Abstract
Aim:
To evaluate the effectiveness of financial incentives for individuals with or at risk of cardiovascular disease (CVD), in promoting adherence with primary and secondary prevention.
Methods:
Systematic review and meta-analysis following PRISMA guidelines. PubMed, CINAHL and ProQuest Central databases were searched for randomised controlled trials (RCTs) involving adults with one or more CVD risk factors. Included interventions were financial incentives for lifestyle, exercise and/or guideline-recommended pharmacotherapy, compared to controls without financial rewards. Adherence with the recommended intervention, clinical and economic outcomes were extracted. Data unsuitable for meta-analysis was reported descriptively. Critical appraisal was undertaken using Joanna Briggs Institute tools.
Results:
The search identified 1,462 studies, after screening 34 RCTs were included with total recruitment of 35,102 patients. Financial incentive types spanned medication co-payment abolishment, lotteries, process or outcome-based, loss or gain-framed mechanisms ranging from approximately AU$5–178 per week (inflation adjusted). In pooled analysis of varied outcomes, financial incentives modestly improved clinical parameters (Standard Mean Difference (SMD) 0.11 (0.03–0.190), I2 63%, p=0.009, 18 trials, n=14,792) and consistently improved adherence with medication and lifestyle interventions (Odds Ratio 2.06 (1.55–2.75), I2 81%, p=0.00001, 8 trials, n=15,613, Figure). High heterogeneity was observed due to diversity of incentives and outcomes. Subgroup analyses indicated that some clinical outcomes (such as weight) regularly improved with incentives, yet haematological parameters and hospital admissions were frequently unchanged.
Conclusions:
This systematic review found financial incentives improve adherence with primary and secondary prevention strategies and may improve some clinical parameters.
To evaluate the effectiveness of financial incentives for individuals with or at risk of cardiovascular disease (CVD), in promoting adherence with primary and secondary prevention.
Methods:
Systematic review and meta-analysis following PRISMA guidelines. PubMed, CINAHL and ProQuest Central databases were searched for randomised controlled trials (RCTs) involving adults with one or more CVD risk factors. Included interventions were financial incentives for lifestyle, exercise and/or guideline-recommended pharmacotherapy, compared to controls without financial rewards. Adherence with the recommended intervention, clinical and economic outcomes were extracted. Data unsuitable for meta-analysis was reported descriptively. Critical appraisal was undertaken using Joanna Briggs Institute tools.
Results:
The search identified 1,462 studies, after screening 34 RCTs were included with total recruitment of 35,102 patients. Financial incentive types spanned medication co-payment abolishment, lotteries, process or outcome-based, loss or gain-framed mechanisms ranging from approximately AU$5–178 per week (inflation adjusted). In pooled analysis of varied outcomes, financial incentives modestly improved clinical parameters (Standard Mean Difference (SMD) 0.11 (0.03–0.190), I2 63%, p=0.009, 18 trials, n=14,792) and consistently improved adherence with medication and lifestyle interventions (Odds Ratio 2.06 (1.55–2.75), I2 81%, p=0.00001, 8 trials, n=15,613, Figure). High heterogeneity was observed due to diversity of incentives and outcomes. Subgroup analyses indicated that some clinical outcomes (such as weight) regularly improved with incentives, yet haematological parameters and hospital admissions were frequently unchanged.
Conclusions:
This systematic review found financial incentives improve adherence with primary and secondary prevention strategies and may improve some clinical parameters.
| Original language | English |
|---|---|
| Pages (from-to) | 1-1 |
| Number of pages | 1 |
| Journal | Heart, Lung and Circulation |
| Volume | 34 |
| Issue number | Supplement 4 |
| Publication status | Published - Aug 2025 |
| Event | Cardiac Society Australia New Zealand Scientific Conference: 73rd Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand - Convention Centre, Brisbane, Australia Duration: 14 Aug 2025 → 17 Aug 2025 https://www.csanzasm.com/ |
