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Cost-effectiveness of financial incentives to improve glycemic control in adults with diabetes: A pilot randomized controlled trial

Author

Listed:
  • Leonard E Egede
  • Rebekah J Walker
  • Clara E Dismuke-Greer
  • Sarah Pyzyk
  • Aprill Z Dawson
  • Joni S Williams
  • Jennifer A Campbell

Abstract

Purpose: Determine the cost-effectiveness of three financial incentive structures in obtaining a 1% within group drop in HbA1c among adults with diabetes. Methods: 60 African Americans with type 2 diabetes were randomized to one of three financial incentive structures and followed for 3-months. Group 1 (low frequency) received a single incentive for absolute HbA1c reduction, Group 2 (moderate frequency) received a two-part incentive for home testing of glucose and absolute HbA1c reduction and Group 3 (high frequency) received a multiple component incentive for home testing, attendance of weekly telephone education classes and absolute HbA1c reduction. The primary clinical outcome was HbA1c reduction within each arm at 3-months. Cost for each arm was calculated based on the cost of the intervention, cost of health care visits during the 3-month time frame, and cost of workdays missed from illness. Incremental cost effectiveness ratios (ICER) were calculated based on achieving a 1% within group drop in HbA1c and were bootstrapped with 1,000 replications. Results: The ICER to decrease HbA1c by 1% was $1,100 for all three arms, however, bootstrapped standard errors differed with Group 1 having twice the variation around the ICER coefficient as Groups 2 and 3. ICERs were statistically significant for Groups 2 and 3 (p

Suggested Citation

  • Leonard E Egede & Rebekah J Walker & Clara E Dismuke-Greer & Sarah Pyzyk & Aprill Z Dawson & Joni S Williams & Jennifer A Campbell, 2021. "Cost-effectiveness of financial incentives to improve glycemic control in adults with diabetes: A pilot randomized controlled trial," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-11, March.
    • Handle: RePEc:plo:pone00:0248762
    DOI: 10.1371/journal.pone.0248762
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    References listed on IDEAS

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    1. Emma L Giles & Shannon Robalino & Elaine McColl & Falko F Sniehotta & Jean Adams, 2014. "The Effectiveness of Financial Incentives for Health Behaviour Change: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-16, March.
    2. Promberger, Marianne & Dolan, Paul & Marteau, Theresa M., 2012. "“Pay them if it works”: Discrete choice experiments on the acceptability of financial incentives to change health related behaviour," Social Science & Medicine, Elsevier, vol. 75(12), pages 2509-2514.
    3. Yujin Lee & Dariush Mozaffarian & Stephen Sy & Yue Huang & Junxiu Liu & Parke E Wilde & Shafika Abrahams-Gessel & Thiago de Souza Veiga Jardim & Thomas A Gaziano & Renata Micha, 2019. "Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study," PLOS Medicine, Public Library of Science, vol. 16(3), pages 1-20, March.
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