A Randomized Trial of Patient Financial Incentives to Reduce CVD Risk

NCT02035826 | Completed DMC

• 1 other identifier: 2013P001902/BWH
• Study Type: interventional
• Target: 53
• Locations: 1 country
• Sites: 1

Brief Summary

Cardiovascular disease (CVD) is the leading cause of death in the United States. Despite strong evidence that reducing low-density lipoproteins (LDL) with statins successfully lowers CVD risk, physicians under-prescribe statins, physicians fail to intensify treatment when indicated, and more than 50% of patients stop taking statins within one year of first prescription though such therapy typically should be life-long. In this study, we will test the effectiveness of different financial incentives in increasing statin use and reducing LDL cholesterol among patients with poor cholesterol control who are at very high risk for CVD. The application of conceptual approaches from behavioral economics offers considerable promise in advancing health and health care. We will test these approaches among patients at very high risk of CVD at Harvard Vanguard Medical Associates. Using a 4-arm, cluster-randomized controlled trial, we aim to answer these questions: \[1\] How does the provision of patient incentives compare to no incentives at all? \[2\] Is success with patient incentives improved by increasing the financial amounts? \[3\] Are results sustained after incentives and other interventions are withdrawn? Study Objectives and Hypothesis Aim 1: To evaluate the effectiveness of varying patient incentives on improvement in LDL cholesterol relative to usual care during a 3-month intervention among patients at high risk of CVD. H1: Each of the incentives will be more effective than usual care in reducing LDL cholesterol. Aim 2: To evaluate the relative effectiveness of those intervention arms superior to control in reducing LDL cholesterol. H2: Higher incentive amounts for patients will be more effective than lower incentive amounts. Aim 3: To evaluate the impact of each effective intervention in sustaining adherence and reduced LDL after the 3-month intervention period. Aim 4: To conduct a rigorous process evaluation to examine why some incentives were more effective than others and to address other factors relevant to broader implementation.

Conditions

Cardiovascular Disease (CVD)

Outcome Measures

Primary Outcomes (1)

• LDL Cholesterol

  The primary outcome will be change in LDL between baseline (prior to randomization) and 3 months.

  Baseline and 3 months

Secondary Outcomes (1)

• LDL Cholesterol

  Baseline to 6 months

Other Outcomes (1)

• Hemoglobin A1c

  Baseline and 3 months

Study Arms (4)

Arm 1

ACTIVE COMPARATOR

Arm (Expected Value) 2 Digit Match 1st Digit Match 2nd Digit Match Arm 1 ($2.80) $100 $10 $10

Behavioral: Behavioral Economics Intervention

Arm 2

ACTIVE COMPARATOR

Arm (Expected Value) 2 Digit Match 1st Digit Match 2nd Digit Match Arm 2 ($1.40) $50 $5 $5

Behavioral: Behavioral Economics Intervention

Arm 3

ACTIVE COMPARATOR

Arm (Expected Value) 2 Digit Match 1st Digit Match 2nd Digit Match Arm 3 ($0.70) $25 $5 $0

Behavioral: Behavioral Economics Intervention

Arm 4

NO INTERVENTION

Control Arm

Interventions

Behavioral Economics Intervention BEHAVIORAL

Patients will receive an active intervention for 3 months followed by 3 months of observation. Incentives will be awarded at the end of the first 3 months, based on an improvement of at least 10 mg/dl in LDL relative to the patient's baseline LDL or achieving or sustaining LDL of 100, depending on baseline LDL and FRS. Adherence in all groups will be measured using Vitality GlowCaps as a recording device. Patients in all arms will be given the GlowCaps and instructions on use. Patients will receive adherence feedback electronically with daily lottery awards to match the timing of their task.

Arm 1; Arm 2; Arm 3

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Between the ages of 18-80 yrs
• FRS of \> 20% with LDL \> 120, or FRS = 10-20% with LDL \> 140, or a coronary artery disease equivalent (diabetes, peripheral artery disease, ischemic CVD, arteriosclerotic CVD, stroke/TIA, CABG, coronary stenting, or coronary bypass anastomosis) with LDL \> 120.

You may not qualify if:

• Patients with a history of side effects to statins. Patients with a history of side effects to statins will be forwarded to the study's medical monitor (a physician aligned with the study) and may still participate in the study if, after the medical monitor reviews the patient's medical record, he/she determines that the patient may safely participate in the study;
• Patients who will not or cannot give consent;
• Patients with terminal illness who are no longer suitable candidates for aggressive lipid management as determined by the patient's primary care physician;
• Patients with ALT values detected at greater than 80 U/L;
• Patients with active or progressive liver disease.

Sponsors & Collaborators

• University of Pennsylvania: lead
• National Institutes of Health (NIH): collaborator
• Harvard Vanguard Medical Associates: collaborator
• Geisinger Clinic: collaborator

Study Sites (1)

Harvard Vanguard Medical Associates

Boston, Massachusetts, 02215, United States

Location

MeSH Terms

Conditions

Cardiovascular Diseases

Study Officials

• Thomas Issac, MD, MPH

  Harvard Vanguard Medical Associates

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: BASIC SCIENCE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 10, 2014
• First Posted: January 14, 2014
• Study Start: January 1, 2014
• Primary Completion: October 1, 2014
• Study Completion: October 1, 2014
• Last Updated: December 10, 2014

Record last verified: 2013-11

Locations

US (1)