Novel incentive-based approaches to adherence

Clin Trials. 2012 Dec;9(6):689-95. doi: 10.1177/1740774512453520. Epub 2012 Jul 30.


Background: Adherence to medications for chronic conditions is often very low, limiting the benefit to patients, even when the medications are effective and have favorable side effect profiles.

Purpose: This article reviews some of the prior work on treatment adherence, introduces novel concepts from behavioral economics that can be used to design interventions to improve adherence, and proposes new approaches for clinical trials.

Methods: Relevant experience of the authors and insights from the literature were combined to identify key issues and propose methodological improvements. Specific examples regarding adherence to warfarin are provided.

Results: Several new approaches to trial design can be effectively applied in the context of medication adherence. These include tailored intervention strategies and sequential multiple assignment randomized trial (SMART) designs.

Limitations: While we have proposed to use these new approaches for ongoing studies of adherence in behavioral health, practical experience with their application is still somewhat limited.

Conclusions: Behavioral economics offer a variety of concepts that, when used in the design of interventions to improve adherence, may be more successful than traditional approaches. New clinical trial designs can also be adopted to improve the efficiency of studies that assess these approaches.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Economics, Behavioral
  • Humans
  • Medication Adherence / psychology*
  • Motivation
  • Randomized Controlled Trials as Topic / methods*
  • Reminder Systems
  • Research Design*
  • Venous Thromboembolism / prevention & control
  • Warfarin / therapeutic use


  • Anticoagulants
  • Warfarin