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Financial incentives to discontinue long-term benzodiazepine use: a discrete choice experiment investigating patient preferences and willingness to participate
  1. Joachim Marti1,
  2. Marcus Bachhuber2,
  3. Jordyn Feingold3,
  4. David Meads4,
  5. Michael Richards5,
  6. Sean Hennessy6
  1. 1 Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
  2. 2 Division of General Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
  3. 3 University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4 Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  5. 5 Department of Health Policy, Vanderbilt University, Nashville, Tennessee, USA
  6. 6 Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
  1. Correspondence to Dr Joachim Marti; jomswiss{at}gmail.com

Abstract

Objectives Investigate the acceptability of financial incentives for initiating a medically supervised benzodiazepine discontinuation programme among people with long-term benzodiazepine use and to identify programme features that influence willingness to participate.

Methods We conducted a discrete choice experiment in which we presented a variety of incentive-based programs to a sample of older adults with long-term benzodiazepine use identified using the outpatient electronic health record of a university-owned health system. We studied four programme variables: incentive amount for initiating the programme, incentive amount for successful benzodiazepine discontinuation, lottery versus certain payment and whether partial payment was given for dose reduction. Respondents reported their willingness to participate in the programmes and additional information was collected on demographics, history of use and anxiety symptoms.

Results The overall response rate was 28.4%. Among the 126 respondents, all four programme variables influenced stated preferences. Respondents strongly preferred guaranteed cash-based incentives as opposed to a lottery, and the dollar amount of both the starting and conditional incentives had a substantial impact on choice. Willingness to participate increased with the amount of conditional incentive. Programme participation also varied by gender, duration of use and income.

Conclusions Participation in an incentive-based benzodiazepine discontinuation programme might be relatively low, but is modifiable by programme variables including incentive amounts. These results will be helpful to inform the design of future trials of benzodiazepine discontinuation programmes. Further research is needed to assess the financial viability and potential cost-effectiveness of such economic incentives.

  • benzodiazepines
  • addiction
  • older adults
  • financial incentives
  • behavioral economics

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors JM and DM led the design of the choice experiment. MB, JF, MR and SH contributed to the design of the choice experiment. JM performed the statistical analyses and drafted the methods and results sections. MB drafted the introduction. All authors contributed to the interpretation of results and manuscript write-up, and read and approved the final version of the manuscript.

  • Funding UPenn’s Center for Health Incentives and Behavioral Economics (CHIBE).

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval University of Pennsylvania Institutional Review Board (protocol 820106).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Our informed consent document does not permit sharing of patient-level data.

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