Financial incentives improve Hep B vaccination rate among injection drug users

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1. Patients undergoing treatment for heroin addiction who received small financial incentives (maximum £30 of supermarket vouchers) were at least 12 times more likely to complete a course of hepatitis B virus (HBV) vaccination than those who received no incentive.

2. At least 80% of participants receiving financial incentives attended appointments on time, ensuring a more efficient use of clinic resources, which may translate into cost-effective practice. 

Evidence Rating Level: 1 (Excellent)      

Study Rundown: High rates of adherence to treatment maximize public health benefits from health interventions. Injecting drug users are at an increased risk for HBV infection and transmission, but adherence to vaccination schedules is poor. This study assessed the effect of providing a small financial incentive (£30 vouchers) to injection drug users completing HBV vaccination. Financial incentive significantly improved adherence to vaccination programs, supporting the implementation of financial incentives in this setting as well as other areas that could potentially benefit from improved appointment adherence such as early antenatal care or tuberculosis testing. Participants were largely representative of patients in opioid substitution programs in the UK, supporting translatability of these findings if this program is scaled-up. Though this study was limited by clinician adherence to some aspects of the intervention (such as failure to explain the schedule and checking understanding of participants) the incentive was correctly given in 96% of appointments.

The study was funded by the UK National Institute for Health Research (RP-PG-0707-10149).

Click to read the study, published today in The Lancet

Relevant Reading: A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users

In-Depth [cluster randomized trial]: This study enrolled 210 eligible participants receiving opioid substitution therapy at 12 National Health Service drug treatment services in the UK. Participants received HBV vaccination on days 0, 7, and 21 and were divided into 3 clusters. On-time attendance for vaccination appointments was rewarded with either no incentive (usual treatment), with a fixed financial incentive (3 £10 vouchers), or with an increasing financial incentive (£5, £10, and £15 vouchers). The participants were divided 1:1:1 randomly to one of the 3 clusters.

HBV vaccination within 28 days was the primary outcome and sensitivity analyses examining vaccination completion with full adherence to appointment schedule in a three-month window were also performed. Participants in the clusters receiving financial incentive met the primary outcome measure at much higher rates than did the cluster receiving no financial incentive. 35 (45%) of 78 participants in the fixed incentive cluster met the primary outcome measure (odds ratio 12.1, 95% CI 3.7-39.9; p<0.0001) as did 32 (49%) of 65 participants in the increasing incentive cluster 14.0, 4.2-46.2; p<0.0001) compared to six (9%) of 67 participants treated without such incentives.

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