Evidence Table 3. Included consumer studies outcomes

Article IDPrevention DefinitionPrevention TargetInterventionIncentive ConditionGroup AssignmentOutcomes
#074ComplexBreast feedingGifts and raffles of high frequency and considerable value - from $15 hair cuts to raffle for trip for two on Grand Canyon Railway. SO Partner also received incentives for attending.Required behavior: complete educational program and self-reported breastfeeding levelsGroup 1) Control - usual education n=29 completedSignificant Findings:
Sciacca et al., 199566 Group 2) Education with a significant other (partner, parent, etc) plus incentives, n=26 completed* Differences between groups in exclusive breast feeding and exclusive formula feeding behaviors at discharge, two week, six week, and three month post-partum from p=.000 to p=.023
#032ComplexSmoking cessationFree nicotine patches for 12 weeksRequired behavior - pick up patches from pharmacyGroup 1) counseling and prescription, n=39No significant difference between groups
Dey et al., 1999103 Group 2) Counseling and free patch, n=58* Rate of self-reported abstinence
UK* Lab-confirmed abstinence
#071ComplexObesity preventionLottery: $100, one per month for a 1/10 chance over three yearsRequired behavior - return postcard that was attached to the newsletterGroup 1) Control, standard behavioral therapy (SBT), n=414Significant Findings:
Jeffery & French, 199974 Group 2) SBT + monthly educational newsletter, n=197* Response rate of returned postcards (direct measure of incentive) Group 2 - 65%, Group 3 - 71%, p<.05
USGroup 3) SBT + newsletter + lottery, n=198* No significant differences for weight gain or behavior changes, though change was in the right direction
#072ComplexWeight lossCash Incentive: Graduated payments of $1 to $3 per exercise session, paid monthly, 222 total possible walks, $266 potential total per personRequired behavior - attend supervised exercised sessionsGroup 1) Control. Standard behavioral therapy (SBT), n=40No significant findings for incentives
Jeffery et al., 199897 Group 2) SBT + Supervised exercise, n=41* Self-reported exercise behavior
USGroup 3) SBT + personal trainer, n=42* Body weight
Group 4) SBT + incentive, n=37* Exercise session attendance
Group 5) SBT + trainer + incentive, n=36
#078ComplexExerciseLottery: one $50 gift certificate (unknown type) at each exercise session and one $2,000 travel certificateRequired behavior - attend exercise sessions.Group 1) 24 week programs with group meetings and three supervised exercise sessions per week, n=16No significant difference between groups
Wing et al., 199691 Travel lottery chances based on how many sessions attendedGroup 2) Plus Incentive, n=21* Weight loss
US* Attendance at exercise sessions
#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:
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<.006
USGroup 3) $20/box gum, n=38* Price elasticity higher for $6 vs $20 (.45) than free vs $6 (.21)
* Decreased cost had non-significant trend to increase cessation
#107ComplexWeight lossContract: Return $5 per session, 14 sessionRequired behavior - attend weight loss educational sessionsGroup 1) Weight loss program, n=24Significant Findings:
Follick et al., 1984109 Cash: Forfeit money split between subjects who hadn't forfeitedGroup 2) Program + monetary contract, n=24* Number of sessions attended per participant, Group 1 - 6.04, Group 2 - 9.42, p<.01
US* No difference in weight loss between groups
#104ComplexWeight lossContract: return $200, $20 per week for 10 weeks, deposited if 1) attended meetings, 2) met calorie restriction goal, or 3) met weight loss goalRequired behavior - attendanceGroup 1) Control - no contract, n=3Significant Findings:
Jeffery et al., 1978106 Required outcome - calorie restriction and weight loss goalsGroup 2) Weight contract, n=7* Weight and calorie contracts groups lost more weight than the attendance group, p<.05
USGroup 3) Calorie contract, n=10* Attendance did not differ between groups
Group 4) Attendance contract, n=7* Calorie group more likely to keep detailed diary, p<.025
#089ComplexNutritionCoupons: fresh produce from farmers' markets, $20 totalRequired behavior - purchase foodGroup 1) Control - no intervention, n=97 completedSignificant Findings:
Anderson et al., 2001102 Group 2) Education, n=123 completed* Groups 3 and 4 more likely to have visited the farmer's market, p<.001
