A randomized trial of lottery-based incentives and reminders to improve warfarin adherence: the Warfarin Incentives (WIN2) Trial.
Previous research has suggested that daily lottery incentives could improve medication adherence. Such daily incentives include implicit reminders. However, the comparative effectiveness of reminders alone versus daily incentives has not been tested.



A total of 270 patients on warfarin were enrolled in a four-arm, multi-center, randomized controlled trial comparing a daily lottery-based incentive, a daily reminder, and a combination of the two against a control group (usual care).



Participants in the reminder group had the lowest percentage of time out of target international normalized ratio (INR) range, the primary outcome, with an adjusted odds of an out-of-range INR 36% lower than among those in the control group, 95%CI [7%, 55%]. No other group had a statistically significant improvement in anticoagulation control relative to the control group or to each other. The only group that had significant improvement in incorrect adherence was the lottery group (incorrect adherence: 12.1% compared with 23.7% in the control group, difference of -7.4% 95%CI [-14%, -0.3%]). However, there was no relationship between changes in adherence and anticoagulation control in the lottery group.



Automated reminders led to the largest improvements in anticoagulation control, although without impacting measured adherence. Lottery-based reminders improved measured adherence but did not lead to improved anticoagulation control. Copyright © 2016 John Wiley & Sons, Ltd.
Center for Therapeutic Effectiveness Research, University of Pennsylvania, Philadelphia, PA, USA. stevek@mail.med.upenn.edu.|Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA. stevek@mail.med.upenn.edu.|Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. stevek@mail.med.upenn.edu.|Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. stevek@mail.med.upenn.edu.
Stephen E
SE
Kimmel
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.|Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Andrea B
AB
Troxel
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.|Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Benjamin
B
French
Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.|Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA.
George
G
Loewenstein
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Jalpa A
JA
Doshi
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Todd E H
TE
Hecht
Department of Pharmacy Service, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Mitchell
M
Laskin
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
Colleen M
CM
Brensinger
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
Chris
C
Meussner
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.|Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.|Department of Health Care Management, University of Pennsylvania, Philadelphia, PA, USA.|Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA.
Kevin
K
Volpp
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009042:Motivation; D017010:Reminder Systems; D014859:Warfarin / Q000008:administration & dosage*
D000925:Anticoagulants; D014859:Warfarin
anticoagulants; behavioral; economics; incentives; pharmacoepidemiology; trials