Addition of Financial Incentives to Mailed Outreach for Promoting Colorectal Cancer Screening: A Systematic Review and Meta-analysis
Open accessAbstract
Importance: Although screening decreases incidence of and mortality from colorectal cancer (CRC), screening rates are low. Health-promoting financial incentives may increase uptake of cancer screening. Objective: To evaluate the relative and absolute benefit associated with adding financial incentives to the uptake of CRC screening. Data Sources: PubMed, Cochrane Central Register of Controlled Trials, and Web of Science were searched from inception to July 31, 2020. Keywords and Medical Subject Headings terms were used to identify published studies on the topic. The search strategy identified 835 studies. Study Selection: Randomized clinical trials (RCTs) were selected that involved adults older than 50 years who were eligible for CRC screening, who received either various forms of financial incentives along with mailed outreach or no financial incentives but mailed outreach and reminders alone, and who reported screening completion by using recommended tests at different time points. Observational or nonrandomized studies and a few RCTs were excluded. Data Extraction and Synthesis: The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Data were abstracted and risk of bias was assessed by 2 independent reviewers. Random-effects meta-analysis was conducted, heterogeneity was examined through subgroup analysis and metaregression, and quality of evidence was appraised. Main Outcomes and Measures: The primary outcome was CRC screening completion within 12 months of receiving the intervention. Results: A total of 8 RCTs that were conducted in the United States and reported between January 1, 2014, and December 31, 2020, were included. The trials involved 110 644 participants, of whom 53 444 (48.3%) were randomized to the intervention group (received financial incentives) and 57 200 (51.7%) were randomized to the control group (received no financial incentives). Participants were predominantly male, with 59 113 men (53.4%). Low-quality evidence (rated down for risk of bias and heterogeneity) suggested that adding financial incentives may be associated with a small benefit of increasing CRC screening vs no financial incentives (odds ratio [OR], 1.25; 95% CI, 1.05-1.49). With mailed outreach having a 30% estimated CRC screening completion rate, adding financial incentives may increase the rate to 33.5% (95% CI, 30.8%-36.2%). On metaregression, the magnitude of benefit decreased as the proportion of participants with low income and/or from racial/ethnic minority groups increased. No significant differences were observed by type of behavioral economic intervention (fixed amount: OR, 1.26 [95% CI, 1.05-1.52] vs lottery: OR, 1.06 [95% CI, 0.80-1.40]; P = .32), amount of incentive (≤$5: OR, 1.09 [95% CI, 1.01-1.18] vs >$5: OR, 1.25 [95% CI, 1.02-1.54]; P = .22), or screening modality (stool-based test: OR, 1.14 [95% CI, 0.92-1.41] vs colonoscopy: OR, 1.63 [95% CI, 1.01-2.64]; P = .18). Conclusions and Relevance: Adding financial incentives appeared to be associated with a small benefit of increasing CRC screening uptake, with marginal benefits in underserved populations with adverse social determinants of health. Alternative approaches to enhancing CRC screening uptake are warranted.
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Based on a meta-analysis, monetary incentives have only modest effects on CRC and might not increase screening for populations with traditionally low screening rates.
“Based on a meta-analysis, monetary incentives have only modest effects on CRC and might not increase screening for populations with traditionally low screening rates [60].”
From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [60]
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Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552 · see citing works
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,577 · see citing works
GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables
Guyatt, G., Oxman, A. D., Akl, E. A., Kunz, R., Vist, G., Brozek, J., Norris, S., Falck-Ytter, Y., Glasziou, P., & deBeer, H. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.04.026 · Cited by 10,681 · see citing works
Hutton, B., Salanti, G., Caldwell, D. M., Chaimani, A., Schmid, C. H., Cameron, C., Ioannidis, J. P. A., Straus, S., Thorlund, K., Jansen, J. P., et al. (2015) · Annals of Internal Medicine · doi:10.7326/m14-2385 · Cited by 8,269 · see citing works
