Lottery Incentives Research Articles

Testing the effectiveness of lottery incentives in online experiments

AbstractThis article investigates the effectiveness of lottery incentive schemes for eliciting consumer valuations in large‐scale online experiments. We implement a fully incentivized condition within a geographically dispersed sample of consumers in which bids for a Criollo steak elicited by a Becker‐DeGroot‐Marschak mechanism are realized with certainty and the products are priority shipped in dry‐ice coolers. The fully incentivized condition is compared to between‐subject random incentivized schemes, in which only a fraction of subjects realize their choices. We tested two treatments with a 10% probability framed as a percentage or an absolute number of subjects, one treatment with a 1% probability, and a purely hypothetical reference condition. The results reveal that between‐subject random incentivized schemes with 10% and 1% payment probabilities are effective in eliciting valuations that are statistically indistinguishable from the fully incentivized scheme. In addition to finding insignificant statistical differences between 10% and 1% and the fully incentivized scheme, all incentivized conditions mitigate hypothetical bias, resulting in lower product valuations than the purely hypothetical condition. We contribute a novel methodological framework for conducting large‐scale experiments with geographically diverse and representative subjects, increasing the external validity and producing reliable valuations while significantly reducing financial and logistic constraints.

Qualitative analysis of a remote monitoring intervention for managing heart failure

BackgroundHeart failure (HF) is one of the most common reasons for hospital admission and is a major cause of morbidity, mortality, and increasing health care costs. The EMPOWER study was a randomized trial that used remote monitoring technology to track patients’ weight and diuretic adherence and a state-of-the-art approach derived from behavioral economics to motivate adherence to the reverse monitoring technology.ObjectiveThe goal was to explore patient and clinician perceptions of the program and its impact on perceived health outcomes and better understand why some patients or clinicians did better or worse than others in response to the intervention.ApproachThis was a retrospective qualitative study utilizing semi-structured interviews with 43 patients and 16 clinicians to understand the trial’s processes, reflecting on successes and areas for improvement for future iterations of behavioral economic interventions.Key resultsMany patients felt supported, and they appreciated the intervention. Many also appreciated the lottery intervention, and while it was not an incentive for enrolling for many respondents, it may have increased adherence during the study. Clinicians felt that the intervention integrated well into their workflow, but the number of alerts was burdensome. Additionally, responses to alerts varied considerably by provider, perhaps because there are no professional guidelines for alerts unaccompanied by severe symptoms.ConclusionOur qualitative analysis indicates potential areas for additional exploration and consideration to design better behavioral economic interventions to improve cardiovascular health outcomes for patients with HF. Patients appreciated lottery incentives for adhering to program requirements; however, many were too far along in their disease progression to benefit from the intervention. Clinicians found the amount and frequency of electronic alerts burdensome and felt they did not improve patient outcomes.Trial registrationClinicalTrials.gov Identifier: NCT02708654.

Effectiveness of Behavioural Economics Informed Interventions for the Prevention, Screening, and Antiretroviral Treatment of HIV Infection: A Systematic Review of Randomized Controlled Trials.

Failure to meet international targets set for the human immunodeficiency virus HIV pandemic suggests that more effective public health strategies are needed. New strategies informed by behavioural economics are now increasingly being tested, with promising results. However, the evidence base is diverse and challenging for policymakers to interpret. This paper aims to synthesise existing evidence by reporting results from a systematic review of behavioural economics-based interventions for addressing HIV prevention, testing and treatment. The reported study was a systematic review of randomized controlled trials. The search was conducted in four electronic medical literature databases, six trial registries, four grey literature sources and was not restricted to any country or region. Bias was assessed using criteria outlined in the Cochrane Handbook for Systematic Reviews; quality of evidence was assessed using GRADE methodology. Fifteen full text articles were included in the final analysis. The synthesis of these studies revealed that strategies involving opt-out defaults, active-choice defaults, and lottery incentives can potentially increase uptake of HIV testing. Lottery incentives also showed signs of effectiveness in improving HIV prevention, ART adherence and initiation. Despite the promising findings, the overall evidence was judged to be of moderate to very low quality. Behavioural economics-based interventions are promising behavioural change strategies, although more well-designed studies are needed to strengthen the evidence base.

