Financial Reinforcers for Improving Medication Adherence: Findings from a Meta-analysis

Abstract

Background Financial reinforcement interventions based on behavioral economic principles are being increasingly applied in health care settings, and this study examined the use of financial reinforcers for enhancing adherence to medications. Methods Electronic databases and bibliographies of relevant references were searched, and a meta-analysis of identified trials was conducted. The variability in effect size and the impact of potential moderators (study design, duration of intervention, magnitude of reinforcement, and frequency of reinforcement) on effect size were examined. Results Fifteen randomized studies and 6 non-randomized studies examined the efficacy of financial reinforcement interventions for medication adherence. Financial reinforcers were applied for adherence to medications for tuberculosis, substance abuse, HIV, hepatitis, schizophrenia, and stroke prevention. Reinforcement interventions significantly improved adherence relative to control conditions with an overall effect size of 0.77 (95% CI = 0.70–0.84), p < .001. Non-randomized studies had a larger average effect size than randomized studies, but the effect size of randomized studies remained significant at 0.44 (95% CI = 0.35–0.53), p < .001. Interventions that were longer in duration, provided average reinforcement of ≥$50/week, and reinforced patients at least weekly resulted in larger effect sizes than those that were shorter, provided lower reinforcers, and reinforced patients less frequently. Conclusions These results demonstrate the efficacy of medication adherence interventions and underscore principles that should be considered in designing future adherence interventions. Importantly, financial reinforcement interventions hold potential for improving medication adherence and may lead to benefits for both patients and society.

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