Colorectal cancer statistics, 2020
Siegel, R. L., Miller, K. D., Sauer, A. G., Fedewa, S. A., Butterly, L. F., Anderson, J. C., Cercek, A., Smith, R. A., & Jemal, A. (2020) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.21601 · Cited by 4,970 · see citing works
Prevention of Colorectal Cancer by Colonoscopic Polypectomy
Winawer, S. J., Zauber, A. G., Ho, M. N., O’Brien, M. J., Gottlieb, L. S., Sternberg, S. S., Waye, J. D., Schapiro, M., Bond, J. H., Panish, J. F., et al. (1993) · New England Journal of Medicine · doi:10.1056/nejm199312303292701 · Cited by 4,585 · see citing works
Norderyd, O. M., Koch, G., Papias, A., Köhler, A. A., Helkimo, A. N., Brahm, C., Lindmark, U., Lindfors, N., Mattsson, A., Rolander, B., et al. (2015) · PubMed · Cited by 3,584 · see citing works
Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths
Zauber, A. G., Winawer, S. J., O’Brien, M. J., Lansdorp‐Vogelaar, I., van Ballegooijen, M., Hankey, B. F., Shi, W., Bond, J. H., Schapiro, M., Panish, J. F., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1100370 · Cited by 3,185 · see citing works
GRADE guidelines 6. Rating the quality of evidence—imprecision
Guyatt, G. H., Oxman, A. D., Kunz, R., Brozek, J., Alonso-Coello, P., Rind, D., Devereaux, P. J., Montori, V. M., Freyschuss, B., Vist, G., et al. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2011.01.012 · Cited by 2,693 · see citing works
Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement
US Preventive Services Task Force, Bibbins-Domingo, K., Grossman, D. C., Curry, S. J., Davidson, K. W., Epling, J. W., García, F. A. R., Gillman, M. W., Harper, D. M., Kemper, A. R., et al. (2016) · JAMA · doi:10.1001/jama.2016.5989 · Cited by 2,509 · see citing works
When and Why Incentives (Don't) Work to Modify Behavior
Uri Gneezy, B., Meier, S., & Rey‐Biel, P. (2011) · The Journal of Economic Perspectives · doi:10.1257/jep.25.4.191 · Cited by 1,739 · see citing works
Higgins (2002) · doi:10.1002/(issn)1097-0258 · Cited by 1,248 · see citing works
Rex, D. K., Boland, C. R., Dominitz, J. A., Giardiello, F. M., Johnson, D. A., Kaltenbach, T. R., Levin, T. R., Lieberman, D. A., & Robertson, D. J. (2017) · Gastroenterology · doi:10.1053/j.gastro.2017.05.013 · Cited by 737 · see citing works
Giles, E. L., Robalino, S., McColl, E., Sniehotta, F. F., & Adams, J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0090347 · Cited by 470 · see citing works
Berlin, J. A., Santanna, J., Schmid, C. H., Szczech, L. A. M., & Feldman, H. I. (2002) · Statistics in Medicine · doi:10.1002/sim.1023 · Cited by 468 · see citing works
Dougherty, M. K., Brenner, A. T., Crockett, S. D., Gupta, S., Wheeler, S. B., Coker-Schwimmer, M., Cubillos, L., Malo, T., & Reuland, D. S. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.4637 · Cited by 362 · see citing works
Self-citationChallenges and Possible Solutions to Colorectal Cancer Screening for the Underserved
Gupta, S., Sussman, D. A., Doubeni, C. A., Anderson, D. S., Day, L., Deshpande, A. R., Elmunzer, B. J., Laiyemo, A. O., Mendez, J., Somsouk, M., et al. (2014) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/dju032 · Cited by 220 · see citing works
Self-citationIssaka, R. B., Avila, P., Whitaker, E. M., Bent, S., & Somsouk, M. (2018) · Preventive Medicine · doi:10.1016/j.ypmed.2018.10.021 · Cited by 126 · see citing works
Screening for Colorectal Neoplasia
Inadomi, J. M. (2017) · New England Journal of Medicine · doi:10.1056/nejmcp1512286 · Cited by 120 · see citing works
May, F. P., Yang, L., Corona, E., Glenn, B. A., & Bastani, R. (2019) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2019.09.008 · Cited by 112 · see citing works
Gupta, S. N., Miller, S., Koch, M. G., Berry, E., Anderson, P. L., Pruitt, S. L., Borton, E. K., Hughes, A. E., Carter, E., Hernandez, S., et al. (2016) · The American Journal of Gastroenterology · doi:10.1038/ajg.2016.286 · Cited by 67 · see citing works
Self-citationMehta, S. J., Feingold, J. H., Vandertuyn, M., Niewood, T., Cox, C. J., Doubeni, C. A., Volpp, K. G. M., & Asch, D. A. (2017) · Gastroenterology · doi:10.1053/j.gastro.2017.07.015 · Cited by 50 · see citing works
Effect of Financial Incentives on Patient Use of Mailed Colorectal Cancer Screening Tests
Mehta, S. J., Pepe, R. S., Gabler, N. B., Kanneganti, M., Reitz, C., Saia, C. A., Teel, J., Asch, D. A., Volpp, K. G. M., & Doubeni, C. A. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.1156 · Cited by 48 · see citing works