Cash versus lottery video messages: online COVID-19 vaccine incentives experiment

Abstract During the COVID-19 pandemic, governments offered financial incentives to increase vaccine uptake. We evaluate the impact on COVID-19 vaccine uptake of cash equivalents versus being entered into lotteries. We randomly assign 1628 unvaccinated US participants into one of three 45-second informational videos promoting vaccination with messages about (a) health benefits of COVID-19 vaccines (control), (b) being entered into lotteries or (c) receiving cash equivalent vouchers. After seeing the control health information video, 16% of individuals wanted information on COVID-19 vaccination. This compared with 14% of those assigned to the lottery video (odds ratio of 0.82 relative to control: 95% credible interval, 0.58–1.17) and 22% of those assigned to the cash voucher video (odds ratio of 1.53 relative to control: 95% credible interval, 1.11–2.11). These results support greater use of cash vouchers to promote information seeking about COVID-19 vaccination and do not support the use of lottery incentives.

Lottery incentives for smoking cessation at the workplace: design and protocol of the smoke-free lottery - a cluster randomized trial

BackgroundSmoking is the leading behavioral risk factor for the loss of healthy life years. Many smokers want to quit, but have trouble doing so. Financial incentives in workplace settings have shown promising results in supporting smokers and their design influences their impact. Lotteries that leverage behavioral economic insights might improve the effectiveness of workplace cessation support.Methods and designWe examine in a cluster randomized trial if a workplace cessation group training paired with lottery deadlines will increase continuous abstinence rates over and above the cessation training alone. Organizations are randomized to either the control arm or lottery arm. The lotteries capitalize regret aversion by always informing winners at the deadline, but withholding prizes if they smoked. In the lottery-arm, winners are drawn out of all participants within a training group, regardless of their smoking status. In weeks 1-13 there are weekly lotteries. Winners are informed about their prize (€50), but can only claim it if they did not smoke that week, validated biochemically. After 26 weeks, there is a long-term lottery where the winners are informed about their prize (vacation voucher worth €400), but can only claim it if they were abstinent between weeks 13 and 26. The primary outcome is continuous abstinence 52 weeks after the quit date.DiscussionThere is a quest for incentives to support smoking cessation that are considered fair, affordable and effective across different socioeconomic groups. Previous use of behavioral economics in the design of lotteries have shown promising results in changing health behavior. This cluster randomized trial aims to demonstrate if these lotteries are also effective for supporting smoking cessation. Therefore the study design and protocol are described in detail in this paper. Findings might contribute to the application and development of effective cessation support at the workplace.Trial registrationNetherlands Trial Register Identifier: NL8463. Date of registration: 17-03-2020.

Supplemental Material for Experimental Tests of Hypothetical Lottery Incentives on Unvaccinated Adults’ COVID-19 Vaccination Intentions

Supplemental Material for Experimental Tests of Hypothetical Lottery Incentives on Unvaccinated Adults’ COVID-19 Vaccination Intentions

Decision and Control Model for Promoting Public Transit via Lottery Incentives

This article reports on a decision model that highlights a reward-based promotional strategy for a bus organization to maintain its market. The market control law is obtained from an optimal solution in the system equations on the basis of the relationship among the transit operator, ticket agent, and government. The article presents a case study for the Taipei bus transit system. Results in this research confirm the effectiveness of the proposed strategy for bus operators as well as for traffic improvement. The proposed model reveals the optimal actions for the agent and bus operators under governmental policy.

Lottery Incentives and Resource Management: Evidence from the Agricultural Data Reporting Incentive Program (AgDRIP)

Lottery Incentives and Resource Management: Evidence from the Agricultural Data Reporting Incentive Program (AgDRIP)

Promised and Lottery Airtime Incentives to Improve Interactive Voice Response Survey Participation Among Adults in Bangladesh and Uganda: Randomized Controlled Trial.

