Evidence map›Paper›PMID 40525292›Full record

Trial reportCirculation. Cardiovascular quality and outcomes2025

Cost-Effectiveness of Gamification, Financial Incentives, or Both to Increase Physical Activity Among Patients With Elevated Risk for Cardiovascular Disease.

Louise B Russell, Kevin G M Volpp, Mitesh S Patel, Neel P Chokshi, Samantha Coratti, David Farraday, Laurie Norton, Charles Rareshide, Jingsan Zhu, Tamar Klaiman and 3 more

Registry-linked trialAbstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Circulation. Cardiovascular quality and outcomes, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03911141 (Behavioral Economic Approaches to Increase Physical Activity Among Patients With Elevated Risk for Cardiovascular Disease), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03911141 nacompletednot on this map

Behavioral Economic Approaches to Increase Physical Activity Among Patients With Elevated Risk for Cardiovascular Disease

TypeinterventionalSponsorUniversity of PennsylvaniaRan2019 to 2024Enrolled1,062ConditionsAtherosclerotic Cardiovascular DiseaseArmsGamification, Financial
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Louise B RussellDepartment of Medical Ethics and Health Policy (L.B.R., K.G.M.V., L.N., J.Z., T.K.).ORCID 0000-0003-3599-0991
Kevin G M VolppDepartment of Medical Ethics and Health Policy (L.B.R., K.G.M.V., L.N., J.Z., T.K.).ORCID 0000-0003-3389-6707
Mitesh S PatelAscension Health, St. Louis, MO (M.S.P.).ORCID 0000-0002-5997-9984
Neel P ChokshiPenn Center for Health Incentives and Behavioral Economics (L.B.R., K.G.M.V., N.P.C., S.C., D.F., L.N., C.R., J.Z., A.C.F.), University of Pennsylvania, Philadelphia.ORCID 0000-0003-1662-4312
Samantha CorattiPenn Center for Health Incentives and Behavioral Economics (L.B.R., K.G.M.V., N.P.C., S.C., D.F., L.N., C.R., J.Z., A.C.F.), University of Pennsylvania, Philadelphia.
David FarradayPenn Center for Health Incentives and Behavioral Economics (L.B.R., K.G.M.V., N.P.C., S.C., D.F., L.N., C.R., J.Z., A.C.F.), University of Pennsylvania, Philadelphia.ORCID 0009-0006-7710-3245
Laurie NortonDepartment of Medical Ethics and Health Policy (L.B.R., K.G.M.V., L.N., J.Z., T.K.).ORCID 0000-0002-2112-9669
Charles RareshidePenn Center for Health Incentives and Behavioral Economics (L.B.R., K.G.M.V., N.P.C., S.C., D.F., L.N., C.R., J.Z., A.C.F.), University of Pennsylvania, Philadelphia.ORCID 0000-0001-8642-4549
Jingsan ZhuDepartment of Medical Ethics and Health Policy (L.B.R., K.G.M.V., L.N., J.Z., T.K.).
Tamar KlaimanDepartment of Medical Ethics and Health Policy (L.B.R., K.G.M.V., L.N., J.Z., T.K.).ORCID 0000-0001-8718-5674
Julia E SzymczakDepartment of Internal Medicine, University of Utah School of Medicine, Salt Lake City (J.E.S.).ORCID 0000-0002-3230-8670
Dylan S SmallLeonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (L.B.R., K.G.M.V., N.P.C., D.S.S., A.C.F.).ORCID 0000-0003-4928-2646
Alexander C FanaroffPenn Center for Health Incentives and Behavioral Economics (L.B.R., K.G.M.V., N.P.C., S.C., D.F., L.N., C.R., J.Z., A.C.F.), University of Pennsylvania, Philadelphia.ORCID 0000-0002-9060-5307

Funding

Behavioral Economic Approaches to Increase Physical Activity among Patients with Elevated Risk for Cardiovascular DiseaseR33HL141440 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI FANAROFF, ALEXANDER CRAIG, VOLPP, KEVIN G · 2019 to 2022
$3.3M
NHLBI NIH HHS R33 HL141440
6 · The paper itself

Abstract

backgroundThe BE ACTIVE trial (Behavioral Economic Approaches to Increase Physical Activity Among Patients with Elevated Risk for Cardiovascular Disease) documented the effectiveness, compared with an attention control arm that received daily text messages, of gamification, financial incentives, or gamification+financial incentives to increase steps/day. Increases in daily step count are associated with longer life expectancy, but understanding the cost-effectiveness of these interventions is essential for payers and other stakeholders seeking to implement findings.

methodsWe built a probabilistic Markov model to compare intervention costs with lifetime estimates of life-years and quality-adjusted life-years for 2 sets of comparisons: (1) each behavioral intervention versus attention control, and (2) each trial arm, including attention control, versus no intervention. Since the durability of changes in steps/day post-intervention is unknown, we modeled optimistic, intermediate, and pessimistic scenarios.

resultsOver the 12-month intervention, per-participant cost to deliver attention control was $878, gamification $938, financial incentives $1534, and gamification+financial incentives $1712. Compared with attention control, gamification's cost-effectiveness ranged from $261 (95% CI, 259-263) per life-year gained if mean steps/day during the last 18 weeks of follow-up are maintained (optimistic), to $30 550 (95% CI, 30 503-30 597) per life-year if steps/day continue to decline at the rate observed during the full 26-week follow-up (pessimistic). Gamification+financial incentives cost <$50 000/life-year only under the optimistic and intermediate scenarios. Financial incentives was dominated by gamification and gamification+financial incentives. When all 4 trial arms, including attention control, were compared with no intervention, gamification again cost <$50 000/life-year across all durability scenarios.

conclusionsAcross a range of scenarios about the durability of increases in steps/day post-intervention, gamification consistently cost <$50 000 per life-year gained, the threshold for high value interventions set by American College of Cardiology/American Heart Association guidelines. Gamification+financial incentives was high-value except in the pessimistic scenario. Financial incentives was dominated. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03911141.

Indexed as

Cardiovascular DiseasesExerciseHealth BehaviorHealth Care CostsHealthy LifestyleMotivationRisk Reduction BehaviorVideo GamesAgedCost-Benefit AnalysisFemaleHeart Disease Risk FactorsHumansMaleMarkov ChainsMiddle Agedcardiovascular diseasescost-benefit analysisexercisegamificationhumans

Identifiers

PMID40525292
PMCPMC12263319

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.