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Evidence Table 7. Reported cost of interventions

Article IDDefinition of PreventionPrevention TargetInterventionIncentive ConditionGroup AssignmentOutcomesCost-Effectiveness
Author
Country
#029SimpleCancer screening - fecal occult blood testFree postageRequired behavior: return completed fecal occult blood test within three monthsGroup 1) Control - return at next visit, n=49Significant findings:Cost per completed kit:
Freedman & Mitchell, 199459 Group 2) Return envelope provided, n=46* Increase in adherence rate, p=.003Group 1 - $2.24
USGroup 3) Stamped return envelope provided, n= 51Adherence rate:Group 2 - $1.61
Group 1 - 37%Group 3 - $1.71
Group 2 - 57%
Group 3 - 71%
#047SimpleImmunizationFree flu shots ($40–$60 value)Required behavior: receive flu shotGroup 1) Control - usual care, n=195Significant findings:Cost per prevented death:
Nexoe et al., 199778 Group 2) Invitation letter, n=195* Increase in vaccination rate, p<0.01Group 2 - $3,990
DenmarkGroup 3) Invitation letter and free shot, n=195Vaccination rate:Group 3 - $17,860
Group 1 - 25%
Group 2 - 49%
Group 3 - 72%
#034SimpleImmunization1) Free day careRequired behaviors:Group 1) Control (combined pure control n=119 completed, and attention control, n=108 completed)Significant findings (at 2 week followup):Cost per target child receiving shot after 3 months:
Yokley & Glenwick, 198462 2) Lottery of $25, $50, and $100 cash prizes1) Leave child at clinic for shots and day care period,Group 2) general prompt, n=124* Increased number of children receiving shots:Group 2 $3.64,
US2) Bring child in for shotsGroup 3) personalized prompt, n=119Group 1 - 11 childrenGroup 3 $2.27,
Group 4) personal prompt + increased access (day care) n=125,Group 4 - 20 childrenGroup 4 $6.28
Group 5) personal prompt + lottery incentive n=120Group 5 - 27 children, p<.05.Group 5 $6.91
* Increased number of children attending clinic:
Group 1 - 13 children
Group 4 - 22 children
Group 5 - 32 children p<.05.
* Increased total number of shots:
Group 1 - 22
Group 4 - 38, p<.05
Group 5 - 46, p<.05
#048SimpleImmunizationLottery: Three $50 grocery gift certificatesRequired behavior: receive shot at clinicGroup 1) Control, n=202Significant findings:Cost per additional immunization:
Moran et al., 199663 Group 2) Educational brochure, n=198* % receiving shot:$3.45 for brochure, $8.74 for incentive
USGroup 3) Lottery incentive, n=198Group 1 - 20%
Group 4) brochure + lottery, n=199Group 2 - 36%, OR 2.29, CI 1.45–3.61, p=.0004, Group 3 - 29%, OR 1.68, CI 1.05 – 2.68, p=.0308, Group 4 - 26%, OR 1.41, non-significant
* For patients with no prior immunization history, only brochure was effective, p=.0002
#044SimpleImmunizationMust come to WIC offices monthly to pick up allotment of vouchers (normal every three months)Required behavior: immunize childGroup 1) Control - no immunization referral, n=2 sitesSignificant findings:Cost per additional up-to-date child:
Hutchins et al., 1999110 Group 2) On-site nurse referral and incentive, n= 2 sites* For enrolled children, coverage increased 10% at first birthday and 23% at second birthday for intervention groups. Control groups decreased 4% and 9% respectively, p<.05.Year 1:
USGroup 3) On-site clinic referral and incentive, n= 1 site* For active WIC participants, increase for intervention groups was 52% by second year vs. 2% for the control groupoff-site = $51
Group 4) Off-site referral and incentive, n= 2 siteson-site = $111
nurse = $164
Year 2:
off-site = $13
on-site = $7
nurse = $21
#062ComplexCVD preventionPrize + competition: Two lottery draws for $40, $40 for meeting three month goal, 1 in 4 chance at $1,000 prize for station with highest percent meeting goalsRequired behavior: self-reported progress toward or meeting lifestyle change goalsGroup 1) Control - health risk assessment (hra) n=115 completedSignificant Findings:In active phase Group 4 least cost-effective. Not effective by 12 month maintenance stage.
Gomel et al., 199369 Group 2) hra + risk factor education n=70 completed* BMI, body fat %, mean blood pressure, aerobic capacity, quit rates - Group 4 usually had strong response within 6 months but relapsed to initial levels by 12 monthsReported under separate study.143
New ZealandGroup 3) hra + behavioral counseling n=102 completed
Group 4) hra + counseling + incentive n=77
#091ComplexSmoking cessationFree or reduced price for nicotine gum; $0, $6, or $20 vs. full price of $24Required behavior: purchase gumGroup 1) Free gum, n=32Significant findings:Financial gain to insurance company per subject enrolled:
Hughes et al., 199176 Group 2) $6/box gum, n=36* Decreased cost increased several measures of incidence of obtaining gum and long-term use, p<.05 to p<.006Free - $1,120
USGroup 3) $20/box gum, n=38*Price elasticity higher for $6 vs. $20 (.45) than free vs. $6 (.21)$6/box - $280
* Decreased cost had non-significant trend to increase cessation$20/box - $413

From: Appendix F. Evidence Tables Continued

Cover of Economic Incentives for Preventive Care
Economic Incentives for Preventive Care.
Evidence Reports/Technology Assessments, No. 101.
Kane RL, Johnson PE, Town RJ, et al.

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