BackgroundIncreased mobile phone penetration allows the interviewing of respondents using interactive voice response surveys in low- and middle-income countries. However, there has been little investigation of the best type of incentive to obtain data from a representative sample in these countries.ObjectiveWe assessed the effect of different airtime incentives options on cooperation and response rates of an interactive voice response survey in Bangladesh and Uganda.MethodsThe open-label randomized controlled trial had three arms: (1) no incentive (control), (2) promised airtime incentive of 50 Bangladeshi Taka (US $0.60; 1 BDT is approximately equivalent to US $0.012) or 5000 Ugandan Shilling (US $1.35; 1 UGX is approximately equivalent to US $0.00028), and (3) lottery incentive (500 BDT and 100,000 UGX), in which the odds of winning were 1:20. Fully automated random-digit dialing was used to sample eligible participants aged ≥18 years. The risk ratios (RRs) with 95% confidence intervals for primary outcomes of response and cooperation rates were obtained using log-binomial regression.ResultsBetween June 14 and July 14, 2017, a total of 546,746 phone calls were made in Bangladesh, with 1165 complete interviews being conducted. Between March 26 and April 22, 2017, a total of 178,572 phone calls were made in Uganda, with 1248 complete interviews being conducted. Cooperation rates were significantly higher for the promised incentive (Bangladesh: 39.3%; RR 1.38, 95% CI 1.24-1.55, P<.001; Uganda: 59.9%; RR 1.47, 95% CI 1.33-1.62, P<.001) and the lottery incentive arms (Bangladesh: 36.6%; RR 1.28, 95% CI 1.15-1.45, P<.001; Uganda: 54.6%; RR 1.34, 95% CI 1.21-1.48, P<.001) than those for the control arm (Bangladesh: 28.4%; Uganda: 40.9%). Similarly, response rates were significantly higher for the promised incentive (Bangladesh: 26.5%%; RR 1.26, 95% CI 1.14-1.39, P<.001; Uganda: 41.2%; RR 1.27, 95% CI 1.16-1.39, P<.001) and lottery incentive arms (Bangladesh: 24.5%%; RR 1.17, 95% CI 1.06-1.29, P=.002; Uganda: 37.9%%; RR 1.17, 95% CI 1.06-1.29, P=.001) than those for the control arm (Bangladesh: 21.0%; Uganda: 32.4%).ConclusionsPromised or lottery airtime incentives improved survey participation and facilitated a large sample within a short period in 2 countries.Trial RegistrationClinicalTrials.gov NCT03773146; http://clinicaltrials.gov/ct2/show/NCT03773146

Remote Monitoring and Behavioral Economics in Managing Heart Failure in Patients Discharged From the Hospital

Close remote monitoring of patients following discharge for heart failure (HF) may reduce readmissions or death. To determine whether remote monitoring of diuretic adherence and weight changes with financial incentives reduces hospital readmissions or death following discharge with HF. The Electronic Monitoring of Patients Offers Ways to Enhance Recovery (EMPOWER) study, a 3-hospital pragmatic trial, randomized 552 adults recently discharged with HF to usual care (n = 280) or a compound intervention (n = 272) designed to inform clinicians of diuretic adherence and changes in patient weight. Patients were recruited from May 25, 2016, to April 8, 2019, and followed up for 12 months. Investigators were blinded to assignment but patients were not. Analysis was by intent to treat. Participants randomized to the intervention arm received digital scales, electronic pill bottles for diuretic medication, and regret lottery incentives conditional on the previous day's adherence to both medication and weight measurement, with $1.40 expected daily value. Participants' physicians were alerted if participants' weights increased 1.4 kg in 24 hours or 2.3 kg in 72 hours or if diuretic medications were missed for 5 days. Alerts and weights were integrated into the electronic health record. Participants randomized to the control arm received usual care and no further study contact. Time to death or readmission for any cause within 12 months. Of the 552 participants, 290 were men (52.5%); 291 patients (52.7%) were Black, 231 were White (41.8%), and 16 were Hispanic (2.9%); mean (SD) age was 64.5 (11.8) years. The mean (SD) ejection fraction was 43% (18.1%). Each month, approximately 75% of participants were 80% adherent to both medication and weight measurement. There were 423 readmissions and 26 deaths in the control group and 377 readmissions and 23 deaths in the intervention group. There was no significant difference between the 2 groups for the combined outcome of all-cause inpatient readmission or death (unadjusted hazard ratio, 0.91; 95% CI, 0.74-1.13; P = .40) and no significant differences in all-cause inpatient readmission or observation stay or death, all-cause cardiovascular readmission or death, time to first event, and total all-cause deaths. Participants in the intervention group were slightly more likely to spend fewer days in the hospital. In this randomized clinical trial, there was no reduction in the combined outcome of readmission or mortality in a year-long intensive remote monitoring program with incentives for patients previously hospitalized for HF. ClinicalTrials.gov Identifier: NCT02708654.

