A recent study titled “Financial Incentives for Completion of Fecal Occult Blood Tests among Veterans: A 2-Stage Pragmatic Cluster Randomized, Controlled Trial”, published in the journal Annals of Internal Medicine, showed that in order for patients to comply with fecal occult blood tests (FOBTs), financial incentives could be a solution.
The randomized, 2-stage, controlled clinical study conducted by researchers at the VA Ann Arbor Healthcare System and University of Michigan took place at the primary care clinic of the Philadelphia Veterans Affairs Medical Center, and demonstrated that if patients were told they had a 1 in 10 chance of winning $50, the probability of completing a home stool blood test was higher.
“Our study is another example of how modest financial incentives may go a long way in improving health behaviors and health care quality,” lead author Jeffrey Kullgren, M.D., M.S. M.P.H., a research scientist in the VA Ann Arbor Healthcare System, said in a press release.
The team followed 1,549 patients who were prescribed an FOBT in two distinct study stages. In the first stage, patients were either randomly assigned to usual care or to a receipt of 5, $10, or $20 for FOBT completion. In the second stage, patients were randomly assigned to usual care or to a receipt of $5, a 1 in 10 chance of $50, or entry into a $500 raffle for FOBT completion.
The results indicated that the $50 lottery had the biggest impact, increasing the completion rate by 20%.
“Integrating a small lottery incentive into usual care is a low cost tool with potential to promote patients’ use of a service proven to saves lives by catching cancer early”, added Dr. Kullgren in the press release.
FOBT consists of a home kit, where patients can collect a sample of their bowel movement and send it to a laboratory. This test can help to detect unnoticed small blood in stool that could be an indication of polyp formation or actual cancer in the colon. Of all the tests, it is the cheapest method for colon cancer screening, and patients who are older than 50 years of age are recommended to do it once a year. However, statistics point that only one-third of patients prescribed actually complete the exam.
“Fecal occult blood tests are inexpensive and an effective way to find colon cancer early and save lives. It’s up to the patient, however, to do this test at home and unfortunately completion rates are low,” added Dr. Kullgren. “Our work supports growing evidence that low cost innovations may be under-utilized in health care. We need to explore more ways to identify how, when and where financial incentives can improve prevention of chronic disease,” he concluded.
