Friday, September 12, 2008

MEDICINE: Aetna-Wharton To Test Paying Patients To Take Their Heart Meds

(previously published here at

Researchers at the University of Pennsylvania's Wharton School are studying whether daily lottery cash incentives of $10 and $100 will help improve the likelihood of patients' taking their prescribed medication.

The research will begin this fall and take place over a six-month period, with results being available in March of next year.

The Aetna Foundation, the non-profit arm of the national health insurer, is sponsoring the study with a $400,000 grant. Philadelphia is a designated community under the foundation's Healthy Community Grants Program and Healthy Community Outreach Program.

Dr. Kevin G. Volpp, director of the Center on Health Incentives at Wharton's Leonard Davis Institute for Health Economics, explained that since people often stop taking medication within a few days, potential health benefits cannot be realized.

"People find it difficult to do things long term [like taking medication] in the short term [on a daily basis]," Dr. Volpp said. "A lot of behavioral economic research shows that people tend to weigh the present more heavily as opposed to [a] future decision."

So he and colleagues designed a two-arm randomized trial based on a system of feedback and incentives and proposed it to Aetna. The trial would enroll 100 participants to test a daily lottery as incentive for taking Warfarin, a blood thinner prescribed to prevent swelling and blood clots.

An electronic monitor would connect to pill boxes, tracking whether each participant takes his or her medicine. Participants would receive daily text messages saying whether he or she has won the lottery, or, if the dose was missed, whether they would have won.

An incentive group of 50 people would have a 1-in-10 chance of winning $10 for every day they take their medication and a 1-in-100 chance of winning $100. A control group of 50 people would use the same electronic monitor but not be entered into the lottery.

According to Dr. Troyen A. Brennan, Aetna's Chief Medical Officer, they chose to sponsor the trial because adherence is key to quality of care and statistics show that a year after beginning medication, only about 50 percent of patients are taking medications as directed. "If it looks like it works, we'll try to incorporate it in things we do," he said.

For Dr. Volpp, the trial's co-founder, this is just one of many possibilities in using behavioral economic tools towards strengthening health applications.

"There is a synergy between health professionals who want people to adopt healthy behaviors and commercial interests who want to find ways to effectively make sure that people ... behave in healthy ways in higher rates," Dr. Volpp said. "I think there are big opportunities to try to think creatively about how to use incentive systems to try to help people adopt healthy behaviors at higher rates."

Heather J. Chin can be reached at

©The Evening Bulletin 2008

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