PHILADELPHIA – Offering $100 to patients eligible for a preventive colonoscopy screening more than doubled the rate of screening when compared to a simple emailed request, according to new research from the Perelman School of Medicine at the University of Pennsylvania. Screening colonoscopies improve the chance of early detection and prevention of colorectal cancer, but tens of millions of Americans who should have preventive screenings fail to get them. The new study, published this week in Gastroenterology, suggests that a simple financial incentive may be able to persuade many of those holdouts to undergo this important medical procedure.
“Colonoscopy is challenging for patients, requiring a day off from work, a bowel cleansing preparation, and transportation, in addition to non-financial costs of anxiety and discomfort,” said lead author Shivan J. Mehta, MD, an assistant professor of Medicine at the Perelman School of Medicine and associate chief innovation officer at Penn Medicine. “The improvement we saw in the rate of screening colonoscopies was statistically significant, and shows for the first time that a financial incentive can at least modestly boost that rate.”
Colorectal cancers kill more than 50,000 people in the US every year – second only to lung cancers – despite the fact that the vast majority of potential colorectal tumors can be detected via colonoscopy and removed easily, usually at the precancerous stage. The U.S. Preventive Services Task Force has recommended screening colonoscopies every 10 years until the age of 75, for most healthy adults starting at age 50, and for adults with a strong family history of colorectal cancer starting earlier. Studies suggest that from one-third to more than one-half of eligible people fail to get screening colonoscopies.
The new study included 2,245 people between 50 and 64 years old. Following a behavioral economics technique called active choice, Mehta and colleagues sent an email to one subset of participants asking that they actively opt in or opt out of a screening colonoscopy. To another subset, the researchers sent an email with the same active choice message plus an inducement of $100 cash for a colonoscopy completed within three months. To a third group, the control group, the researchers sent an email with just a phone number for scheduling a screening colonoscopy.
Only 1.6 percent of the control group and 1.5 percent of the simple active choice group ended up receiving a screening colonoscopy within three months, compared to 3.7 percent of the group that was offered the $100 inducement. The rate of appointment scheduling was also more than double in the $100-inducement group (4.8 percent) compared to the control and active choice groups (2.1 percent and 2.0 percent, respectively).
