Financial Incentives for Alzheimer's Prevention

(FIND-AD Trial)

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Southern California

Disqualifiers: Below age 50, Dementia diagnosis

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

48000 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Financial Incentives for Alzheimer's Prevention?

Research shows that financial incentives can motivate changes in health-related behaviors and improve performance in healthcare settings. However, the effectiveness of these incentives can vary based on how they are designed and implemented, especially for older adults who may have different decision-making processes. ^{1 2 3 4 5}

Is the treatment involving financial incentives for Alzheimer's prevention safe for humans?

The research does not provide specific safety data for financial incentives as a treatment for Alzheimer's prevention, but it mentions the importance of considering safety and tolerability in future trials. ^{6 7 8 9 10}

How does the financial incentive treatment for Alzheimer's prevention differ from other treatments?

This treatment is unique because it uses financial incentives to encourage healthy behaviors that may prevent Alzheimer's, rather than relying on medication or traditional therapies. It focuses on motivating lifestyle changes through monetary rewards, which is a novel approach compared to standard medical treatments for Alzheimer's. ^{1 11 12 13 14}

What is the purpose of this trial?

This single-blind, three-arm, randomized, controlled trial will assess the impact of messages and financial incentives on the enrollment of demographically diverse individuals to the Alzheimer Prevention Trials (APT) Webstudy. The APT Webstudy is a novel, online registry that employs quarterly cognitive testing using validated platforms. The APT Webstudy implements fully remote assessments, coordinated by the Alzheimer's Therapeutic Research Institute (ATRI) under USC IRB #HS-17-00746. The purpose of the current study is to test whether we can increase enrollment of diverse individuals into the registry. To do this, we will work with Contra Costa Regional Medical Center (CCRMC), the county public hospital and its affiliated health centers in Contra Costa County, California, to test whether sending messages with and without financial incentives to patients who receive primary care with the health system can increase enrollment to the APT Webstudy. The investigators hypothesize that 1) a certain small financial incentive and an award opportunity based incentive (or a drawing with a prize) will increase enrollment rates of CCHS members into the APT Webstudy relative to the control group. The investigators further hypothesize that the award opportunity incentive will increase the enrollment rate of CCRMC patients into the APT Webstudy more than a certain financial incentive with the same expected value.

Eligibility Criteria

This trial is for individuals aged 50 or older who are patients at Contra Costa Regional Medical Center and its affiliated health centers. Participants must be literate in English or Spanish. The study aims to recruit a diverse group of people into an online Alzheimer's disease registry.

Inclusion Criteria

I am 50 years old or older.

I can read and understand either English or Spanish.

You are a patient registered at CCRMC or its associated health centers.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Enrollment

Participants are enrolled into the APT Webstudy and randomized into different arms with or without financial incentives

2 weeks

Fully remote

Cognitive Assessment

Participants complete cognitive assessments using the Cognitive Function Instrument and/or Cogstate Brief Battery

2 weeks

Quarterly remote assessments

Follow-up

Participants are monitored for enrollment status and completion of cognitive assessments

Annual

Treatment Details

Interventions

• Financial Incentives
• Message

Trial Overview The study is testing if sending messages with financial incentives, such as small cash rewards or prize drawings, can increase enrollment in the APT Webstudy—a remote cognitive testing program—compared to just sending messages without incentives.

Participant Groups

Group I: Small Incentive Experimental Treatment 1 Intervention

16,000 participants will be randomized to Arm 2 where a small one-time monetary incentive is offered.

Group II: Prize Incentive Experimental Treatment 1 Intervention

16,000 participants will be randomized to Arm 3 where an opportunity based incentive (or a drawing with a prize) with a single winner will be offered.

Group III: Messaging Only Active Control 1 Intervention

16,000 participants will be randomized to Arm 1 where no monetary incentive is offered.

Who Is Running the Clinical Trial?

University of Southern California

Lead Sponsor

Trials

956

Recruited

1,609,000+

American Heart Association

Collaborator

Trials

352

Recruited

6,196,000+

Schaeffer Center for Health Policy & Economics

Collaborator

Trials

1

Recruited

48,000+

Alzheimer's Therapeutic Research Institute

Collaborator

Trials

18

Recruited

58,400+

Findings from Research

Financial incentive programs aimed at changing health-related behaviors may not be suitable for older adults due to their unique cognitive and emotional characteristics, such as changes in emotional regulation and decision-making preferences.