USGroup 3) Coupons, n=114 completed* Coupons increased fruit and vegetable consumption, p<.01
Group 4) Education + coupons, n=121 completed* Education “improved” attitudes and beliefs regarding fruit and vegetable consumption p<.01
#061ComplexCholesterol levelLottery: Five $100 cash prizes. 5 in 29 chance if all participants make goalRequired out-come - to participate in lottery, lower serum cholesterol by 20%, or be under 200, within six monthsGroup 1) Control - health fair and follow-up test, n=34 completedSignificant Findings:
Francisco et al., 199493 Group 2) health fair, test, and chance for lottery entry, n=29* Change in cholesterol level:
US Group 1 - 11.3% decrease, Group 2 - 13.2% decrease, p=.035
#069ComplexWeight lossCash Incentive: minimum of $12.50 to maximum of $25 per week depending on percent of goal attained, 20 weeks totalRequired outcome - lose weight and maintain lossGroup 1) Control - no treatmentNo significant findings for incentives.
Jeffery, Forster, French et al., 1993105 Group 2) Standard behavioral therapy (SBT), n=40* Change in BMI, completion of food records, quality of diet, nutrition knowledge
USGroup 3) SBT + food provision, n=40
Group 4) SBT + incentive, n=40
Group 5) SBT + food provision + incentive, n=41
#102ComplexWeight lossContract 1: return $30 for every 5 pound reduction, total of $150Required outcome - weight lossGroup assignment stratified by population source, 2×3 factorial design: 3 contract types and 2 long-term maintenance enhancementsSignificant Findings:
Jeffery et al., 1984107 Contract 2: return $5, $10, $20, $40, $75 for successive five pound reductions* Percent weight change higher for constant contract (10.8%) vs control (8.5%), p<.03, and increasing contract (12.8%) vs control (8.5%), p<.001
#103ComplexWeight lossContracts: refunds of $1, $5, or $10 per pound ($30, $150, or $300 total). Forfeit money split between participants who made goalRequired outcome - weight loss2×3 factorial design. Contract levels of $30, $150, and $300, and group or individual contracts.No significant difference between contract sizes:
Jeffery et al., 1983108 * Weight loss
US* Group contracts lost more weight than individual, p<.05
#108ComplexSmoking cessationCash Incentive of $25 at six weeks and $25 at six monthsRequired outcome - abstinenceGroup 1) Control - self help program, n= 95No difference in cessation rates between groups for incentives
Windsor et al., 198896 Group 2) Self-help+skills training/social support, n=94
USGroup 3) Self-help + incentive, n=95
Group 4) Self-help+skills training/ social support + incentive, n=94
#062ComplexCVD preventionLottery + Competition: Two lottery draws for $40, $40 for meeting 3threemonth goal, 1/4 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 n=115 completedSignificant Findings
Gomel et al., 199369 Group 2) hra+risk factor education n=70 completed* BMI, body fat percent, mean blood pressure, aerobic capacity, quit rates - Group 4 usually had strong response within six months but relapsed to initial levels by 12 months
New ZealandGroup 3) hra+behavioral counseling n=102 completed
Group 4) hra+counseling+incentive n=77
#065ComplexSmoking cessationPrize + competition: workers paid $50 to participate, rewarded $15/month of abstinence for up to five months, plus first place team wins up to $1,980 (split five ways), 1/13 chance to winRequired outcome: lab-verified abstinenceGroup 1) Control - traditional non-smoking program. Worksite n=29Significant Findings:
Koffman et al., 199868 Group 2) Multifaceted program. Worksite n=80* Group 3 quit rates significantly higher than Group 2 at end of 6 month program, p=.02
USGroup 3) Multifaceted program + incentive. Worksite n=68* Biochem confirmed quit rates were not significantly different between Groups 2 and 3 at six months past program
#066ComplexSmoking cessation/ obesityMonetary contract: money withheld from paycheck, minimum of $5 per check. If goal met, money returned to employeeRequired outcome: lab-verified smoking reduction goals or weight loss goalsGroup 1) Control - no treatment, n=16, 645 employeesSignificant Findings:
Jeffery, Forster, Baxter et al., 199398 Group 2) 11 bi-weekly behavior modification sessions + incentive, n=16, 597 employeesGroup 2 significantly greater smoking abstinence at end of program, p=.03.
