.2%, 37.1%, and 86.3% for the control group, group A, and group B, respectively. And the risk ratio for group A was 1.75 (95% confidence interval [CI] 1.45-2.12) and that of group B was 4.08 (95% CI 3.44-4.83). The parameters of group A and group B also were significant when estimated using generalized linear mixed models. However, the cost-effectiveness (incremental cost-effectiveness ratio (ICER)) of the nudge-based reminder with the full subsidies was lower than that of only the nudge-based reminder.

CONCLUSIONS

While fully subsidized screening led to the highest hepatitis screening rates, modifying client reminders using nudge theory significantly increased hepatitis screening uptake at lower costs per person.

摘要

背景

尽管乙型肝炎筛查对于降低肝癌死亡率至关重要，但在日本，筛查率仍然很低。先前的研究表明，全额补贴可以提高筛查率，但全额补贴成本高昂，在资源匮乏的环境中难以实施。另一种方法是通过信息设计应用助推理论，以较低的成本提高筛查率。本研究旨在考察这两种方法在提高工作场所乙型肝炎病毒筛查率方面的效果。

方法

一家日本运输公司的 1496 名员工在接受常规健康检查前收到了乙型肝炎病毒筛查的客户提醒。A 组和 B 组收到了基于“简单”和“吸引人”原则设计的客户提醒，而对照组则收到了未使用助推理论设计的客户提醒。此外，对照组和 A 组可缴纳 612 日元的共同支付费用进行乙型肝炎病毒筛查，但 B 组则全额补贴。采用 Bonferroni 校正的卡方检验比较各组的乙型肝炎病毒筛查率，计算 A 组和 B 组相对于对照组的风险比。为了调整每个群组的不可观测异质性，采用广义线性混合模型进行回归分析。

结果

对照组、A 组和 B 组的筛查率分别为 21.2%、37.1%和 86.3%。A 组的风险比为 1.75（95%置信区间[CI] 1.45-2.12），B 组的风险比为 4.08（95%CI 3.44-4.83）。使用广义线性混合模型估计时，A 组和 B 组的参数也具有统计学意义。然而，基于助推理论的提醒并全额补贴的成本效益（增量成本效益比[ICER]）低于仅基于助推理论的提醒。