Opportunity 

Cardiovascular disease is the leading cause of death in the United States. Statins lower cholesterol and reduce the risk of myocardial infarction by 30 percent, but even among patients who have had a heart attack, nearly half stop taking their statin medications within a year of their initial prescription. 

Intervention 

A team of researchers at the University of Pennsylvania leveraged Way to Health to assess whether behavioral economic interventions might improve statin adherence and low-density lipoprotein cholesterol (LDL-C) levels in at-risk populations. The team recruited 805 participants at elevated risk of heart disease and suboptimal statin adherence to participate in a randomized controlled trial.  

All participants received a wireless-enabled pill bottle for their statins and consented to receive daily reminder messages to take their medication. Participants in intervention arms were eligible for one of three financial incentives for six months: 1) A simple sweepstakes rewarding daily medication adherence, 2) A deadline sweepstakes where participants received either a full or reduced incentive depending on whether they took their medication before or after their daily reminder, or 3) Incentives divided between daily sweepstakes and a monthly deposit.  

LDL-C was measured at baseline, six months, and 12 months. 

Impact 

Compared with the control group, different financial incentives improved statin adherence but not LDL-C levels. This result points to the importance of directly measuring health outcomes, rather than simply adherence, in trials aimed at improving health behaviors.