#079ComplexSmoking cessationCash: $50 per month for each abstinent month, max of ten months, pre-term + two months post-partumRequired outcome: lab-verified abstinenceGroup 1) Control - education, n=108Significant Findings:
Donatelle et al., 200067 Group 2) education + incentives + social support from significant other* Biochem confirmed quit rates p<.0001 at eight months, p<.0009 at two months post-partum
#082ComplexExerciseCoupons: One free use of fitness center, up to six possibleRequired behavior - attend 40 minute motivational interviewsGroup 1) Control - baseline health risk assessment, n=91 completedNo significant difference attributable to vouchers.
Harland et al., 199999 Group 2) baseline hra + 1 interview, n=96 completed* Increased self-report physical activity
UKGroup 3) baseline hra + 1 interview and voucher, n=88 completed* Increased self-report moderate activity
Group 4) baseline hra + 6 interviews, n=88 completed* Increased self-report vigorous activity
Group 5) baseline hra + 6 interviews and vouchers* Regression analysis showed interaction effect between vouchers and interview, p=.01
* No lasting effects at 12 month followup
#105ComplexSmoking cessationCash Incentive of $0, $1, $5, or $10 per day, ten payment periodsRequired out-come - reduce CO levels to 50% of baselineGroup 1) $0 payment groupSignificant Findings:
Stitzer & Bigelow, 198375 Group 2) $1 payment group* CO levels decreased in orderly fashion as pay increased, p<.001
USGroup 3) $5 payment group* Number of daytime cigarettes also decreased in orderly fashion, p<.001
Group 4) $10 payment group* Percent of targets met increased in orderly fashion, p<.01
#084ComplexSmoking cessationPrize + Competition: Cold turkey buffet; participants (smokers and non-smoking supporters) were charged a $5 incentive fee which was pooled and refunded to winning worksitesRequired behavior: Turkey buffet to work-sites with highest recruitment rate; pooled kitty to split among quitters at work-site with the highest proportion of quittersGroup 1) Control/ Comparison - non-competition sites, n=6Significant Findings:
Gottlieb & Nelson, 199071 Group 2) Competition sites, n=6* 70% of employees in Group 2 participated in program vs 17% of employees in Group 1, p<.001
US* 28% of smokers in Group 2 participated vs 6% of smokers in Group 1, p<.001
#109ComplexSmoking cessationGift: ceramic coffee mug at the end of first two program units.Required behavior: return unit progress reports of self-help programGroup 1) Control - self-help program, n=305Significant Findings:
Curry et al., 199172 Lottery: All-expense-paid one-week trip for two to Hawaii, expense-paid weekend at San Juan Island resort, weekend at a deluxe hotel in downtown Seattle. Bonus entries for returning second two program units.Group 2) Intrinsic motivation - personalized feedback + program, n=304* Extrinsic more likely to complete first unit, p=.0001, and complete at least one activity in more than one of the last six units, p=.039
USGroup 3) Extrinsic motivation - financial incentives + program, n=304* Intrinsic more likely to show continuous abstinence, p=.004
Group 4) Intrinsic + extrinsic + program, n=304Compared to extrinsic groups, intrinsic OR was 2.67
#110ComplexSmoking cessationPrize + Competition: within site competition between teams, prizes of $5 to $15 per participantRequired behavior: team with greatest percent of initial participants completing program; highest quit rate at six months; highest abstinence rate at six monthsGroup 1) Control/ Comparison - non-competition sites, n= not reportedSignificant Findings:
Klesges et al., 198770 Group 2) Competition sites, n=not reported* Higher cessation rates for Group 2, 39% vs 16%, p<.01, at end of program
