Conceptual Model and Economic Experiments to Explain Nonpersistence and Enable Mechanism Designs Fostering Behavioral Change

• Published in: Value in health Vol. 17; no. 8; pp. 814 - 822
• Main Authors: Djawadi, Behnud Mir, Fahr, René, Turk, Florian
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2014
• Subjects: behavioral economics; Choice Behavior; Decision Making; financial incentives; Health Behavior; Humans; Internal Medicine; laboratory experiment; medication adherence; medication persistence; mental accounting; Models, Economic; Models, Psychological; patient behavior; patient compliance; Patient Compliance - psychology; Patient Dropouts - psychology; Patient Preference - economics; Patient Preference - psychology; prospect theory; Public Health; Research Design; prospect theory; patient compliance; health behavior; behavioral economics; medication adherence; medication persistence; patient behavior; mental accounting; financial incentives; laboratory experiment
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1016/j.jval.2014.08.2669

Medical nonpersistence is a worldwide problem of striking magnitude. Although many fields of studies including epidemiology, sociology, and psychology try to identify determinants for medical nonpersistence, comprehensive research to explain medical nonpersistence from an economics perspective is rather scarce. The aim of the study was to develop a conceptual framework that augments standard economic choice theory with psychological concepts of behavioral economics to understand how patients’ preferences for discontinuing with therapy arise over the course of the medical treatment. The availability of such a framework allows the targeted design of mechanisms for intervention strategies. Our conceptual framework models the patient as an active economic agent who evaluates the benefits and costs for continuing with therapy. We argue that a combination of loss aversion and mental accounting operations explains why patients discontinue with therapy at a specific point in time. We designed a randomized laboratory economic experiment with a student subject pool to investigate the behavioral predictions. Subjects continue with therapy as long as experienced utility losses have to be compensated. As soon as previous losses are evened out, subjects perceive the marginal benefit of persistence lower than in the beginning of the treatment. Consequently, subjects start to discontinue with therapy. Our results highlight that concepts of behavioral economics capture the dynamic structure of medical nonpersistence better than does standard economic choice theory. We recommend that behavioral economics should be a mandatory part of the development of possible intervention strategies aimed at improving patients’ compliance and persistence behavior.