Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial

Judah, Gaby, Darzi, Ara, Vlaev, Ivo, Gunn, Laura, King, Derek ORCID: 0000-0002-2408-4558, King, Dominic, Valabhji, Jonathan and Bicknell, Colin (2018) Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial. British Journal of Ophthalmology, 102 (8). ISSN 0007-1161

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Abstract

Objective Conflicting evidence exists regarding the impact of financial incentives on encouraging attendance at medical screening appointments. The primary aim was to determine whether financial incentives increase attendance at diabetic eye screening in persistent non-attenders. Methods and analysis A three-armed randomised controlled trial was conducted in London in 2015. 1051 participants aged over 16 years, who had not attended eye screening appointments for 2 years or more, were randomised (1.4:1:1 randomisation ratio) to receive the usual invitation letter (control), an offer of £10 cash for attending screening (fixed incentive) or a 1 in 100 chance of winning £1000 (lottery incentive) if they attend. The primary outcome was the proportion of invitees attending screening, and a comparative analysis was performed to assess group differences. Pairwise comparisons of attendance rates were performed, using a conservative Bonferroni correction for independent comparisons. Results 34/435 (7.8%) of control, 17/312 (5.5%) of fixed incentive and 10/304 (3.3%) of lottery incentive groups attended. Participants who received any incentive were significantly less likely to attend their appointment compared with controls (risk ratio (RR)=0.56; 95% CI 0.34 to 0.92). Those in the probabilistic incentive group (RR=0.42; 95% CI 0.18 to 0.98), but not the fixed incentive group (RR=1.66; 95% CI 0.65 to 4.21), were significantly less likely to attend than those in the control group. Conclusion Financial incentives, particularly lottery-based incentives, attract fewer patients to diabetic eye screening than standard invites in this population. Financial incentives should not be used to promote screening unless tested in context, as they may negatively affect attendance rates.

Item Type:	Article
Official URL:	http://bjo.bmj.com/
Additional Information:	© 2018 The Authors
Divisions:	Care Policy and Evaluation Centre
Subjects:	R Medicine > RE Ophthalmology
Date Deposited:	19 Jun 2018 15:44
Last Modified:	19 Oct 2024 21:42
Projects:	12/64/112
Funders:	National Institute for Health Research
URI:	http://eprints.lse.ac.uk/id/eprint/88380

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