Lottery Incentive Program for High Blood Pressure

(BETTER-BP Trial)

Overseen by John Dodson, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: NYU Langone Health

Trial Summary

What is the purpose of this trial?

This trial encourages patients with high blood pressure, who don't take their medication regularly, to stick to their treatment by offering chances to win prizes.

Do I have to stop taking my current medications for this trial?

The trial does not specify that you need to stop taking your current medications. In fact, you need to have an active prescription for at least one antihypertensive medication to participate.

What data supports the idea that Lottery Incentive Program for High Blood Pressure is an effective treatment?

The available research shows that the Lottery Incentive Program for High Blood Pressure, also known as BETTER-BP, was designed to improve adherence to blood pressure medication and reduce blood pressure levels. Although the specific results of this program are not detailed in the provided information, the concept of using financial incentives to improve health outcomes is supported by other studies. For example, a study on financial incentives for health screenings showed a significant increase in participation rates, with the most effective intervention leading to a 31.2 percentage point increase in screenings for conditions like hypertension. This suggests that similar incentive-based approaches, like the Lottery Incentive Program, could be effective in encouraging people to stick to their blood pressure treatment plans. ^{1 2 3 4 5}

What safety data exists for the Lottery Incentive Program for High Blood Pressure?

The available research does not directly address safety data for the Lottery Incentive Program for High Blood Pressure. The BETTER-BP study focuses on improving medication adherence through a lottery incentive but does not provide specific safety data. Other studies mentioned do not relate to the safety of this program. ^{1 3 6 7 8}

Is the Regret Lottery treatment a promising way to help people stick to their high blood pressure medication?

Yes, the Regret Lottery treatment is promising because it uses a fun and engaging way to encourage people to take their medication regularly, which can help lower their blood pressure. ^{1 2 3 7 9}

Research Team

John Dodson, MD

Principal Investigator

New York Langone Health

Eligibility Criteria

The BETTER-BP trial is for individuals with high blood pressure who have been less than 80% adherent to their antihypertensive medication. Participants must have at least one blood pressure reading of ≥140 mmHg, a hypertension diagnosis, and be on prescribed medication like thiazide diuretics or ACE inhibitors. It's not for pregnant individuals, those unable to use the study app in English/Spanish, with technology barriers due to sensory impairments, incarceration, or life expectancy under 12 months.

Inclusion Criteria

I have been diagnosed with high blood pressure.

My blood pressure is 140 mmHg or higher, even with medication.

I often forget to take my medication as prescribed.

Exclusion Criteria

Clear barrier to technology use (e.g. visual or hearing impairment)

Unable/unwilling to consent

Doctor thinks you may not live for another year.

Treatment Details

Interventions

• Control Condition (Behavioural Intervention)
• Regret Lottery (Behavioural Intervention)

Trial Overview This phase II trial tests if a 'regret lottery' incentive program delivered via smartphone can improve adherence to blood pressure medications over six months. Of the 435 patients recruited from NYC clinics with poor adherence records, two-thirds will receive this intervention while the rest are in control condition without incentives.

Participant Groups

Group I: Regret lottery Experimental Treatment 1 Intervention

Will receive a lottery incentive ("regret lottery") for 6 months

Group II: Control Condition Placebo Group 1 Intervention

Will complete a total of 3 in-person study visits, approximately one hour each.

Who Is Running the Clinical Trial?

NYU Langone Health

Lead Sponsor

Trials

1,431

Recruited

838,000+

Dr. Alec C. Kimmelman

NYU Langone Health

Chief Executive Officer

MD and PhD from Mount Sinai School of Medicine

Dr. Nicole M. Adler

NYU Langone Health

Chief Medical Officer since 2023

MD

National Heart, Lung, and Blood Institute (NHLBI)

Collaborator

Trials

3,987

Recruited

47,860,000+

Dr. Gary H. Gibbons

National Heart, Lung, and Blood Institute (NHLBI)

Chief Executive Officer since 2012

MD from Harvard Medical School

Dr. James P. Kiley

National Heart, Lung, and Blood Institute (NHLBI)

Chief Medical Officer since 2011

MD from University of California, San Francisco

Findings from Research

The BETTER-BP trial is testing a digitally-enabled incentive lottery to improve adherence to antihypertensive medications among 435 patients with poorly controlled hypertension over a 6-month period.

If effective, this innovative approach could significantly enhance medication adherence and lower systolic blood pressure in vulnerable populations, potentially leading to broader implementation in healthcare settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Study design of BETTER-BP: Behavioral economics trial to enhance regulation of blood pressure. Dodson, JA., Schoenthaler, A., Fonceva, A., et al.[2023]

A randomized controlled trial showed that personalized physician invitations significantly increased health screening rates for diabetes and hypertension among Armenian adults, with an increase of about 15 percentage points for three of the interventions.