US* Six-month followup, no significant difference between groups
#096SimpleCholesterol levelLottery: microwave ovenRequired behavior - show up for retestGroup 1) Control - no reminder of retest, n=1659No significant differences between groups:
Owen et al., 199073 Group 2) Reminder letter for retest, n=1648* Percent returning for retest
AustraliaGroup 3) Reminder letter + lottery ticket, n=1629* Cholesterol levels
* Weight
#075SimpleAIDS prevention1) Cash incentive, three possible ($35 total) versusRequired behavior - attend educational sessionsGroup 1) Money orders, n=1455Significant Findings:
Deren et al., 199452 2) Grocery gift certificates, three possible ($35 total)Group 2) Grocery gift certificates, n=551* Difference in percent returning to initial session: Group 1- 83%, Group 2 - 66%, p<.001
US* Difference in percent attending at least one session: Group 1 - 50%, Group 2 - 36%, p<.01
#076SimpleSTD prevention“High value” coupons - 75% off purchase priceRequired behavior - purchase package of 12 condomsGroup 1) Control - 10% off couponsSignificant Findings:
Dahl et al., 1999101 Group 2) High value coupons, 75% off* Widespread disbursement redemption rate: 0 control coupons vs 13 high value coupons, p<.01
US* No difference between in-store coupon redemption rates
#077SimpleHIV/STD prevention1) Cash incentive, two possible ($15 each) versusRequired behavior - attend one 90 minute group education session and one 60 minute individual sessionGroup 1) coupon incentives, n=160Significant Findings:
Kamb et al., 199864 2) Coupons for goods and services, two possible ($15 each)Group 2) cash incentives, n=198* Difference in education participation rate, Group session: Group 1 - 46%, Group 2 - 67%, p<.0001 Both sessions: Group 1 - 37%, Group 2 - 55%, p<.0001
US* More enrolled in Group 2 - 31%, than Group 1 - 23%, p=.002
#092SimpleSmoking cessationLottery: dinner for two at a local restaurantRequired behavior - attend non-smoking clinicGroup 1) Control - received registration material for off-site cessation program, n=34 sitesNo significant difference between groups in participation rates
Emont & Cummings, 199292 Group 2) Lottery ticket plus registration package, n=33 sites
#043SimpleImmunizationMust come to WIC offices monthly to pick up allotment of vouchers (normal every two months)Required behavior - immunize childGroup 1) education and “referral”, n=281Significant Findings:
Birkhead et al., 199557 Group 2) education and escort to immunization, n=377* Increased immunization rate, Group 2 - RR 1.58, Group 3 - RR 1.44
US3) education and voucher disincentive, n=178* Shorter time to vaccination, Group 1- 45 days, Group 2 - 14 days, p<.001,Group 3 - 26 days, p<.001
#049SimpleImmunizationLose AFDC benefits provided to nonimmunized childRequired Behavior - provide proof of immunizationGroup 1) Control - usual care, n=1000Significant Findings:
Kerpelman et al., 200058 Group 2) Subject to sanction, n=1500* Group 2 had statistically significant (p<.05) and clinically meaningful higher coverage (6–7% points) for all five vaccines for all five years
#053SimpleFollowup of abnormal pap1) Fee bus passes mailed out with remindersRequired behavior: for voucher, attend at least one followup visit. No requirement for free bus passesGroup 1) Control - usual follow-upNo significant differences between groups
Kaplan et al., 2000100 2) Voucher for $15 off a $40 clinic fee, redeemable by those at higher riskGroup 2) Incentives and intensive contact
#034SimpleImmunization1) Free day careRequired Behaviors -Group 1) Control (combined pure control n=119 completed, and attention control, n=108 completed)Significant Findings (at two week followup):