To be effective, these programs should be designed with the specific needs and decision-making styles of older adults in mind, which could enhance their impact and economic success in improving health outcomes for this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Challenges and opportunities for developing and implementing incentives to improve health-related behaviors in older adults. Klein, E., Karlawish, J.[2021]

Financial incentives can be effective in changing healthcare professional practices, particularly in improving processes of care and prescribing costs, but the evidence is limited and has serious methodological flaws.

There is no conclusive evidence that financial incentives positively impact patient outcomes, highlighting the need for more comprehensive and rigorous studies in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Flodgren, G., Eccles, MP., Shepperd, S., et al.[2022]

A study involving 1,917 patients showed that while 62% of those with prescription drug coverage were enrolled in incentive-based pharmacy plans, many were unaware of their out-of-pocket costs during doctor visits, with 54% reporting they were 'never' or only 'sometimes' aware.

Patients in plans with no copayments were less likely to discuss out-of-pocket costs with their physicians compared to those in incentive-based plans, indicating that lack of awareness and communication may reduce the effectiveness of financial incentives in guiding treatment decisions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of pharmacy benefit design on patient-physician communication about costs. Shrank, WH., Fox, SA., Kirk, A., et al.[2021]

Health care systems can enhance value for money by implementing both financial and non-financial incentive structures to improve performance and reduce financial barriers for providers.

There is no one-size-fits-all approach to incentives in health care; their effectiveness varies based on specific circumstances, and careful design involving stakeholders is crucial for success.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increasing performance of health care services within economic constraints: working towards improved incentive structures. Custers, T., Klazinga, NS., Brown, AD.[2019]

Changing financial rewards can influence healthcare behavior, but simply increasing payments for quality does not guarantee better health outcomes, as evidenced by mixed research results.

Financial incentives must be carefully designed to avoid unintended consequences, such as focusing on low-risk patients or undermining intrinsic motivation, and should be evaluated for their effectiveness compared to other quality improvement strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Paying hospitals for quality: can we buy better care? Hall, JP., van Gool, KC.[2019]

Home visits significantly increased the willingness of study partners to allow their relatives with Alzheimer's disease to participate in clinical trials, with predicted participation rising from 17% to 27% when home visits were included.

Combining home visits with low risk and a higher chance of receiving the active treatment could boost willingness to participate to 60%, highlighting the importance of reducing travel hassles in recruiting participants, especially those with more severe Alzheimer's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How redesigning AD clinical trials might increase study partners' willingness to participate. Karlawish, J., Cary, MS., Rubright, J., et al.[2022]

Despite ongoing efforts, no primary prevention trial has successfully delayed the onset of Alzheimer's disease (AD), highlighting the challenges in this area of research.

Future trials must focus on safety, tolerability, long-term follow-up, and effective recruitment strategies to improve the chances of success in preventing AD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prevention of Alzheimer disease. Thal, LJ.[2019]

Disclosing Alzheimer's disease risk has traditionally been discouraged due to the limited predictive value of tests and concerns about psychological harm, but interest in risk information is growing, especially with the rise of direct-to-consumer genetic tests.

Research indicates that individuals seeking Alzheimer's risk information through formal education and counseling generally find it beneficial and do not report negative effects, suggesting a potential shift in how risk information could be communicated.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Estimating and disclosing the risk of developing Alzheimer's disease: challenges, controversies and future directions. Roberts, JS., Tersegno, SM.[2021]

In a study involving 132 older volunteers, the method of informing participants about amyloid PET scan results (blinded vs. transparent enrollment) did not affect their willingness to participate in a preclinical Alzheimer's disease trial.

Participants prioritized study risks and the need for a study partner over the disclosure of biomarker results, suggesting that requiring biomarker enrollment criteria may not hinder recruitment for Alzheimer's trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disclosure of amyloid status is not a barrier to recruitment in preclinical Alzheimer's disease clinical trials. Grill, JD., Zhou, Y., Elashoff, D., et al.[2023]

A survey of 422 older adults in a dementia prevention trial revealed high overall satisfaction with participation, particularly favoring staff-administered interviews over automated methods.

