A Randomized Controlled Trial of Incentives for Habit Formation

描述(申请人提供)：心血管疾病(CVD)是美国主要的死亡原因。尽管有强有力的证据表明，用他汀类药物降低低密度脂蛋白(LDL)成功地降低了心血管疾病的风险，但超过50%的患者在最初开出处方后一年内停止服用他汀类药物，尽管这种治疗通常应该是终生的。在这项研究中，我们将测试不同的行为经济干预措施在养成长期坚持他汀类药物的习惯和降低低密度脂蛋白方面的有效性，这些患者的胆固醇控制较差，是心血管疾病的高危人群。来自行为经济学的概念方法的应用在促进健康和医疗保健方面提供了相当大的希望。基于经济奖励的干预措施在干预期间成功地改变了健康行为，但在许多情况下，在干预之后就不是了。在胆固醇控制不佳、心血管疾病风险较高的患者中，我们建议测试不同的行为经济学技术在诱导坚持使用他汀类药物的习惯形成和停止财务激励后持续降低低密度脂蛋白胆固醇方面的有效性。我们将在全国范围内的CVS Caremark成员中测试这些方法。使用四臂随机对照试验，我们的目标是回答这些问题：[1]每日彩票、习惯养成彩票和混合彩票存款合同，所有这些都包括每日提醒，与 在干预阶段每天提醒改善他汀类药物的依从性和低密度脂蛋白的控制？[2]这3种激励措施与干预后每天提醒改善依从性和改善低密度脂蛋白控制相比如何？[3]这些方法在成本效益方面如何比较？

DESCRIPTION (provided by applicant): 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, more than 50% of patients stop taking statins within one year of initial prescription though such therapy typically should be lifelong. In this study, w will test the effectiveness of different behavioral economic interventions in shaping lasting habit for statin adherence 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. Interventions based on financial incentives are successful in changing health behaviors during the intervention period but in many cases not thereafter. In patients with suboptimal cholesterol control who are at high risk for CVD, we propose to test the effectiveness of different behavioral economic techniques in inducing habit formation for adherence to statin use and sustained reductions in LDL cholesterol after financial incentives are discontinued. We will test these approaches among members of CVS Caremark nationwide. Using a 4-arm, randomized controlled trial, we aim to answer these questions: [1] How do daily lotteries, habit formation lotteries, and hybrid lottery deposit contracts, all of which include daily reminders, compare with daily reminders in improving statin adherence and LDL control during the intervention phase? [2] How do these 3 incentives compare to daily reminders in achieving improved adherence and improved LDL control post- intervention? [3] How do these approaches compare in cost-effectiveness?