Do Incentives Crowd Out Motivation? A Feasibility Study of a Community Vector-Control Campaign in Peru

Incentives are a useful tool in encouraging healthy behavior as part of public health initiatives. However, there remains concern about motivation crowd out—a decline in levels of motivation to undertake a behavior to below baseline levels after incentives have been removed—and few public health studies have assessed for motivation crowd out. Here, we assess the feasibility of identifying motivation crowd out following a lottery to promote participation in a Chagas disease vector control campaign. We look for evidence of crowd out in subsequent participation in the same behavior, a related behavior, and an unrelated behavior. We identified potential motivation crowd out for the same behavior, but not for related behavior or unrelated behaviors after lottery incentives are removed. Despite some limitations, we conclude that motivation crowd out is feasible to assess in large-scale trials of incentives.

IMPACT OF LOTTERY INCENTIVE ON RESPONSE RATE AND DATA QUALITY: EVIDENCE FROM ORGANIC FOOD CONSUMPTION SURVEY OF CONVENTIONAL SHOPPERS

Incentives of different forms and at different stages are used for motivating people to participate in human subject research. Although it is widely accepted that incentives, in general, play a positive role in increasing participation rate and are widely used, there are exceptions that they may not increase response rate and may even contaminate the quality of data resulting in poor research findings. This study examines the impact of pre- and post-disclosed committed lottery incentives on response rate and data quality in a face-to-face survey of conventional consumers for organic food consumption. A survey was conducted at the premises of four conventional grocery stores in Edmonton, Alberta, Canada. Half of the randomly approached and agreed upon respondents were disclosed the lottery incentives at the beginning, and the rest half were told at the end. Data quality was measured using three indicators – edit occurrences, imputation occurrences, and proportion of incomplete answers. Our study finds little difference in response rate between pre- and post-disclosed committed lottery payments. However, the useability of incomplete questionnaires among post-disclosed lottery was significantly higher than those of pre-disclosed. Our study also shows that people with likings of organic food and buying organic food more frequently are likely to offer a better quality of information.

The Origins of Behavioural Public Policy

The Origins of Behavioural Public Policy

VAT lottery incentives: An opportunity for South Africa?

Some countries have introduced receipt-based tax lotteries (value-added tax (VAT) lotteries) in recent years in an effort to improve tax compliance. This acknowledges that the traditional method of tax compliance enforcement through audits, fines and penalties alone may no longer be optimal. The idea of a VAT lottery is to incentivise consumers to ask for a receipt when paying for goods or services, which serves as a lottery ticket that gives the consumer an opportunity to win a prize. The decline in tax compliance globally poses a threat to revenue collection and, ultimately, to governments’ ability to meet their spending commitments. Other countries, but particularly South Africa, may benefit from implementing a VAT lottery to assist in improved VAT collection. This study aims to analyse VAT lotteries that have been implemented across the world – particularly in the European Union (EU) member countries – through a systematised review in order to determine whether such a lottery could improve taxpayer compliance in South Africa. Of the six EU member countries analysed in detail, four showed a decrease in the VAT gap in the years following the VAT lottery implementation. VAT gap data post-implementation was not available for two of the countries. Positive results include an increase in the number of vendors reported for refusing to issue invoices, a reduction in the number of non-validated receipts, and increased VAT collection. The finance ministers of two countries, and the Ministry of Finance of another, publicly declared the VAT lotteries successful.

