title: Conceptual model and economic experiments to explain nonpersistence and enable mechanism designs fostering behavioral change.
abstract: BACKGROUND
  Medical nonpersistence is a worldwide problem of striking magnitude. Although many fields of studies including epidemiology, sociology, and psychology try to identify determinants for medical nonpersistence, comprehensive research to explain medical nonpersistence from an economics perspective is rather scarce.
  
  
  OBJECTIVE
  The aim of the study was to develop a conceptual framework that augments standard economic choice theory with psychological concepts of behavioral economics to understand how patients' preferences for discontinuing with therapy arise over the course of the medical treatment. The availability of such a framework allows the targeted design of mechanisms for intervention strategies.
  
  
  METHODS
  Our conceptual framework models the patient as an active economic agent who evaluates the benefits and costs for continuing with therapy. We argue that a combination of loss aversion and mental accounting operations explains why patients discontinue with therapy at a specific point in time. We designed a randomized laboratory economic experiment with a student subject pool to investigate the behavioral predictions.
  
  
  RESULTS
  Subjects continue with therapy as long as experienced utility losses have to be compensated. As soon as previous losses are evened out, subjects perceive the marginal benefit of persistence lower than in the beginning of the treatment. Consequently, subjects start to discontinue with therapy.
  
  
  CONCLUSIONS
  Our results highlight that concepts of behavioral economics capture the dynamic structure of medical nonpersistence better than does standard economic choice theory. We recommend that behavioral economics should be a mandatory part of the development of possible intervention strategies aimed at improving patients' compliance and persistence behavior.
authors.affiliation: Department of Management, University of Paderborn, Paderborn, Germany. Electronic address: behnud.djawadi@wiwi.uni-paderborn.de.
authors.forename: Behnud Mir
authors.initials: BM
authors.lastname: Djawadi
authors.affiliation: Department of Management, University of Paderborn, Paderborn, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Fahr
authors.affiliation: GlaxoSmithKline plc, Brentford, Middlesex, UK.
authors.forename: Florian
authors.initials: F
authors.lastname: Turk
mesh_terms: D002755:Choice Behavior; D003657:Decision Making; D015438:Health Behavior; D006801:Humans; D018803:Models, Economic; D008960:Models, Psychological; D010349:Patient Compliance / Q000523:psychology*; D010352:Patient Dropouts / Q000523:psychology; D057240:Patient Preference / Q000191:economics* / Q000523:psychology*; D012107:Research Design
keywords: behavioral economics; financial incentives; health behavior; laboratory experiment; medication adherence; medication persistence; mental accounting; patient behavior; patient compliance; prospect theory