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The Lancet: Should at-risk patients be paid to receive interventions?

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Mark Platt
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The Lancet: Should at-risk patients be paid to receive interventions?
Posted on: July 15 2014, 11:57 am

Should at-risk patients be paid to receive interventions? By A Thomas McLellan

It is hard to think of a study that is more definitive, ostensibly valid, practical, or relevant to public health than that reported by Tim Weaver and colleagues in The Lancet.

Their study addressed the global problem of how to reduce the spread of hepatitis B virus (HBV) by drug users,2 and in particular the practical problem of increasing full compliance with the recommended regimen of three HBV vaccinations spread over a 3 month period.

In a cluster randomised trial done in the UK, the investigators showed that modest, contingent financial rewards significantly increased the likelihood of completion of all HBV vaccinations in this difficult to access and high-risk group. Provision of 30, delivered either in equal or graduated instalments in return for as-scheduled attendance for the three injections, raised the rate of full adherence from 9% (six of 67 participants) in the treatment-as-usual group to more than 45% in the contingency management groups (35 of 78 [45%] and 32 of 65 [49%] participants receiving fixed or escalating value rewards, respectively; odds ratios 121 [37399] and 140 [42462]).

Larger financial incentives therefore might produce even greater adherence of patients and public health protection for the UK's population. But is it ethical to use this reward mechanism, is it practical, and is it smart policy?

To continue reading see: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60490-6/fulltext
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