Compensation for participating in clinical trials

 Here's an opinion piece from Medpage Today:

It's Time to Pay Clinical Trial Participants More — Accelerating trial enrollment can catalyze access to much-needed medications  by Gunnar Esiason 

He writes:

"Most people I know with cystic fibrosis have participated in at least one, if not several clinical trials. 

...

"Participating in a trial can be like working for a company that hasn't invested in its employees in a long time. In this case, the employees are clinical trial participants. The pay is low despite the time required to participate in research and the growing number of trials that need participants.

"From 2019-2022, the number of registered clinical trials grew by 25%opens in a new tab or window globally -- yet participant pay remains arbitrary and inconsistentopens in a new tab or window between studies. It's almost like mismatched supply and demand curves, where participants are in high demand but unwilling to participate.

"Increasing trial participant pay might be a path toward alleviating the participant supply crunch in trials hungry for patients. One key benefit of increasing pay for patients could be substantial: namely, speeding up clinical trials through a more competitive enrollment process.

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"More than 80% of clinical trials fail to enroll on time, leading to costs of anywhere from $600,000 to $8 million per dayopens in a new tab or window and making trials take up to twice as longopens in a new tab or window.

"And yet it has been shownopens in a new tab or window that moderately increasing pay can motivate participation without being an "unjust inducement." In other words, patients are encouraged to participate -- but not coerced to do so.

"If increasing participant pay can accelerate trial enrollment, then a safe and effective drug can reach the market faster and therefore reduce the amount of time products remain in the pre-revenue stage. The return on investment for study sponsors who increase participant pay should be clear from a business perspective.

"From a patient perspective, even a marginal improvement in time to accessing new drugs is something worth celebrating. For patients, we pay the cost of delays with our health."

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Some earlier related posts:

Monday, February 22, 2021

Ethical Payment in Human Infection Challenge Studies in the American Journal of Bioethics

Monday, March 1, 2021

Compensating challenge vaccine trial participants: further discussion in the American Journal of Bioethics

Thursday, October 29, 2020

Paying participants in challenge trials of Covid-19 vaccines, by Ambuehl, Ockenfels, and Roth

"we note that increasing hourly pay by a risk-compensation percentage as proposed in the target article provides compensation proportional to risk only if the risk increases proportionally with the number of hours worked. (Some risky tasks take little time; imagine challenge trials to test bulletproof vests.) "

Sunday, November 1, 2020

What do we know about the effects of payments to participants in challenge trials for vaccines, and other public spirited activities?

Social media advertising and COVID vaccination, in PNAS

 Vaccine rollout is different than allocating other (initially) scarce goods because it involves overcoming vaccine hesitancy.  Here's a meta-analysis which concludes that advertising was helpful and cost effective.

Athey, Susan, Kristen Grabarz, Michael Luca, and Nils Wernerfelt. "Digital public health interventions at scale: The impact of social media advertising on beliefs and outcomes related to COVID vaccines." Proceedings of the National Academy of Sciences 120, no. 5 (2023): e2208110120.

Abstract: Public health organizations increasingly use social media advertising campaigns in pursuit of public health goals. In this paper, we evaluate the impact of about $40 million of social media advertisements that were run and experimentally tested on Facebook and Instagram, aimed at increasing COVID-19 vaccination rates in the first year of the vaccine roll-out. The 819 randomized experiments in our sample were run by 174 different public health organizations and collectively reached 2.1 billion individuals in 15 languages. We find that these campaigns are, on average, effective at influencing self-reported beliefs—shifting opinions close to 1% at baseline with a cost per influenced person of about $3.41. Combining this result with an estimate of the relationship between survey outcomes and vaccination rates derived from observational data yields an estimated cost per additional vaccination of about $5.68. There is further evidence that campaigns are especially effective at influencing users’ knowledge of how to get vaccines. Our results represent, to the best of our knowledge, the largest set of online public health interventions analyzed to date.

"Financial incentives for vaccination do not have negative unintended consequences," in Nature

 Here's a recent article in Nature whose title effectively summarizes its conclusions, and brings some evidence from RCTs to bear on the issue of whether financial incentives corrupt innate values:

Florian H. Schneider, Pol Campos-Mercade, Stephan Meier, Devin Pope, Erik Wengström & Armando N. Meier, "Financial incentives for vaccination do not have negative unintended consequences. Nature (2023). https://doi.org/10.1038/s41586-022-05512-4

