Cardiovascular disease (CVD) is the leading cause of death in the United States. Despite strong evidence that reducing low-density lipoproteins (LDL) with statins successfully lowers CVD risk, more than 50% of patients stop taking statins within one year of initial prescription though such therapy typically should be lifelong. In this study, w will test the effectiveness of different behavioral economic interventions in shaping lasting habit for statin adherence and reducing LDL cholesterol among patients with poor cholesterol control who are at very high risk for CVD. The application of conceptual approaches from behavioral economics offers considerable promise in advancing health and health care. Interventions based on financial incentives are successful in changing health behaviors during the intervention period but in many cases not thereafter. In patients with suboptimal cholesterol control who are at high risk for CVD, we propose to test the effectiveness of different behavioral economic techniques in inducing habit formation for adherence to statin use and sustained reductions in LDL cholesterol after financial incentives are discontinued. We will test these approaches among members of CVS Caremark nationwide. Using a 4-arm, randomized controlled trial, we aim to answer these questions:  How do daily lotteries, habit formation lotteries, and hybrid lottery deposit contracts, all of which include daily reminders, compare with daily reminders in improving statin adherence and LDL control during the intervention phase?  How do these 3 incentives compare to daily reminders in achieving improved adherence and improved LDL control post- intervention?  How do these approaches compare in cost-effectiveness?
The application of conceptual approaches from behavioral economics offers considerable promise in advancing health and health care. In patients with suboptimal cholesterol control who are at high risk for CVD, we propose to test the effectiveness and cost-effectiveness of different behavioral economic techniques to improve statin adherence following discontinuation of the intervention.