Effect of Financial Incentives on Hypertension Control: A Multicenter Randomized Controlled Trial in China

BACKGROUND: Poorly controlled hypertension is a great challenge to global public health. Incentive approaches, based on behavioral and economic concepts, may improve patients' adherence to treatment. METHODS: We conducted a 2-arm randomized controlled trial to test whether financial incentives can help patients with poorly controlled hypertension in China reduce their blood pressure (BP). Participants were randomized 1:1 to the control and intervention groups. All participants received WeChat-based standard education and support for hypertension management. The intervention group received financial incentives, including process- and outcome-based incentives. RESULTS: No statistically significant differences in BP reduction and hypertension control rates were found between the two groups from baseline to 12-month follow-up. Mean systolic BP decreased from 158.7 to 149.8 mm Hg in the intervention group and 159.7 to 149.5 mm Hg in the control group (P=0.639). Mean diastolic BP decreased from 93.7 to 86.6 mm Hg in the intervention group and 93.9 to 86.3 mm Hg in the control group (P=0.667). Hypertension control rates in the intervention and control groups were 20.8% and 15.8%, respectively (P=0.318). Medication adherence was 84.2% in the intervention group and 86.2% in the control group (P=0.705). CONCLUSIONS: Financial incentives were effective in the short term for BP control, but a sustained effect of incentive-based BP control was not identified beyond 3 months of intervention. Future studies that focus on identifying the appropriate amount and structure of financial incentives for BP control are warranted.

Automated summary

This study found that financial incentives were effective in the short-term for controlling blood pressure in patients with poorly controlled hypertension, but did not show a sustained effect beyond 3 months of intervention. Future research is needed to identify the appropriate amount and structure of financial incentives for blood pressure control.