HealthPrize CMO, Katrina Firlik, M.D., Describes Our Newly Published Peer Reviewed Adherence Study

HealthPrize recently published very favorable medication adherence results from our RespiPoints™program, further proving the efficacy of our approach to behavior change which combines education, gamification, and insights from behavioral science including the use of rewards. The study was done in collaboration with Boehringer Ingelheim and data and analytics partner IQVIA. RespiPoints™ was established seven years ago for the benefit of patients with chronic obstructive pulmonary disease (COPD) prescribed Boehringer Ingelheim’s Stiolto and Spiriva inhalers.


The following are key topline results for RespiPoints™ participants vs. matched-pair controlled nonparticipants. The full study can be accessed here in Expert Review of Pharmacoeconomics & Outcomes Research.

  • 44% higher rate of adherence, with a mean PDC of 0.72 vs. 0.50 (p<0.0001)
  • 2.5 times higher odds of being fully adherent (≥80% PDC) (p<0.0001)
  • 47% reduction in the risk of discontinuing medication
  • Fewer participants were hospitalized during follow-up (13.74% vs 17.56%, p=0.23)
  • Reduced total mean healthcare costs by $8,299.49 ($26,515 vs $34,814, p=0.12)

To our knowledge, having closely followed the published literature on medication adherence for over 12 years, no other intervention has ever been proven to have a greater effect on medication adherence. A 44% increase in adherence is truly unprecedented, which is a testament to the fact that our program approaches the problem through the lens of human behavior and leverages multiple synergistic interventions that impact both short-term extrinsic motivation and longer-term intrinsic motivation.

The RespiPoints™ program was designed to be fun and engaging for patients, and the high degree of engagement achieved by the program is what drives effective behavior change. The average participant engages 5.1 times per week and persists in the program for 265 days—very notable metrics for a digital program in healthcare. The patient experience mirrors other HealthPrize programs, offering disease-specific education, gamified interaction, and incentives, with all prescription fills verified by HealthPrize’s proprietary verification system and/or by third party systems.

Rigorous control for selection bias

Studies in digital health are often criticized for failing to account for possible selection bias in participants vs. nonparticipants. While it is impossible to fully control for selection bias, we went to great lengths in this study to account for bias in whatever ways possible given the data available to us via IQVIA’s claims-based data set. And importantly, IQVIA—as an impartial third party—performed all matching and data analysis to avoid any perception of influence by either HealthPrize or Boehringer Ingelheim. Regarding the matching of participants vs. controls, the following important criteria were well-balanced between cohorts: (1) number of pre-enrollment COPD medication claims and total medication costs (as markers of medication adherence) and (2) adherence to other preventive health behaviors, specifically mammograms PSA screenings, and vaccines (to control for the “healthy adherer” effect as a form of selection bias).

For payers and providers looking to improve adherence-related STAR ratings in diabetes, hypertension, and high cholesterol, and for pharmaceutical companies eager to boost adherence across other diverse disease categories, it is worth noting that improving adherence in COPD is a particularly tough nut to crack. Adherence rates to prescribed pharmacotherapy in this patient population are lower than in other chronic conditions and typically range from 20% to 60%. Many patients do not fill a prescription at all, or fill just once before discontinuing.

Not surprisingly, then, internal HealthPrize data from our programs in other therapeutic areas such as diabetes demonstrate even greater degrees of adherence. In addition to this peer-reviewed study, we have many years’ worth of robust internal data that mirror and exceed this significant lift in adherence across a number of other conditions, either using patients as their own controls or patients vs. historic norms.

Healthcare costs are complex and multifactorial—often affected by factors that are difficult to control for, such as diet, exercise, and socioeconomic factors—and tend to require large sample sizes often over long time periods. While our focus was on adherence as a primary endpoint, the cost reduction data between participants and controls were also very encouraging. Multiple larger scale studies published over the past several years have confirmed a strong correlation between better adherence and lower costs both in COPD and across multiple chronic conditions. Given the magnitude of the adherence lift achieved with our program, future cost data would be expected to match our favorable adherence data.

As payers and pharmaceutical brands continue to seek more effective solutions to health-related behavioral challenges including medication nonadherence, HealthPrize’s novel approach offers a game-changing alternative to traditional, more costly, and far less engaging, interventions. Most adherence programs struggle to offer more than single-digit increases in adherence rates. The 44% lift demonstrated in this study should serve as motivation to try a new approach.

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