Addition of Financial Incentives to Mailed Outreach for Promoting Colorectal Cancer Screening

Abstract

Key Points Question Does adding financial incentives to mailed outreach and reminders increase the rate of colorectal cancer screening? Findings In this systematic review and meta-analysis of 8 randomized clinical trials with 110 644 participants, the addition of financial incentives to promotion interventions appeared to be associated with a modest benefit of increasing colorectal cancer screening completion compared with using no financial incentives. However, no clear benefit was observed in underserved populations with adverse social determinants of health. Meaning Monetary incentives may not substantially increase colorectal cancer screening rates in populations with a traditionally low rate of screening completion.

Financial incentives for vaccination do not have negative unintended consequences

“…Our findings are also important because worries about unintended consequences of payments reach well beyond vaccination 43 . Financial incentives intended to motivate healthy and prosocial behaviours have been considered in many contexts, for instance, to motivate blood 1 , 44 , 45 and organ donation 46 , to curtail smoking 3 , 4 , 47 , to encourage exercising and healthy eating 10 , 11 , 48 , to boost medication adherence 49 , to foster clinical trial participation 50 , 51 and to increase uptake of preventive measures, such as cancer screening 2 , 52 . Our findings and methods inform the large and long-standing academic literature discussing the potential negative consequences of financial incentives for behaviour change more generally.…”

Financial Incentives to Improve Colorectal Cancer Screening—Time to Cut Our Losses

“…Because the screening behavior of individuals aged 45 to 49 years is unknown, financial incentives may be explored to incentivize screening in this population. However, based on the mounting evidence on this topic as summarized by Facciorusso et al, 2 we would advise investigators to proceed with caution.…”

“…In their systematic review and meta-analysis of randomized clinical trials (RCTs), Facciorusso et al, evaluated the benefit of financial incentives for CRC screening uptake. This study included RCTs of adults who were eligible for CRC screening and received various financial incentives (fixed-amount or lottery-based incentives that were unconditional or conditional on screening completion) or no financial incentives (screening reminders or mailed outreach alone).…”

Examining the relationship between household wealth and colorectal cancer screening behaviors among U.S. men aged 45–75

“…However, our findings do align with published studies suggesting that money is not a key determinant of having completed a CRC screening exam ( Issaka & Dominitz, 2021 ; Levin, 2017 ). For example, offering a financial incentive to adults who are eligible for CRC screening has not been consistently found to increase screening uptake ( Facciorusso et al, 2021 ), although larger incentives (e.g., $100) that offset some of the costs associated with screening may help to some degree compared with smaller incentives (e.g., $5, $10; Mehta et al, 2017 ). Additionally, increasing insurance coverage for adults with lower incomes was estimated to increase CRC screening by 4%, yet their completion rates remained 10% lower than those of adults with higher incomes, suggesting that educational attainment, age, and current health status also drive income disparities in screening rates ( McMorrow et al, 2014 ).…”