Way to Healthy Cholesterol:

Transcription

1 Way to Healthy Cholesterol: A Randomized Trial of Incentives for Habit Formation LDI Center For Health Incen1ves and Behavioral Economics SUMR Scholar: Shamarlon Yates Mentors: Kevin Volpp, MD, PhD and Dana GaEo, BS

2 Agenda Background Goal Significance Study Design My Role Findings Next Steps Acknowledgements

3 Background Cardiovascular Disease (CVD) Sta1ns lower low- density lipoproteins, CVD risk High non- adherence rates to sta1ns 50% of pa1ents stop taking sta1ns within one year

4 Statin Adherence Levels Source: Jackevicius CA, et al. JAMA 2002; 288(4):

5 Goal See how effec1ve behavioral economic techniques are at inducing habit forma1on for sta1n adherence both during the interven1on period and aaer financial incen1ves are discon1nued. Reduc1on in LDL levels at end of study (12 months) Sustained levels of sta1n adherence aaer incen1ves are ended aaer 6 months of interven1on

6 Significance CVD is the leading cause of death in U.S. 1.2 million Americans have new or recurring heart aeacks each year Diabetes is a risk factor for CVD $500 billion/per year in indirect and direct expenditures related to CVD Shaping las1ng habits in adherence Cost- effec1veness

7 Study Design

8 Vitality GlowCaps

9 Way to Health Portal

10 Behavioral Economics and Incentives Present- biased preferences: People are more responsive to frequent feedback and rewards, preferably daily If they won or would have won if they had been adherent Dispropor1onate weight placed on small probabili1es of large payoffs Frequent small payoffs and infrequent large payoffs Regret aversion regret as a mo1vator Pre- commitment or deposit contracts People are more sensi1ve to losses than gains

11 Study Arm 1: Control Daily reminders to take stain medica1ons. Text Voice GlowCaps track adherence

12 Study Arm 2: Standard Sweepstakes Same as control + daily sweepstakes 2 digit loeery number is chosen (e.g. 56) LoEery runs daily and par1cipant is only eligible if sta1n medica1on was taken on the previous day. $10 payout of matching 1 number $100 payout for matching 2 numbers

13 Study Arm 3: Habit Formation Sweepstakes Same as simple sweepstakes arm Par1cipants only receive half the incen1ves if they take sta1n medica1on aaer the reminder $5 payout of matching 1 number $50 payout for matching 2 numbers

14 Study Arm 4: Hybrid Sweepstakes Same as standard sweepstakes arm but par1cipants only win $5 for matching 1 number and $50 for matching 2. Par1cipants are seeded $45 at start of each month $1.50 deducted each day they are non- adherent Receive check at the end of each month for the balance

15 My Role Upkeep of study website Logging lab results for par1cipants Mailing out study materials Repor1ng on enrollment sta1s1cs for weekly study mee1ngs Coordina1ng and troubleshoo1ng with par1cipants

16 Latest Recruitment Numbers Home Depot 2085 leeers mailed 157 signed up (7.5%) 135 screened (6.5%) 102 eligible aaer screen (4.9%) 87 consented (4.2%) 77 completed baseline survey and send lab slips (3.7%) 50 lab result received (2.4%) 18 eligible and started in study (0.8%)

17 Home Depot Outreach Test Group #1: Standard LeEer/Standard Envelope

18 Home Depot Outreach Test Group #2: Standard LeEer/Oversized Envelope

19 Home Depot Outreach Test Group #3: Standard LeEer/USPS Priority Mail Envelope

20 Home Depot Outreach Test Group #4: Amazon LeEer/Amazon Envelope

21 Home Depot Outreach Results Le#ers Mailed Number Responded Response Rate Home Depot Outreach Results Standard Le#er Standard Envelope % Standard Le#er Oversized Envelope Standard Le#er Priority Mail Envelope Amazon Le#er Amazon Envelope % % % Total %

22 Other Findings No correla1on between MPR and direct LDL measurements Gelng prescrip1on from other sources Falsely low MPR E.g. Splilng 80mg tablet in half Healthier people are more mo1vated to sign up for study

23 Next Steps Expanding recruitment of diabe1c/cvd par1cipants taking sta1ns with LDL > 100 Partner with other CVS health plan members that have LDL data Penn Prac1ces (Primary Care, Endocrinology, Cardiology)

24 Special Thanks Dana GaEo, BS Kevin Volpp, MD, PhD Study Team Joanne Levy Safa Browne LDI CHIBE SUMR Scholars 14