Yokley & Glenwick, 198462 2) Lottery of $25, $50, and $100 cash prizes1) Leave child at clinic for shots and day care periodGroup 2) general prompt, n=124* Increased number of children receiving shots - Group 1 - 11 children, Group 4 - 20 children, Group 5 - 27 children, p<.05
US2) Bring child in for shotsGroup 3) personalized prompt, n=119* Increased number of children attending clinic - Group 1 - 13 children, Group 4 - 22 children, Group 5 - 32 children, p<.05
Group 4) personal prompt + increased access (day care) n=125* Increased total number of shots - Group 1 - 22, Group 4 - 38, p<.05, Group 5 - 46, p<.05
Group 5) personal prompt + lottery incentive n=120
#038SimpleTuberculosis screening1) Cash Incentive of $10Required behavior - return for a reading of the Mantoux testGroup 1) Control, n=215Significant Findings:
Malotte et al., 199954 2) Grocery gift certificate $10Group 2) Cash incentive, n=217* Percent returned on time for reading: Group 1 - 49%, Group 2 - 95%, OR 19.2, CI 9.9–37.3, p<.001, Group 3 - 86%, OR 6.2, CI 3.9–9.8, p<.001, Group 4 - 83%, OR 4.9, CI 3.1–7.6, p<.001. Group 5 - 47%
US3) Free bus passes or fast food coupons for total of $10.Group 3) Grocery incentive, n=217* Group 2 vs Group 3, p=.002. Group 2 vs Group 4, p<.001
Group 4) Choice of bus pass or fast food chain coupons, n=218
Group 5) 5–10 minute motivational education session, n=214
#048SimpleImmunizationLottery: Three $50 grocery gift certificatesRequired behavior - receive shot at clinicGroup 1) Control, n=202Significant Findings:
Moran et al., 199663 Group 2) Educational brochure, n=198* Percent receiving shot, Group 1 - 20%, Group 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
USGroup 3) Lottery incentive, n=198* For patients with no prior immunization history, only brochure was effective, p=.0002
Group 4) Brochure + lottery, n=199
#054SimpleFollowup: post-partum examGift: Gerry Cuddler (unknown value)Required behavior - attend post-partum appointmentGroup 1) Control - appointment recommendation, n=132Significant Findings:
Stevens-Simon et al., 199456 Group 2) Recommendation and coupon for gift, n=108* Compliance at eight weeks; Group 1 - 52%, Group 2 - 71%, p=.002
US* Compliance at 12 weeks: Group 1 - 65%, Group 2 - 82%, p=.003
#055SimpleFollowup: post-partum exam1) Coupon for infant formula (unknownn value)Required behavior - attend post-partum appointment on assigned dayGroup 1) Control, n=192Significant Findings:
Smith et al., 199055 2) gift of jewelry (unknown value)Group 2) Infant formula coupon, n=149* Adherence rate: Group 1 - 22%, Group 2 - 37%, p<.003, Group 3 - 23%
USGroup 3) Jewelry gift, n=193* Controlling for ethnicity, Group B significance dropped to p=.07 for blacks
#094SimplePrenatal care1) $5 department store gift certificateRequired behavior - attend prenatal and postpartum checkGroup 1) Control - usual care, n=101No significant differences between groups for:
Laken & Ager, 199565 2) $5 gift certificate + $100 raffleGroup 2) Gift certificates for each prenatal appointment, n=51* Percent missed prenatal appointments
USGroup 3) Gift certificates for each visit + raffle, n=53* Percent attending post-partum appointment
* Length of gestation
* Birth weight
#106SimpleTuberculosis screeningCash Incentive 1) $5Required behavior - return for skin test reading2×3 factorial design. Education or no education by $0, $5, and $10 cash incentiveSignificant Findings:
Malotte et al., 199853 Cash Incentive 2) $10* Odds ratio for $5 incentive = 11.2, $10 incentive = 24.5
US* Education was not significant
#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:
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
USGroup 3) On-site clinic referral and incentive, n= 1 site* For active WIC participants, increases for intervention groups was 52% by second year vs 2% for the control group