Financial Incentives for Completion of Fecal Occult Blood Tests Among Veterans
Kullgren, J. T., Dicks, T. N., Fu, X., Richardson, D., Tzanis, G. L., Tobi, M., & Marcus, S. C. (2014) · Annals of Internal Medicine · doi:10.7326/m13-3015 · Cited by 47 · see citing works
Financial Incentives to Increase Colorectal Cancer Screening Uptake and Decrease Disparities
Green, B. B., Anderson, M. L., Cook, A. J., Chubak, J., Fuller, S., Kimbel, K. J., Kullgren, J. T., Meenan, R. T., & Vernon, S. W. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.6570 · Cited by 43 · see citing works
Wender, R. C., Doroshenk, M., Brooks, D. D., Hotz, J. A., & Smith, R. A. (2018) · The American Journal of Gastroenterology · doi:10.1038/s41395-018-0384-1 · Cited by 35 · see citing works
Slater, J. S., Parks, M. J., Nelson, C. L., & Hughes, K. D. (2018) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-18-0038 · Cited by 34 · see citing works
Mauro, M., Rotundo, G., & Giancotti, M. (2019) · Health Policy · doi:10.1016/j.healthpol.2019.09.012 · Cited by 31 · see citing works
Mehta, S. J., Oyalowo, A. O., Reitz, C., Dean, O. R., McAuliffe, T. L., Asch, D. A., & Doubeni, C. A. (2020) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2020.101114 · Cited by 20 · see citing works
Effect of Behavioral Economic Incentives for Colorectal Cancer Screening in a Randomized Trial
Mehta, S. J., Reitz, C., Niewood, T., Volpp, K. G. M., & Asch, D. A. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.06.047 · Cited by 19 · see citing works
Financial Incentives to Promote Colorectal Cancer Screening: A Longitudinal Randomized Control Trial
Lieberman, A., Gneezy, A., Berry, E., Miller, S., Koch, M. G., Ahn, C. W., Balasubramanian, B. A., Argenbright, K. E., & Gupta, S. N. (2019) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-19-0039 · Cited by 18 · see citing works
Self-citationDacus, H., Wagner, V. L., Collins, E. A., Matson, J. M., Gates, M. A., Hoover, S., Tangka, F. K. L., Larkins, T. L., & Subramanian, S. (2018) · Cancer · doi:10.1002/cncr.31692 · Cited by 11 · see citing works
Nisa, C. F., Bélanger, J. J., & Schumpe, B. M. (2019) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.14115 · Cited by 10 · see citing works
Flagged first, then by citations
1 of the 36 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [20]Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Chapter 3: systematic reviews of effectiveness. In: Aromataris E, Munn Z, eds. Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute; 2017.
Cited by
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Schneider, F., Campos‐Mercade, P., Meier, S., Pope, D. G., Wengström, E., & Meier, A. N. (2023) · Nature · doi:10.1038/s41586-022-05512-4 · Cited by 71 · see citing works
Syvyk, S., Roberts, S. E., Finn, C. B., Wirtalla, C. J., & Kelz, R. R. (2022) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2022.02.049 · Cited by 23 · see citing works
Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers
Sykes, E. A., Weisbrod, N., Rival, E., Haque, A., Fu, R., & Eskander, A. E. (2023) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2023.3010 · Cited by 23 · see citing works
Predictors of treatment refusal in patients with colorectal cancer: A systematic review
Moodley, Y., Govender, K. N., Wyk, J. V., Reddy, S., Ning, Y. M., Wexner, S. D., Stopforth, L. W., Bhadree, S., Naidoo, V. G., Kader, S., et al. (2022) · Seminars in Oncology · doi:10.1053/j.seminoncol.2023.01.002 · Cited by 14 · see citing works
Latip, S. N. B. A., Chen, S. E., Im, Y. R., Zielinska, A. P., & Pawa, N. (2022) · Ethnicity and Health · doi:10.1080/13557858.2022.2139815 · Cited by 10 · see citing works
Taylor, L. C., Kerrison, R., Herrmann, B., & Stoffel, S. (2022) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2022.101747 · Cited by 10 · see citing works
Jalili, F., Austin, N., Lavergne, M. R., & Hajizadeh, M. (2024) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-24-1239 · Cited by 9 · see citing works
Financial Incentives to Improve Colorectal Cancer Screening—Time to Cut Our Losses
Issaka, R. B., & Dominitz, J. A. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.22661 · Cited by 9 · see citing works
Choudhury, H. K., & Borah, R. K. (2022) · Journal of Cancer Policy · doi:10.1016/j.jcpo.2022.100324 · Cited by 8 · see citing works
