Abstract
BackgroundDespite the importance of hepatitis screening for decreasing liver cancer mortality, screening rates remain low in Japan. Previous studies show that full subsidies increase screening uptake, but full subsidies are costly and difficult to implement in low-resource settings. Alternatively, applying nudge theory to the message design could increase screening at lower costs. This study examined the effects of both methods in increasing hepatitis virus screening rates at worksites.Methods1496 employees from a Japanese transportation company received client reminders for an optional hepatitis virus screening before their general health checkups. Groups A and B received a client reminder designed based on the principles of “Easy” and “Attractive,” while the control group received a client reminder not developed using nudge theory. Additionally, hepatitis virus screening was offered to the control group and group A for a co-payment of JPY 612, but was fully subsidized for group B. The hepatitis virus screening rates among the groups were compared using a Chi-square test with Bonferroni correction, and the risk ratios of group A and group B to the control group were also calculated. To adjust for unobservable heterogeneity per cluster, the regression analysis was performed using generalized linear mixed models.ResultsThe screening rate was 21.2%, 37.1%, and 86.3% for the control group, group A, and group B, respectively. And the risk ratio for group A was 1.75 (95% confidence interval [CI] 1.45–2.12) and that of group B was 4.08 (95% CI 3.44–4.83). The parameters of group A and group B also were significant when estimated using generalized linear mixed models. However, the cost-effectiveness (incremental cost-effectiveness ratio (ICER)) of the nudge-based reminder with the full subsidies was lower than that of only the nudge-based reminder.ConclusionsWhile fully subsidized screening led to the highest hepatitis screening rates, modifying client reminders using nudge theory significantly increased hepatitis screening uptake at lower costs per person.
Highlights
Liver cancer is one of the leading causes of cancer deaths worldwide [1]
This study examines the effects of (i) making screenings free of charge and (ii) applying nudge theory to the design of client reminders on hepatitis virus screening among members of Japan Health Insurance Association (JHIA)
Cost-effectiveness of each intervention on hepatitis virus screening rates using the incremental cost-effectiveness ratio (ICER) calculation Table 3 shows the cost-effectiveness of each intervention, where a lower ICER value represents greater costeffectiveness
Summary
Liver cancer is one of the leading causes of cancer deaths worldwide [1]. In Japan, an estimated 29,000 people died of liver cancer in 2017 [2]. Approximately 70% of liver cancer cases in Japan develop from an infection caused by the hepatitis B virus (HBV) or hepatitis C virus (HCV) [3]. These patients, especially those who are infected with HCV, can be cured with minimal adverse effects using direct-acting antivirals (DAAs) [4]. Hepatitis virus screening rates at the municipal level increased. Hepatitis virus screening rates at worksites remain low in Japan. Despite the importance of hepatitis screening for decreasing liver cancer mortality, screening rates remain low in Japan. This study examined the effects of both methods in increasing hepatitis virus screening rates at worksites
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