Group 4) Off-site referral and incentive, n= 2 sites
#029SimpleFollowup: cancer screeningFree postageRequired behavior - return completed fecal occult blood test within three monthsGroup 1) Control - return at next visit, n=49Significant Findings:
Freedman & Mitchell, 199459 Group 2) Return envelope provided, n=46* Increase in adherence rate, p=.003
USGroup 3) Stamped return envelope provided, n= 51 Adherence rate: Group 1 - 37%, Group 2 - 57%, Group 3 - 71%
#037SimpleImmunizationFree flu shots (unknown value)Required behavior - receive flu shotGroup 1) Control - usual care, n=930Significant Findings:
Satterthwaite, 1997104 Group 2) Invitation letter, n=931* Increase in vaccination rate, p<0.001
New ZealandGroup 3) Invitation letter and free shot, n=930 Vaccination rate: Group 1 - 17%, Group 2 - 27%, Group 3 - 45%
#047SimpleImmunizationFree flu shots ($40–$60 value)Required behavior - receive flu shotGroup 1) Control - usual care, n=195Significant Findings:
Nexoe et al., 199778 Group 2) Invitation letter, n=195* Increase in vaccination rate, p<0.01
DenmarkGroup 3) Invitation letter and free shot, n=195 Vaccination rate: Group 1 - 25%, Group 2 - 49%, Group 3 - 72%
#051SimpleFollowup: cancer screeningFree bus transportation ($2.00 to $2.90 value)Nothing required - mailed with followup reminder; may be used for other purposes2×2×2 factorial table assignment totaling 8 groups.Significant Findings:
Marcus et al., 199260 Three intervention factors:* Improved loss-to-followup - transportation incentive p<.05, OR 1.48, CI 1.06 – 2.06
US1) personalized followup* Sub-group - more likely for county (vs non-county) patients, p<.05, more severe pap score, p<.01, and non-insured, p<.01
2) educational video
3) transportation incentives
#052SimpleFollowup: cancer screeningVoucher: $20 to $25 off clinic visit fee, about 2/3 price reduction, redeemable by non-insured patients, about 70% of popRequired behavior - attend at least one followup visitGroup 1) Control, n=377Significant Findings:
Marcus et al., 199861 Group 2) Intensive contact follow-up, n=335* Improved loss-to-followup - Group 2 - OR 1.56, CI 1.12 – 2.17, p<.01, Group 3 - OR 1.50, CI 1.09 – 2.05, p<.01
USGroup 3) Voucher incentive, n=396* Regression analysis showed no interaction effect between two intervention factors
Group 4) Intensive + incentive, n=345
#095SimplePrenatal care1) Taxicab voucherRequired behavior - attend first prenatal clinic visitGroup 1) Control - usual care, n=35Significant Findings:
Melnikow et al., 199777 2) Gift: baby blanketGroup 2) Blanket incentive, n=35* Compliance with first appointment, Group 1 - 66%, Group 2 - 54%, Group 3 - 82%, Unadjusted OR 0.32 (CI 0.12 – 0.88)
USGroup 3) Taxi voucher, n=34* No significance difference for Group 2, blanket incentive
#042SimpleCancer screening - mammographyGift: Stay-fit Nutrition Kit (brochures and educational material valued at $2)Required behavior - complete mammographyGroup 1) Control - reminder postcard, n=91No significant difference, and change in wrong direction
Mayer et al., 199494 Group 2) Postcard and gift coupon, n=96* Percent difference in appointment keeping rate
#050SimpleCancer screening - mammographyGift: Stay-fit Nutrition Kit (brochures and educational material valued at $2)Required behavior - complete mammographyGroup 1) Control - information, n=49Significant Findings:
Mayer & Kellogg, 198995 Group 2) Information and coupon for gift package, n=47* Increase in appointment keeping rate, p<0.05
US Appointment rate:
 Group 1 - 59%, Group 2 - 81%

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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