Family monetary incentives as a value-based care model for oral hygiene: rationale and design of the BEhavioral EConomics for Oral health iNnovation (BEECON) trial.

Effective prevention-focused, value-based strategies are needed to improve oral health. Despite evidence that monetary incentives can motivate healthy behavior, well-powered studies have yet to examine incentives for improving children's oral hygiene. Describe the rationale and design of the BEhavioral EConomics for Oral health iNnovation (BEECON) trial, which tests lottery-based monetary incentives as a consumer-oriented, value-based care model for improving children's oral hygiene. Phase II, stratified, permuted block randomized, controlled, two-arm, parallel groups, prevention trial. Study visits occur at three Los Angeles, CA health clinics. Two hundred and forty-four parent-child dyads with a child aged 6-48 months. Eligible dyads were randomized in equal allocation to one of two groups: lottery incentive group or waitlist (delayed incentive) control group. Weekly lottery incentives were offered for 6 months based on Bluetooth-recorded toothbrushing frequency. Both groups received weekly text message feedback on toothbrushing performance. The primary outcome was toothbrushing performance from baseline to 6 months, measured as the mean number of qualifying half-day Bluetooth-recorded episodes per week when the child's teeth were brushed. Secondary outcomes included toothbrushing performance sustainability through 12 months and dental caries status. BEECON offers a consumer-oriented approach to promoting value-based oral health care. We hypothesize that lottery-based incentives can improve oral hygiene in young children. Study results will inform programming efforts to enhance oral disease prevention in young children. ClinicalTrials.gov identifier NCT03576326.

Monetary incentives for improving smartphone-measured oral hygiene behaviors in young children: A randomized pilot trial.

AimsTo assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application.DesignA stratified, parallel-group, three-arm individually randomized controlled pilot trial.SettingTwo Los Angeles area Early Head Start (EHS) sites.Participants36 parent-child dyads enrolled in an EHS home visit program for 0–3 year olds.InterventionsEligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks.OutcomesPrimary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child’s teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs.FindingsDigital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16.ConclusionsTrial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration.Trial registrationClinicalTrials.gov identifier NCT03862443.

Lottery incentives have short-term impact on ART initiation among men: results from a randomized pilot study.

IntroductionAmong people living with HIV in South Africa, viral suppression is lower among men than women. The study aim was to test the impact of lottery incentives, which reward positive health choice (e.g. antiretroviral therapy (ART) linkage) with a chance to win a prize, on strengthening the HIV care continuum including ART initiation and viral suppression for men.MethodsWe conducted a randomized, prospective trial of lottery incentives in the context of HIV testing and linkage to ART in rural KwaZulu‐Natal, South Africa. Men living with HIV were randomly allocated to: lottery incentives and motivational text messages or motivational text messages only. Lottery prize eligibility was conditional on clinic registration, ART initiation, or viral suppression by one, three and six months respectively. After completing each continuum step, participants in the lottery group were notified whether they had won and were encouraged to continue in care. Lottery prizes were either a mobile phone, data or a gift card (valued at R1000/$100). Kaplan–Meier curves were plotted to determine time to ART initiation by study group. The primary outcome was viral suppression at six months.ResultsBetween November 2017 and December 2018, we tested 740 men for HIV and enrolled 131 HIV‐positive men who reported not being on ART. At baseline, 100 (76%) participants were 30 years and older, 95 (73%) were unemployed and the median CD4 count was 472 cells/μL. At study exit, 84% (110/131) of participants had visited a clinic and 62% (81/131) were virally suppressed. Compared to motivational text messages, lottery incentives decreased the median time to ART initiation from 126 to 66 days (p = 0.0043, age‐adjusted Cox regression) among all participants, and, from 134 days to 20 days (p = 0.0077) among participants who were not virally suppressed at baseline. Lottery incentives had an inconclusive effect on clinic registration (RR = 1.21, 95% CI: 0.83 to 1.76) and on viral suppression at six months (RR = 1.13, 95% CI: 0.73 to 1.75) compared to motivational text messages.ConclusionsConditional lottery incentives shortened the time to ART initiation among South African men. Behavioural economics strategies strengthen linkage to ART, but the study power was limited to see an impact on viral suppression.Clinical Trial NumberNCT03808194.

