Prescription Adherence Study Pays Cash for Compliance

Researchers are investigating the benefits of a new approach to adherence that includes cash incentives for patients who take their medications faithfully.

An article published in this week’s New York Times features a novel approach many health care providers are considering to combat the costs of nonadherence: paying patients—in cash—for taking their medicine.

“The idea, which is being embraced by doctors, pharmacy companies, insurers, and researchers, is that paying modest financial incentives up front can save much larger costs of hospitalization,” wrote NYT reporter Pam Belluck.

She cites a 2008 study involving volunteers from the University of Pennsylvania Anticoagulation Management Center. Researchers found that lottery-based system of financial rewards improved adherence and clinical outcomes among patients who had been taking warfarin for at least 3 months.

“While there is controversy about whether such payments to patients should be used, the degree of improvement observed in non-adherence rates in this pilot is striking,” the study’s authors wrote in an analysis of the report.

If they took their medications as directed, patients were entered into a daily lottery with a chance of winning either $10 or $100. To determine the optimal rate of return, researchers divided the volunteers into 2 treatment groups: pilot 1, with a 1 in 5 chance of winning $10; and pilot 2, with a 1 in 10 chance of winning $10. Both groups had a 1 in 100 chance of winning $100.

Adherence was monitored using a pill compartment called the InforMedix Med-eXpert ™ System, which transmitted data by telephone to a central database manned by a study administrator. Researchers gauged success using 2 factors: the proportion of incorrect warfarin doses and the proportion of international normalized ratio measurements (INRs) that were out of the therapeutic range.

In pilot 1, the percent of out-of-range INRs decreased by almost two thirds, from 35.0% to 12.2%. Following the intervention, out-of-range INRs increased to 42%. The proportion of incorrect doses was 2.3% during the intervention, down from a historic mean of 22% among the clinic population studied. In pilot 2, out-of-range INRs decreased from 65.0% to 40.4%, and incorrect doses decreased to 1.6%.

The results suggest a lottery system with small payouts could be a cost-effective solution to improve adherence on a long-term basis, the researchers concluded.

“Behavioral economics literature finds that even highly motivated individuals often have difficulty in making decisions in the short term that favor their long-term interests,” they wrote. “A lottery can be thought of as a way to help patients internalize these long-term benefits.”

For other articles in this issue, see:

• Pharmacies Helping Fans at the World Cup
• Lawmakers Caught in Medical Marijuana Tug-of-War
• 20% of Teens Seek "Safe High" from Rx Drugs