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The use of statins can prevent heart disease, but the question of whether patients and doctors should be rewarded financially for reducing their high cholesterol level remains controversial. (Credit: Getty Royalty Free)
A study published in 2015 sparked a lot of boasting because of its enticing conclusion: financial incentives to lower LDL cholesterol levels have made people more likely to adhere to statin-based treatments, making them is actually healthier. But was it cost-effective, given the additional costs associated with providing such incentives?
A follow-up study published today in the journal JAMA Network Open seek to answer this question. The results are convincing, but they also raise a new set of questions.
The original study, led by the University of Pennsylvania, involved 340 physicians and 1,503 patients, randomly assigned to one of four groups. In one group, only physicians received financial rewards for reducing their patients' LDL levels, while in another, only patients received payments. In a third group, patients and doctors received financial rewards. The fourth group, control, did not receive any financial incentive.
Study participants received many technology assistants, such as electronic vials to track drug adherence and a web platform that they used to fill out surveys and collect their financial rewards . Patients received quarterly goals to lower their cholesterol levels.
In the end, only the patients in the group who paid them at a time and their physicians had a statistically different LDL reduction from the control group. Financial incentives could reach $ 1,024 a year, which physicians shared with their patients.
The idea of paying patients for what they adopt healthy habits is not as delusional as it may seem, especially with regard to cardiovascular disease. In the United States, about one in four deaths is attributed to heart disease, making it the leading cause of death for both men and women, according to the Centers for Disease Control and Prevention. Statins have been shown to reduce the risk of atherosclerosis, an accumulation of cholesterol-laden plaques in the arteries that impede blood flow, increasing the risk of heart attack and stroke.
But all the technology used in the 2015 study, not to mention the actual incentive premiums, equated to a higher cost of care than just writing prescriptions for statins and telling people to patients to fill them. So researchers at Harvard University TH Chan School of Public Health, in collaboration with one of Penn's researchers from the original study, decided to browse the data to try to determine the profitability of physicians and patients to achieve cholesterol goals.
They developed a model simulating the progression of cardiovascular disease over a lifetime in 1 million patients similar to the participants in the 2015 study. Next, they examined the cost-per-year ratio. QALY, a metric commonly used in public health, used to determine the true cost of a quality year of life. A ratio between $ 50,000 and $ 150,000 per QALY is considered acceptable.
The result: Paying both doctors and patients to lower LDL levels at an additional cost-effectiveness ratio of $ 60,000 per QALY.
"The combination of financial incentives for providers and patients with advanced technologies to monitor compliance, including electronic vials, has the potential to improve patient care while remaining cost-effective, and this strategy should be evaluated." ", said Thomas Gaziano. in the Department of Policy and Management of Health at Brigham and Women's Hospital, in a statement.
The idea of using financial incentives to promote a healthy lifestyle is not new, of course. In fact, the lead author of the first essay on financial incentives and statin use, David Asch, has been studying this issue for years. Asch, the executive director of the Penn Medicine Center for Health Care Innovation, has been involved in studies asking if financial incentives could increase colonoscopy rates, for example, or lower rates of hospital readmission among victims heart attacks. case: not really).
As the promising results of this new analysis are promising, the authors admit that some questions remain. More importantly, they had to make assumptions about the duration of the benefits of LDL reduction and the number of years of intervention required. Therefore, they concluded, there remains a "need for a larger, longer-term, real-world demonstration to assess the likelihood that a shared incentive strategy will be adopted and prove effective on a large scale. ".
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The use of statins can prevent heart disease, but the question of whether patients and doctors should be rewarded financially for reducing their high cholesterol level remains controversial. (Credit: Getty Royalty Free)
A study published in 2015 sparked a lot of boasting because of its enticing conclusion: financial incentives to lower LDL cholesterol levels have made people more likely to adhere to statin-based treatments, making them is actually healthier. But was it cost-effective, given the additional costs associated with providing such incentives?
A follow-up study published today in the journal JAMA Network Open seek to answer this question. The results are convincing, but they also raise a new set of questions.
The original study, led by the University of Pennsylvania, involved 340 physicians and 1,503 patients, randomly assigned to one of four groups. In one group, only physicians received financial rewards for reducing their patients' LDL levels, while in another, only patients received payments. In a third group, patients and doctors received financial rewards. The fourth group, control, did not receive any financial incentive.
Study participants received many technology assistants, such as electronic vials to track drug adherence and a web platform that they used to fill out surveys and collect their financial rewards . Patients received quarterly goals to lower their cholesterol levels.
In the end, only the patients in the group who paid them at a time and their physicians had a statistically different LDL reduction from the control group. Financial incentives could reach $ 1,024 a year, which physicians shared with their patients.
The idea of paying patients for what they adopt healthy habits is not as delusional as it may seem, especially with regard to cardiovascular disease. In the United States, about one in four deaths is attributed to heart disease, making it the leading cause of death for both men and women, according to the Centers for Disease Control and Prevention. Statins have been shown to reduce the risk of atherosclerosis, an accumulation of cholesterol-laden plaques in the arteries that impede blood flow, increasing the risk of heart attack and stroke.
But all the technology used in the 2015 study, not to mention the actual incentive premiums, equated to a higher cost of care than just writing prescriptions for statins and telling people to patients to fill them. So researchers at Harvard University TH Chan School of Public Health, in collaboration with one of Penn's researchers from the original study, decided to browse the data to try to determine the profitability of physicians and patients to achieve cholesterol goals.
They developed a model simulating the progression of cardiovascular disease over a lifetime in 1 million patients similar to the participants in the 2015 study. Next, they examined the cost-per-year ratio. QALY, a metric commonly used in public health, used to determine the true cost of a quality year of life. A ratio between $ 50,000 and $ 150,000 per QALY is considered acceptable.
The result: Paying both doctors and patients to lower LDL levels at an additional cost-effectiveness ratio of $ 60,000 per QALY.
"The combination of financial incentives for providers and patients with advanced technologies to monitor compliance, including electronic vials, has the potential to improve patient care while remaining cost-effective, and this strategy should be evaluated." further "in the Department of Policy and Health Management at Brigham and Women's Hospital, in a statement.
The idea of using financial incentives to promote a healthy lifestyle is not new, of course. In fact, the lead author of the first essay on financial incentives and statin use, David Asch, has been studying this issue for years. Asch, the executive director of the Penn Medicine Center for Health Care Innovation, has been involved in studies asking if financial incentives could increase colonoscopy rates, for example, or lower rates of hospital readmission among victims heart attacks. case: not really).
As the promising results of this new analysis are promising, the authors admit that some questions remain. More importantly, they had to make assumptions about the duration of the benefits of LDL reduction and the number of years of intervention required. Therefore, they concluded, there remains a "need for a larger, longer-term, real-world demonstration to assess the likelihood that a shared incentive strategy will be adopted and prove effective on a large scale. ".