Cash is not king in incentivizing online surveys

ABSTRACT We analyse the effect of different incentive structures on response rates for an online survey of New Zealand landowners who have previously not responded to an earlier wave of the survey. We find response rates are lowest for direct cash payment, lower even than for a control group with no incentive, which may be due to direct payment extinguishing any warm glow people receive from the charitable act of completing a survey. Lottery and charitable donation incentives do not increase response rates relative to a control group with no incentive.

Behavioral Economics Incentives to Support HIV Treatment Adherence (BEST): Protocol for a randomized controlled trial in Uganda

BackgroundMany HIV-positive patients do not appropriately adhere to their antiretroviral medication (ART). This leads to higher viral loads and greater probability of HIV transmission. Present bias—a tendency to give in to short-term temptations at the expense of long-term outcomes—is a potential driver of low adherence. In this study we test a novel intervention rooted in behavioral economics that is designed to overcome present bias and increase ART adherence.Methods/designWe will enroll 330 HIV-positive patients at Mildmay Hospital in Kampala, Uganda, into a 2-year randomized controlled trial. Participants will be randomized to one of three groups. The first intervention group (T1, n = 110) will be eligible for small lottery prizes based on timely clinic visits and demonstration of viral suppression. Group 2 (T2, n = 110) will be eligible for the same lottery prizes conditional on high adherence measured by a medication event management system (MEMS) cap. The control group (n = 110) will receive the usual standard of care. Adherence will be measured continuously throughout the intervention period and for 12 months post-intervention to evaluate effect persistence. Surveys will be conducted at baseline and then every 6 months. Viral loads will be measured annually. Primary outcomes are whether the viral load is detectable and MEMS-measured adherence. Secondary outcomes are the log-transformed viral load as a continuous measure and a binary measure for whether the person took at least 90% of their ART pills.DiscussionOur study is one of the first to investigate the effectiveness of lottery incentives for improving ART adherence, and in addition, it compares the relative efficacy of using electronically measured adherence versus viral load to determine lottery eligibility. MEMS caps are relatively costly, whereas viral load testing is now part of routine clinical care in Uganda. BEST will test whether directly incentivizing viral suppression (which can be implemented using readily available clinic data) is as effective as incentivizing electronically measured adherence. Cost-effectiveness analyses of the two implementation modes will also be performed.Trial registrationClinicalTrials.gov, NCT03494777. Registered on 11 April 2018.

Modeling lottery incentives for daily adherence.

Many health issues require adherence to recommended daily activities, such as taking medication to manage a chronic condition, walking a certain distance to promote weight loss, or measuring weights to assess fluid balance in heart failure. The cost of nonadherence can be high, with respect to both individual health outcomes and the healthcare system. Incentivizing adherence to daily activities can promote better health in patients and populations and potentially provide long‐term cost savings.Multiple incentive structures are possible. We focus here on a daily lottery incentive in which payment occurs when both the participant's lottery number matches the number drawn and the participant adheres to the targeted daily behavior.Our objective is to model the lottery's effect on participants' probability to complete the targeted task, particularly over the short term. We combine two procedures for analyzing such binary time series: a parameter‐driven regression model with an autocorrelated latent process and a comparative interrupted time series. We use the output of the regression model as the control generator for the comparative time series in order to create a quasi‐experimental design.