Abstract: Financial incentives to encourage healthy and prosocial behaviours often trigger initial behavioural change1,2,3,4,5,6,7,8,9,10,11, but a large academic literature warns against using them12,13,14,15,16. Critics warn that financial incentives can crowd out prosocial motivations and reduce perceived safety and trust, thereby reducing healthy behaviours when no payments are offered and eroding morals more generally17,18,19,20,21,22,23,24. Here we report findings from a large-scale, pre-registered study in Sweden that causally measures the unintended consequences of offering financial incentives for taking the first dose of a COVID-19 vaccine. We use a unique combination of random exposure to financial incentives, population-wide administrative vaccination records and rich survey data. We find no negative consequences of financial incentives; we can reject even small negative impacts of offering financial incentives on future vaccination uptake, morals, trust and perceived safety. In a complementary study, we find that informing US residents about the existence of state incentive programmes also has no negative consequences. Our findings inform not only the academic debate on financial incentives for behaviour change but also policy-makers who consider using financial incentives to change behaviour.

"We exploit a randomized controlled trial (RCT) in the context of financial incentives for COVID-19 vaccination (P.C.-M. et al., unpublished, and ref. 5). Participants were offered payments of 200 Swedish krona (SEK; about US $24 at the time) for taking a first dose of a COVID-19 vaccine, which increased first-dose uptake by 4 percentage points 30 days after the trial (uptake remained higher even 3 months later). The RCT setting is ideal in that it allows us to compare individuals who were randomly offered financial incentives for vaccination with individuals who were not offered any financial incentives. We combine the RCT data with new Swedish administrative records for second-dose uptake and with rich, individual-level survey data.

...

"We complement our evidence from Sweden with evidence on the effects of large-scale incentive programmes implemented by US state governments. In a pre-registered study in the USA (n = 3,062), participants randomly assigned to the incentives condition received detailed information about their state’s COVID-19 vaccine incentive programme, whereas participants in the control condition did not receive this information. Because most of the participants were unaware that their state offered incentives for vaccination, this experimental design overcomes the identification problems by creating random variation in perceived exposure to incentives. In line with the evidence from Sweden, we find no negative impacts of being informed about incentive programmes on the willingness of participants to take a further dose"

Economics of pandemic vaccination in Oxford Review of Economic Policy

Vaccine development and distribution during the Covid pandemic has had some notable successes and some significant shortcomings. 

Here's the latest issue of the Oxford Review of Economic Policy, which has collected articles by economists concerning some of those successes and failures and their lessons for future pandemics.

Volume 38, Issue 4, Winter 2022

Economics of Pandemic Vaccination

ARTICLES

Vaccines and the Covid-19 pandemic: lessons from failure and success 

Scott Duke Kominers, Alex Tabarrok

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 719–741, https://doi.org/10.1093/oxrep/grac036

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Expanding capacity for vaccines against Covid-19 and future pandemics: a review of economic issues 

Susan Athey, Juan Camilo Castillo, Esha Chaudhuri, Michael Kremer, Alexandre Simoes Gomes ...

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 742–770, https://doi.org/10.1093/oxrep/grac037

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Covid-19 vaccine supply chains and the Defense Production Act 

Chad P Bown

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 771–796, https://doi.org/10.1093/oxrep/grac026

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Clinical trials for accelerating pandemic vaccines 

Witold Więcek

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 797–817, https://doi.org/10.1093/oxrep/grac029

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The race that stopped a nation: lessons from Australia’s Covid vaccine failures 

Richard Holden, Andrew Leigh

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 818–832, https://doi.org/10.1093/oxrep/grac028

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Financing vaccine equity: funding for day-zero of the next pandemic 

Ruchir Agarwal, Tristan Reed

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 833–850, https://doi.org/10.1093/oxrep/grac032

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Is it possible to prepare for a pandemic? 

Robert Tucker Omberg, Alex Tabarrok

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 851–875, https://doi.org/10.1093/oxrep/grac035

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Seven finance and trade lessons from Covid-19 for future pandemics 

Ruchir Agarwal, Gita Gopinath

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 876–886, https://doi.org/10.1093/oxrep/grac031

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Covid in the nursing homes: the US experience 

Markus B Bjoerkheim, Alex Tabarrok

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 887–911, https://doi.org/10.1093/oxrep/grac033

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• Supplementary data

Optimal allocation of vaccines in a pandemic 

Joshua S Gans

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 912–923, https://doi.org/10.1093/oxrep/grac027

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Reserve system design for allocation of scarce medical resources in a pandemic: some perspectives from the field 

Parag Pathak, Govind Persad, Tayfun Sönmez, M Utku Ünver

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 924–940, https://doi.org/10.1093/oxrep/grac034

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Distributing a billion vaccines: COVAX successes, challenges, and opportunities 

Eric Budish, Hannah Kettler, Scott Duke Kominers, Erik Osland, Canice Prendergast ...

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 941–974, https://doi.org/10.1093/oxrep/grac038

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