CRC screening: financial incentives fail to boost overall uptake

  • Green BB & al.
  • JAMA Netw Open
  • 3 Jul 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A $10 reward or entry into a lottery led to an increase in completion of mailed fecal immunochemical test (FIT) screening kits, but not overall colorectal cancer (CRC) screening.

Why this matters

  • Financial incentives could reduce the disparity of CRC screening among disadvantaged populations.

Study design

  • 838 individuals who were due for CRC screening but had no CRC history were randomly assigned to receive up to 3 standard mailings, 3 mailings with a guarantee of $10 cash upon screening completion, or 3 mailings with a lottery giving them a 1 in 10 chance to win $50.
  • Funding: National Cancer Institute.

Key results

  • Within 6 months, there was no significant difference in CRC screening completion rate among the 3 groups (monetary, 76.7%; lottery, 74.6%; mail only, 71.5%; P=.11).
  • For FIT completion, compared with mail only, there were significant increases in completion percentage in the monetary group (+7.7%; 95% CI, 0.3%-15.1%) and the lottery group (+7.1%; 95% CI, −0.2% to 14.3%; P=.04).
  • Among Medicaid patients, financial incentives (monetary+lottery combined) led to net increase in FIT completion of 37.7% (95% CI, 11.0%-64.3%) compared with 5.6% (95% CI, −0.9% to 12.2%) for other insurance types.

Limitations

  • Relied on mailed screening questionnaires.

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