Researchers studied about 1,500 patients with blood cholesterol levels that put them at risk for heart disease and stroke to try to encourage them (via cash) to take their medicines – statins. Results were mixed, but the doctor-and-patient pairs who both received cash rewards showed the best results in lowering cholesterol levels. This story does an excellent job of explaining the study, providing great context on the underlying problems related to medication adherence, and quoting experts not involved in the study This is a lucid and well-rounded article on a very interesting topic.
Solving behavioral issues that prevent patients from taking their medications is an important challenge. Even in this study, even with rewards, fewer than half the patients treated for high cholesterol levels kept taking their medication as prescribed. Many of the established Good Ideas in medicine (medications, etc) are stymied by downstream hurdles — doctors don’t prescribe the treatment as often as they should, patients don’t follow through, etc. Statins are a great example. It is really important to examine these gaps and design clever, cost-effective ways to close them.
The story discusses costs in a very interesting way – because the point of the research was modifying human behavior by paying “rewards” of cash to patients and sometimes doctors. What we didn’t find in the story is the “cost” of manpower to run a program like this. How much would it cost (besides the actual cost of $1,204 per patient-doctor pair) to administer this? How practical is it?
We applaud the writer for including this paragraph – giving the real context that matters most. Italics added by editor.
“Still to come is an analysis of whether the amounts paid in the study – up to $1,024 over the course of a year – would be worth it, in terms of avoiding the costs of treating a certain number of heart attacks and strokes.”
Overall, the story does an excellent job of addressing the cost trade-offs.
There were four patient groups. The story does a great job of describing the precise benefits, in terms of blood cholesterol, that each patient group showed (if any).
The group that benefited the most was the one where both patients and doctors received incentives. That group showed a drop of 33.6 points in LDL cholesterol, compared to a 25.1 drop in the group that received no money. It may have been useful to include a sense of how that reduction might translate into reduced risk of a heart attack (one could use the risk calculator the story mentions to calculate an estimate, or ask one of the sources to help with this).
But while quantifying the drops in cholesterol is important, we also wanted to know whether the incentives actually translated to increased compliance with the medication regimen. Other factors beyond the medication usage (diet, genetics, etc.) may have impacted participants’ cholesterol levels, so it would be interesting to know if the cholesterol results were confirmed by the medication adherence findings.
The story does a nice job describing some of the subtle downsides associated with the pay-for-taking-meds approach as well as the side effects of the meds themselves.
All four groups in the study, even those who did not receive any payment, were issued electronic pill bottles. As one commenter said “they might have felt they were being watched.” The bottles sent a signal of some sort when opened, so that researchers would know who opened the top. Another commenter pointed out that if money as incentive works for a short-term, how do we know patients would continue past the payment stage?
These limitations are part of why one outside commenter described the results as “a nice first step.”
The story makes clear the methods and comparison in the randomized controlled study, and the quality of evidence. It includes important elements like study size and study design, and it touches on some limitations.
There is no disease mongering.
The story goes beyond just “satisfactory.” Extra stars for including a patient (who was not involved) who is an advocate in this area, as well as researchers not involved in the study. The piece does a great job on this.
The alternatives in this case would be other ways to motivate patients to take statins, and we think the story does this well.
The story makes clear that paying cash to patients to take medicine is an experimental idea, not something that your local doctor is likely to offer. But with that said, it might have been helpful to ask one of the sources about how widespread this approach is and in what contexts it is being used (there are examples around the country).
The story accurately suggests that’s what’s novel here is paying both patients and physicians to improve compliance. The story could have been clearer about the fact that there are a number of other studies looking at patient financial incentives. The story mentions one example (related to smoking) in the introduction, but it could have gone further.
The story does not rely on a news release, but is a fine example of where extra reporting can provide context.