Participants were primarily motivated by altruism and expressed a desire for more human interaction, feedback on their performance, and less repetitiveness in assessments, suggesting that future trials should focus on enhancing these aspects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Participant satisfaction with dementia prevention research: Results from Home-Based Assessment trial. Sano, M., Egelko, S., Zhu, CW., et al.[2022]

A systematic review of 15 studies found that explicit financial incentives aimed at promoting health among older adults produced mixed results in changing health-related behaviors, indicating that their effectiveness may vary significantly.

Qualitative findings revealed that older individuals often have limited trust in financial incentives for health promotion, suggesting that the design of these incentive systems is critical for their acceptance and success.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Financial incentives for a healthy life style and disease prevention among older people: a systematic literature review. Tambor, M., Pavlova, M., Golinowska, S., et al.[2018]

A review of Medicaid incentive programs revealed mixed effectiveness, with only about half of the available credits claimed in Florida, indicating potential issues with understanding or attractiveness of the incentives.

In contrast, Idaho's program successfully increased the number of children receiving timely well-child visits, suggesting that well-designed incentives can lead to positive health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medicaid incentive programs to encourage healthy behavior show mixed results to date and should be studied and improved. Blumenthal, KJ., Saulsgiver, KA., Norton, L., et al.[2022]

In a study of 35 randomized controlled trials, financial incentives (FIs) based on behavioral-economic principles, particularly deposit contracts, were found to be the most effective in promoting healthy diet, weight control, and physical activity, significantly increasing goal achievement compared to no incentives.

While both deposit and lottery-based incentives improved physical activity levels during the intervention, only the deposit incentive maintained its effectiveness in the follow-up period, suggesting that behavioral insights can enhance the long-term impact of financial incentives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of the Effectiveness of Behavioral Economic Incentive Programs for Goal Achievement on Healthy Diet, Weight Control and Physical Activity: A Systematic Review and Network Meta-analysis. Boonmanunt, S., Pattanaprateep, O., Ongphiphadhanakul, B., et al.[2023]

Financial incentives can be a promising strategy to encourage healthy behaviors in children, but their design must consider factors like intrinsic motivation and ethical implications, as well as the child's developmental stage.

Current research indicates that immediate, small incentives may be more effective than delayed, larger ones for promoting behaviors like healthy eating, but there is no clear advantage of loss-framed incentives over gain-framed ones in children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting Healthy Childhood Behaviors With Financial Incentives: A Narrative Review of Key Considerations and Design Features for Future Research. Kenyon, CC., Flaherty, C., Floyd, GC., et al.[2023]

References

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

Challenges and opportunities for developing and implementing incentives to improve health-related behaviors in older adults. [2021]

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

An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. [2022]

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

The effect of pharmacy benefit design on patient-physician communication about costs. [2021]

4. Germany pubmed.ncbi.nlm.nih.gov

Increasing performance of health care services within economic constraints: working towards improved incentive structures. [2019]

5. Australia pubmed.ncbi.nlm.nih.gov

Paying hospitals for quality: can we buy better care? [2019]

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

How redesigning AD clinical trials might increase study partners' willingness to participate. [2022]

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

Prevention of Alzheimer disease. [2019]

8. England pubmed.ncbi.nlm.nih.gov

Estimating and disclosing the risk of developing Alzheimer's disease: challenges, controversies and future directions. [2021]

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

Disclosure of amyloid status is not a barrier to recruitment in preclinical Alzheimer's disease clinical trials. [2023]

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

Participant satisfaction with dementia prevention research: Results from Home-Based Assessment trial. [2022]

11. England pubmed.ncbi.nlm.nih.gov

Financial incentives for a healthy life style and disease prevention among older people: a systematic literature review. [2018]

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

Medicaid incentive programs to encourage healthy behavior show mixed results to date and should be studied and improved. [2022]

13. England pubmed.ncbi.nlm.nih.gov

Evaluation of the Effectiveness of Behavioral Economic Incentive Programs for Goal Achievement on Healthy Diet, Weight Control and Physical Activity: A Systematic Review and Network Meta-analysis. [2023]

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

Promoting Healthy Childhood Behaviors With Financial Incentives: A Narrative Review of Key Considerations and Design Features for Future Research. [2023]