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Effect of Financial Incentives for Process, Outcomes, or Both on Cholesterol Level Change: A Randomized Clinical
Peter P Reese1,2,3,4,5, Iwan Barankay4,6, Mary Putt1,4
1Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Network Open
|October 4, 2021
Summary
Financial incentives targeting medication adherence or cholesterol levels did not significantly lower LDL-C in adults at high cardiovascular risk. This study found no added benefit from process-plus-outcomes incentives compared to control for improving cholesterol levels.
Area of Science:
- Cardiovascular disease prevention
- Behavioral economics in health
- Clinical trial methodology
Background:
- Financial incentives are explored to enhance health behaviors, but their effectiveness in targeting specific processes versus outcomes remains unclear.
- Understanding the impact of different incentive structures on low-density lipoprotein cholesterol (LDL-C) reduction is crucial for cardiovascular health.
Purpose of the Study:
- To compare the efficacy of financial incentives for medication adherence (process), LDL-C level reduction (outcomes), or both, against a control group in lowering LDL-C levels.
- To investigate if financial incentives influence key health behaviors and clinical outcomes in adults at high risk for atherosclerotic cardiovascular disease.
Main Methods:
- A randomized clinical trial involving 764 adults with elevated cardiovascular risk and suboptimal LDL-C levels was conducted over 12 months.
- Participants were assigned to receive daily incentives for adherence, quarterly incentives for LDL-C reduction, or a combination, alongside standard care.
- Adherence was monitored using smart pill bottles, and LDL-C levels were measured quarterly.
Main Results:
- All incentive groups showed reductions in LDL-C levels, but these were not statistically significantly greater than the control group.
- Mean LDL-C reductions ranged from -36.9 mg/dL in the control group to -42.8 mg/dL in the process plus outcomes group.
- Exploratory analyses found no significant impact on hemoglobin A1c or blood pressure in participants with diabetes and hypertension.
Conclusions:
- Financial incentives, whether targeting medication adherence, LDL-C outcomes, or both, did not demonstrate superior effectiveness in reducing LDL-C levels compared to standard care in this trial.
- The findings suggest that current financial incentive models may not be a potent strategy for improving LDL-C levels in this high-risk population.
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