The most effective intervention was the personalized invitation with a conditional financial incentive, which resulted in a remarkable 31.2 percentage point increase in screening rates for both conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Invitations, incentives, and conditions: A randomized evaluation of demand-side interventions for health screenings. de Walque, D., Chukwuma, A., Ayivi-Guedehoussou, N., et al.[2022]

An online spaced-education game for primary care clinicians significantly reduced the time it took for hypertensive patients to reach their blood pressure target, with a hazard ratio of 1.043 indicating a modest improvement.

The study involved 111 clinicians and analyzed 17,866 hypertensive periods among 14,336 patients, showing that the game was effective in enhancing clinician engagement and performance in managing hypertension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An online spaced-education game among clinicians improves their patients' time to blood pressure control: a randomized controlled trial. Kerfoot, BP., Turchin, A., Breydo, E., et al.[2022]

A randomized clinical trial involving 805 participants showed that various financial incentives significantly improved adherence to statin medication compared to a control group, with adherence rates reaching up to 87% in incentive groups.

Despite improved adherence, the study found no significant reduction in LDL-C levels among the incentive groups compared to the control, highlighting the need to measure actual health outcomes rather than just medication adherence in such interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Patient Financial Incentives on Statin Adherence and Lipid Control: A Randomized Clinical Trial. Barankay, I., Reese, PP., Putt, ME., et al.[2021]

Family doctors responded to stricter payment targets for controlling blood pressure by increasing treatment intensity, including a 1.2 percentage point rise in prescribing antihypertensive medications and more frequent blood pressure measurements, based on data from 107,148 patients.

However, the study also revealed that doctors engaged in 'gaming' behaviors, such as increasing the number of patients recorded as meeting the new targets by 3.1 percentage points, indicating that while treatment improved, the accuracy of reported outcomes may have been compromised.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Family doctor responses to changes in target stringency under financial incentives. Wilding, A., Munford, L., Guthrie, B., et al.[2022]

Displaying traffic fatality counts on highway signs as part of a safety campaign led to an increase in crashes during the campaign weeks, suggesting that the intervention may have unintended negative effects.

The negative impact of this campaign did not persist beyond the weeks it was active, indicating that overly attention-grabbing interventions can distract from safe driving behaviors rather than promote them.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can behavioral interventions be too salient? Evidence from traffic safety messages. Hall, JD., Madsen, JM.[2022]

Home blood pressure monitoring is more effective than clinic monitoring for diagnosing and treating hypertension, and it is cost beneficial for insurers, with estimated net savings ranging from $33 to $166 per member in the first year and up to $1364 over ten years.

The analysis indicates a strong return on investment for insurers, with returns ranging from $0.85 to $3.75 for every dollar spent in the first year, and from $7.50 to $19.34 in the long run, supporting the case for reimbursement of home BP monitoring.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cost-benefit analysis of home blood pressure monitoring in hypertension diagnosis and treatment: an insurer perspective. Arrieta, A., Woods, JR., Qiao, N., et al.[2023]

Financial incentives based on behavioral economics significantly increased the odds of health behavior change, with participants having nearly four times higher odds of changing their behavior compared to those in the control group (odds ratio of 3.96).

The effectiveness of these financial incentives did not vary significantly by demographic factors such as gender, age, or education, but showed that Black participants had higher odds of behavior change compared to White participants when using conditional payments, while higher-income individuals had lower odds of change with a specific incentive structure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis. Haff, N., Patel, MS., Lim, R., et al.[2022]

The Achieve BP study assessed the willingness to accept (WTA) and willingness to pay (WTP) for blood pressure management among 38 patients with uncontrolled blood pressure, highlighting the importance of considering patient time and costs in evaluating treatment adherence.

Results showed that WTP was about twice as responsive as WTA, indicating that patients may value their willingness to pay for interventions more than their willingness to accept them, which can inform future health services research and cost-effectiveness evaluations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Willingness to pay and willingness to accept in a patient-centered blood pressure control study. Gleason-Comstock, J., Streater, A., Goodman, A., et al.[2022]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

Study design of BETTER-BP: Behavioral economics trial to enhance regulation of blood pressure. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Invitations, incentives, and conditions: A randomized evaluation of demand-side interventions for health screenings. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

An online spaced-education game among clinicians improves their patients' time to blood pressure control: a randomized controlled trial. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Effect of Patient Financial Incentives on Statin Adherence and Lipid Control: A Randomized Clinical Trial. [2021]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Family doctor responses to changes in target stringency under financial incentives. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Can behavioral interventions be too salient? Evidence from traffic safety messages. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Cost-benefit analysis of home blood pressure monitoring in hypertension diagnosis and treatment: an insurer perspective. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Willingness to pay and willingness to accept in a patient-centered blood pressure control study. [2022]