Study Will Provide Cash Payments To Encourage People With Chronic Diseases To Take Medications

The Hartford Courant on Sunday examined a new lottery-like program that offers patients a chance at winning daily cash prizes of $10 or $100 if they promptly take their prescription medications.

According to the Courant, the lottery program -- part of a $40,000 study developed by the University of Pennsylvania's School of Medicine and the Aetna Foundation -- is "an unusual and fun way of getting at a huge problem -- failure of people with chronic conditions to take medications as prescribed." According to the Courant, patients' failure to take medications on schedule can have "dire and costly consequences for people's health and the nation's strained health care system."

For the study, Stephen Kimmel -- director of cardiovascular epidemiology and associate professor of medicine and epidemiology at Penn -- and Kevin Volpp, the key investigators in the study, will enroll 100 adult patients and observe them for 180 days. Each patient will be given a "Med-eMonitor," a device that is electronically linked to a medication database and programmed remotely via the Internet. While the device's reminder mechanism will not be activated for the duration of the study, it will ask patients to indicate when they are taking their pills, so that they will be entered into the daily drawing for the cash prize.

Only 50 of the 100 participants will be eligible for the drawings, while the remaining 50 patients will be the control group. More than half of the 100 patients already have been enrolled in the study, which will focus on patients who take warfarin, a blood-thinning drug to prevent stroke that is commonly sold under the brand name Coumadin. Kimmel said he believes other drugs that require careful, consistent use also would lend themselves to a lottery approach, such as certain anti-epileptic drugs, medications to prevent rejection of transplanted organs and HIV/AIDS drugs. Kimmel said that after the warfarin study concludes, "then we have to have a discussion about whether and when it's appropriate to use (a lottery), if at all."

Extent, Implications, Debate
According to the World Health Organization, various reports indicate that only about 50% of patients with serious ailments in developed countries take their medications as prescribed. In addition, about 125,000 people in the U.S. die annually from illnesses that can be treated because they fail to take their medications as instructed, according to a study published in the Journal of Applied Research.

The study also stated that about $8.5 billion in incurred costs at U.S. hospitals can be attributed to the failure of patients to take their medications properly. According to the Courant, a "lively debate is likely" regarding the program.

Shannon Kampa, a principal and director of pharmacy for Mercer, said that, if employers used the program, they would have to consider whether it is fair because it could seem as if employees are being rewarded for being ill. In addition, the lottery could be viewed "as a bribe to people who should have taken more initiative on their own to protect or improve their health," the Courant reports (Levick, Hartford Courant, 6/22).