Korous, K. M., Cuevas, A. G., Chahoud, J., Ogbonnaya, U. C., Brooks, E., & Rogers, C. R. (2022) · SSM - Population Health · doi:10.1016/j.ssmph.2022.101222 · Cited by 7 · see citing works
Financial Incentives for COVID-19 Vaccination
Ternovski, J., Jilke, S., Keppeler, F., & Vogel, D. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.58542 · Cited by 3 · see citing works
Hoeck, S., & Tran, T. N. (2022) · Gastrointestinal Disorders · doi:10.3390/gidisord5010001 · Cited by 3 · see citing works
Chua, W. Y., Yong, A., Lim, O., Seow‐En, I., Chong, D., Wong, E., Han, S., Koo, S., Tan, I., & Ng, K. (2025) · ESMO Gastrointestinal Oncology · doi:10.1016/j.esmogo.2025.100243 · Cited by 1 · see citing works
Incentivising Personalised Colorectal Cancer Screening: an Adversarial Risk Analysis Approach
Corrales, D., & Insua, D. R. (2025) · Proceedings - IEEE Symposium on Computer-Based Medical Systems · doi:10.1109/cbms65348.2025.00068 · Cited by 1 · see citing works
Winters, S., Katabaro, E., Joseph, B., Msasa, J., Maila, H., Hassan, K., Sabasaba, A. N., Dow, W. H., Njau, P. F., & McCoy, S. I. (2026) · BMJ Global Health · doi:10.1136/bmjgh-2025-022505 · Cited by 1 · see citing works
Kelly, A., Walker, S. C., Carney, G., Levu, K., Horn, C., Jenkins, M. A., Taylor, N., & Feletto, E. (2026) · Journal of Public Health Management and Practice · doi:10.1097/phh.0000000000002367 · Cited by 1 · see citing works
Dickdarmkrebsscreening in der Schweiz: Sind unsere Patienten genügend motiviert?
Marbet, U., Stoffel, S., & Brunner-Schaub, N. (2022) · Schweizer Gastroenterologie · doi:10.1007/s43472-022-00076-0 · Cited by 1 · see citing works
Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review
Palsola, M., Likki, T., Snijders, V., Corbex, M., Lasierra, L., & Curtis, B. (2026) · Glasnik javnog zdravlja · doi:10.5937/serbjph2601086p
Wang, Q., Gong, C., Lv, Y., Tan, Y., Liu, S., & Yang, L. (2024) · BMJ Surgery Interventions & Health Technologies · doi:10.1136/bmjsit-2024-000300
Perry, L. M., Peacock, E., LeBlanc, A., Williams, L. G., Wiltz, G. M., & Krousel-Wood, M. A. (2025) · Health Services Research · doi:10.1111/1475-6773.70011
Usoltseva, N., Gohil, S., Aranda, G., Ellis, T., Akinsoto, N., & Greene, M. (2026) · Current Medical Research and Opinion · doi:10.1080/03007995.2026.2631922
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Sathya, S., Zaw, C., Quintero, J., Hue, L., Tang, F., Campos, M., Balbin, E., Mirsaeidi, M. S., & Holt, G. E. (2026) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2026.101625
Lumia, C., Nespoli, A., Ausili, D., Fumagalli, S., & Dumont, A. (2026) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2026.103507
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White, P. M., Trejo, M., & Williams, R. (2026) · Gastrointestinal Endoscopy Clinics of North America · doi:10.1016/j.giec.2026.05.004
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Khalaj, N., Panahi, I., McLaren, E. J., Jahan, S., Leitch, J., & Garvey, G. (2026) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-25-2071
- Authors
- Facciorusso, A., Demb, J., Mohan, B. P., Gupta, S., & Singh, S.
- Affiliations
- Ospedali Riuniti di Foggia (IT)
- University of California San Diego (US)
- University of Utah (US)
- Corresponding author
- Singh, Siddharth
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2021-08-25
- Volume
- 4
- Issue
- 8
- Pages
- e2122581
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC8387849
- OpenAlex
- W3195991747
- Cited by
- 26
- References
- 36
- Citations by year
- 2026: 9 · 2025: 4 · 2024: 2 · 2023: 2 · 2022: 8 · 2021: 1
- FWCI
- 0.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Pfizer
- Health Services Research and Development
- National Institutes of Health
- National Cancer Institute (C19 20-394, UG3CA233314, F32CA239360, CA222866, R37CA222866)
- National Institute of Diabetes and Digestive and Kidney Diseases (R03DK129631, K23DK117058)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- colorectal cancer screening, financial incentives, screening uptake, health promotion, reminders, older adults, screening completion, risk of bias, low-quality evidence, cost-effectiveness, health disparities, racial and ethnic disparities, socioeconomic disparities, health care costs, quality of care, health care outcomes
- MeSH terms
- Aged, Aged, 80 and over, Female, Health Promotion, Humans, Male, Mass Screening, Middle Aged, Motivation, Reimbursement Mechanisms, United States, Colorectal Neoplasms, Early Detection of Cancer
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