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Using Adherence-Contingent Rebates on Chronic Disease Treatment Costs to Promote Medication Adherence: Results from a Randomized Controlled Trial

Author

Listed:
  • Marcel Bilger

    (Health Economics and Policy, Vienna University of Business and Economics
    Duke-NUS Medical School)

  • Tina T. Wong

    (Singapore National Eye Centre, Singapore Eye Research Institute)

  • Jia Yi Lee

    (Singapore National Eye Centre, Singapore Eye Research Institute)

  • Kaye L. Howard

    (Duke-NUS Medical School)

  • Filipinas G. Bundoc

    (Duke-NUS Medical School)

  • Ecosse L. Lamoureux

    (Duke-NUS Medical School
    Singapore National Eye Centre, Singapore Eye Research Institute)

  • Eric A. Finkelstein

    (Duke-NUS Medical School
    Duke University)

Abstract

Background Poor adherence to medications is a global public health concern with substantial health and cost implications, especially for chronic conditions. In the USA, poor adherence is estimated to cause 125,000 deaths and cost $US100 billion annually. The most successful adherence-promoting strategies that have been identified so far have moderate effect, are relatively costly, and raise availability, feasibility, and/or scalability issues. Objective The main objective of SIGMA (Study on Incentives for Glaucoma Medication Adherence) was to measure the effectiveness on medication adherence of a novel incentive strategy based on behavioral economics that we refer to as adherence-contingent rebates. These rebates offered patients a near-term benefit while leveraging loss aversion and regret and increasing the salience of adherence. Methods SIGMA is a 6-month randomized, controlled, open-label, single-center superiority trial with two parallel arms. A total of 100 non-adherent glaucoma patients from the Singapore National Eye Centre were randomized into intervention (adherence-contingent rebates) and usual care (no rebates) arms in a 1:1 ratio. The primary outcome was the mean change from baseline in percentage of adherent days at Month 6. The trial registration number is NCT02271269 and a detailed study protocol has been published elsewhere. Findings We found that participants who were offered adherence-contingent rebates were adherent to all their medications on 73.1% of the days after 6 months, which is 12.2 percentage points (p = 0.027) higher than in those not receiving the rebates after controlling for baseline differences. This better behavioral outcome was achieved by rebates averaging 8.07 Singapore dollars ($US5.94 as of 2 November 2017) per month during the intervention period. Conclusion This study shows that simultaneously leveraging several insights from behavioral economics can significantly improve medication adherence rates. The relatively low cost of the rebates and significant health and cost implications of medication non-adherence suggest that this strategy has the potential to cost-effectively improve health outcomes for many conditions.

Suggested Citation

  • Marcel Bilger & Tina T. Wong & Jia Yi Lee & Kaye L. Howard & Filipinas G. Bundoc & Ecosse L. Lamoureux & Eric A. Finkelstein, 2019. "Using Adherence-Contingent Rebates on Chronic Disease Treatment Costs to Promote Medication Adherence: Results from a Randomized Controlled Trial," Applied Health Economics and Health Policy, Springer, vol. 17(6), pages 841-855, December.
  • Handle: RePEc:spr:aphecp:v:17:y:2019:i:6:d:10.1007_s40258-019-00497-0
    DOI: 10.1007/s40258-019-00497-0
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    Cited by:

    1. Rafael CorrĂȘa & Matheus Britto Froner & Benjamin Miranda Tabak, 2024. "Assessing the Impact of Behavioral Sciences Interventions on Chronic Disease Prevention and Management: A Systematic Review of Randomized Controlled Trials," IJERPH, MDPI, vol. 21(7), pages 1-9, June.
    2. Marcel Bilger & Mitesh Shah & Ngiap Chuan Tan & Cynthia Y. L. Tan & Filipinas G. Bundoc & Joann Bairavi & Eric A. Finkelstein, 2021. "Process- and Outcome-Based Financial Incentives to Improve Self-Management and Glycemic Control in People with Type 2 Diabetes in Singapore: A Randomized Controlled Trial," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 14(5), pages 555-567, September.
    3. Dalia Littman & Scott E. Sherman & Andrea B. Troxel & Elizabeth R. Stevens, 2022. "Behavioral Economics and Tobacco Control: Current Practices and Future Opportunities," IJERPH, MDPI, vol. 19(13), pages 1-10, July.

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