Active Choice and Financial Incentives to Increase Rates of Screening Colonoscopy – a Randomized Controlled Trial

In Gastroenterology, Shivan Mehta and colleagues, including Chyke Doubeni, Kevin Volpp, and David Asch, examine various behavioral economics approaches to increase uptake for colorectal cancer screening. The authors assigned 2,245 individuals, all employees of a large academic health system, to one of three interventions: an e-mail containing a phone number for scheduling (control), an e-mail with the active choice to opt in or opt out (active choice), or the active choice e-mail plus a $100 incentive (financial incentive). Participants were followed to determine whether they got a colonoscopy within three months. Higher proportions of participants in the financial incentive group underwent screening (3.7%) than in the control (1.6%) or active choice groups (1.5%). The authors conclude that behavioral economic incentives can modestly increase colonoscopy rates, and employers and insurers may use these tactics to reduce the burden of colorectal cancer.