Fecal immunochemical test (FIT) completion rates did not increase with different types of financial incentives of the same monetary value, which might be because financial incentives are not effective in this context, according to results from a randomized clinical trial published in JAMA Network Open.

A group of investigators for the Single Center Randomized Pilot Study Of Colorectal Cancer Screening Outreach (CRCSO; ClinicalTrials.gov Identifier: NCT02594150) selected 897 participants (56% women, 44% men, aged 50-75 years) to receive a mailed FIT kit and a letter from their primary care physician indicating they were due for colorectal cancer screening.

Participants were randomly assigned to 1 of 4 groups: to receive no financial incentive, to receive an unconditional $10 incentive included with the letter, to receive a $10 incentive conditional to completion of the kit, or to be entered in a conditional lottery with a 10% chance of winning $100 after completion of testing.

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The primary and secondary outcomes measured were the percentages of patients who completed the mailed FIT in ≤2 months and ≤6 month, respectively, after receiving the kit.

At 2 months, the total combined completion rate was 23.5%, with a 26.0% rate from the control group, 27.2% from the unconditional incentive arm, 23.2% from the conditional incentive arm, and 17.7% from the lottery incentive arm

A similar pattern was observed for participants who completed their FIT kits within 6 months, with a 28.9% total combined completion rate. Rates for no incentive, unconditional incentive, conditional incentive, and lottery incentive were 32.7%, 31.7%, 26.8%, and 24.3%, respectively.

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The differences in completion rates between no incentive and incentive cohorts were insignificant.

Possible reasons for financial incentive inefficacy included small monetary value, improper communication of incentive, inadequate calculation of power, and error in design of incentive.

“Further efforts are needed to enhance uptake of [colorectal cancer] screening to make it more scalable and effective,” the authors concluded.


Mehta SJ, Pepe RS, Gabler NB, et al; for the Single Center Randomized Pilot Study Of Colorectal Cancer Screening Outreach (CRCSO). Effect of financial incentives on patient use of mailed colorectal cancer screening tests: a randomized clinical trial. JAMA Netw Open. 2019;2(3):e191156.