title: Novel incentive-based approaches to adherence.
abstract: BACKGROUND
  Adherence to medications for chronic conditions is often very low, limiting the benefit to patients, even when the medications are effective and have favorable side effect profiles.
  
  
  OBJECTIVE
  This article reviews some of the prior work on treatment adherence, introduces novel concepts from behavioral economics that can be used to design interventions to improve adherence, and proposes new approaches for clinical trials.
  
  
  METHODS
  Relevant experience of the authors and insights from the literature were combined to identify key issues and propose methodological improvements. Specific examples regarding adherence to warfarin are provided.
  
  
  RESULTS
  Several new approaches to trial design can be effectively applied in the context of medication adherence. These include tailored intervention strategies and sequential multiple assignment randomized trial (SMART) designs.
  
  
  CONCLUSIONS
  While we have proposed to use these new approaches for ongoing studies of adherence in behavioral health, practical experience with their application is still somewhat limited.
  
  
  CONCLUSIONS
  Behavioral economics offer a variety of concepts that, when used in the design of interventions to improve adherence, may be more successful than traditional approaches. New clinical trial designs can also be adopted to improve the efficiency of studies that assess these approaches.
authors: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, 19104-6021, USA.
authors: Stephen E
authors: SE
authors: Kimmel
authors: Andrea B
authors: AB
authors: Troxel
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D060909:Economics, Behavioral; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D009042:Motivation; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D017010:Reminder Systems; D012107:Research Design; D054556:Venous Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin