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Biosimilars have the potential to save a significant amount of money in cancer treatment costs. However, barriers exist in the adoption of biosimilar products. Japan introduced a new health policy in 2022 to promote the use of biosimilars in oncology by offering financial incentives to eligible hospitals. This study aims to examine the association between these financial incentives and prescription patterns. The study analyzed Diagnosis Procedure Combination (DPC) data to assess the impact of the new health policy on the use of biosimilar products in oncology. The policy provided an additional fee for hospitals using biosimilar products. The study included patients with specific types of cancer and analyzed the proportion of monthly biosimilar prescriptions using the number of prescriptions of reference and biosimilar products. A generalized synthetic control method was used for analysis. From April 2020 to March 2023, the study involved 27,737 patients in 114 hospitals, with 63 eligible hospitals receiving financial incentives. The average number of prescriptions of the drugs (rituximab, trastuzumab, and bevacizumab) increased gradually in both eligible and ineligible hospitals. The financial incentives were associated with a significant increase in the proportion of biosimilar product prescriptions, with a monthly increase of 0.092 per month (95% CI, 0.040-0.145) [9.2%, 95% CI, 4.0-14.5] compared to ineligible hospitals. Our study indicates that providing financial incentives to hospitals to utilize biosimilar products increased their prescriptions. Japan's recent health policy of moderate financial incentives is an effective approach to increasing prescriptions of biosimilar products.

Clinical research should conform to high standards of ethical and scientific integrity, given that human lives are at stake. However, economic incentives can generate conflicts of interest for investigators, who may be inclined to withhold unfavorable results or even tamper with data in order to achieve desired outcomes. To shed light on the integrity of clinical trial results, this paper systematically analyzes the distribution of P values of primary outcomes for phase II and phase III drug trials reported to the ClinicalTrials.gov registry. First, we detect no bunching of results just above the classical 5% threshold for statistical significance. Second, a density-discontinuity test reveals an upward jump at the 5% threshold for phase III results by small industry sponsors. Third, we document a larger fraction of significant results in phase III compared to phase II. Linking trials across phases, we find that early favorable results increase the likelihood of continuing into the next phase. Once we take into account this selective continuation, we can explain almost completely the excess of significant results in phase III for trials conducted by large industry sponsors. For small industry sponsors, instead, part of the excess remains unexplained.

Millions of people across the tropics rely on wildlife for food and income. However, overhunting to satisfy this demand is causing the decline of many species; an issue known as the wild meat crisis. We applied a before‐after control‐intervention design to assess the effects of social marketing (an information campaign and community engagement) with and without an economic incentive (discount coupons for chicken) on wild meat consumption. Coupons increased chicken consumption, as expected, but did not reduce wild meat consumption. In contrast, social marketing without the price incentive reduced wild meat consumption by ∼62%. This study demonstrates how social marketing and price incentives may be effective at reducing demand for meat and other wildlife products.

Low adherence to preventative medications against life-long health conditions is a major contributor to global morbidity and mortality. We implemented a pilot randomized controlled trial in Mexico to measure the extent to which conditional economic incentives help male sex workers increase their adherence to pre-exposure prophylaxis (PrEP) for HIV prevention. We followed n  = 110 male sex workers over 6 months. At each quarterly visit (at months 0, 3, and 6), all workers received a $10 transport reimbursement, a free 3-month PrEP supply, and completed socio-behavioral surveys. The primary outcome was an objective biomarker of medication adherence based on tenofovir (TFV) drug concentration levels in hair collected at each visit. Individuals randomized to the intervention received incentives based on a grading system as a function of PrEP adherence: those with high (> 0.043 ng/mg TFV concentration), medium (0.011 to 0.042 ng/mg), or low (< 0.011 ng/mg) adherence received $20, $10, or $0, respectively. Six-month pooled effects of incentives on PrEP adherence were analyzed using population-averaged gamma generalized estimating equation models. We estimated heterogeneous treatment effects by sex worker characteristics. The incentive intervention led to a 28.7% increase in hair antiretroviral concentration levels over 6 months consistent with increased PrEP adherence ( p  = 0.05). The effect of incentives on PrEP adherence was greater for male sex workers who were street-based (vs. internet) workers ( p  < 0.10). These pilot findings suggest that modest conditional economic incentives could be effective, at scale, for improving PrEP adherence among male sex workers, and should be tested in larger implementation trials. ClinicalTrials.gov Identifier: NCT03674983.

Pay-for-performance (P4P) incentives can be paid as a bonus (gain) or a penalty (loss). Diminishing marginal utility of wealth suggests that, starting from the same initial wealth, individuals dislike losses more than they like equivalent gains. This study reports the minimum financial gain or loss required to motivate primary care providers and clinical staff to try to increase their human papillomavirus (HPV) vaccination rates. In 2022, we conducted a national U.S. survey through WebMD's Medscape Network of clinical staff working in primary care clinics that provided HPV vaccination to children ages 9 through 12 years (N = 2,527; response rate = 57%). We randomized respondents to one of two hypothetical HPV vaccine incentive designs: a bonus for reaching an unspecified target HPV vaccination rate and a penalty for failing to reach the unspecified target. The primary outcome is the self-reported smallest incentive amount (U.S. dollars) that would motivate participants to try and increase their HPV vaccination rates. We tested for differences across P4P designs using unadjusted responses and linear regressions adjusting for clinic and respondent characteristics. We also tested for heterogeneous responses by experience with incentizves, training, and rurality. The mean amount required to motivate effort was $2,155 in the gain P4P design and $1,185 in the loss P4P design (unadjusted difference =  $970 [p < 0.001], adjusted difference =  $967 [p < 0.001]). There were no heterogeneous effects by rurality or experience with incentives. Physicians reported the highest differences (in dollars) between gain and loss P4P designs. Stated preference data from primary care clinical staff suggests that effective P4P incentives could be half as large if designed as losses rather than gains.

The Internet of Things (IoT) has revolutionized the connectivity of physical devices, leading to an exponential increase in multimedia wireless traffic and creating substantial demand for radio spectrum. Given the inherent scarcity of available spectrum, Cognitive Radio (CR)-assisted IoT emerges as a promising solution to optimize spectrum utilization through cooperation between cognitive and IoT nodes. Unlicensed IoT nodes can opportunistically access licensed spectrum bands without causing interference to licensed users. However, energy constraints may lead to reduced cooperation from IoT nodes during the search for vacant channels, as they aim to conserve battery life. To address this issue, we propose a Punishment-reward-based Cooperative Sensing and Data Forwarding (PR-CSDF) approach for IoT data transmission. Our method involves two key steps: (1) distributing sensing tasks among IoT nodes and (2) enhancing cooperation through a reward and punishment strategy. Evaluation results demonstrate that both secondary users (SUs) and IoT nodes achieve significant utility gains with the proposed mechanism, providing strong incentives for cooperative behaviour.

Background There is international interest in whether improved primary care, in particular for patients with chronic or complex conditions, can lead to decreased use of health resources and whether financial incentives help achieve this goal. This trial (EQuIP-GP) will investigate whether a funding model based upon targeted, continuous quality incentive payments for Australian general practices increases relational continuity of care, and lessens health-service utilisation, for high-risk patients and children. Methods We will use a mixed methods approach incorporating a two-arm pragmatic cluster randomised control trial with nested qualitative case studies. We aim to recruit 36 general practices from Practice-Based Research Networks (PBRN) covering urban and regional areas of Australia, randomised into intervention and control groups. Control practices will provide usual care while intervention practices will be supported to implement a new service model incorporating incentives for relational continuity and timely access to appointments. Patients will comprise three groups: older (over 65 years); 18–65 years with chronic and/or complex conditions; and those aged less than 16 years with increased risk of hospitalisation. The funding model includes financial incentives to general practitioners (GPs) for providing longer consultations, same day access and timely follow-up after hospitalisation to enrolled patients. The payments are proportional to expected health system savings associated with improved quality of GP care. An outreach facilitator will work with practices to help incorporate the incentive model into usual work. The main outcome measure is relational continuity of care (Primary Care Assessment Tool short-form survey), with secondary outcomes including health-related quality of life and health service use (hospitalisations, emergency presentations, GP and specialist services in the community, medicine prescriptions and targeted pathology and imaging ordering). Outcomes will be initially evaluated over a period of 12 months, with ongoing data collection for 5 years. Discussion The trial will provide robust evidence on a novel approach to providing continuous incentives for improving quality of general practice care, which can be compared to block payment incentives awarded at target quality levels of pay-for-performance, both within Australia and also internationally. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000105246 . Registered on 23 January 2018.

A key element required for translating new knowledge into effective therapies is early-stage venture capital that finances the work needed to identify a lead molecule or medical device prototype and to develop it to the proof-of-concept stage. This early investment is distinguished by great uncertainty over whether the molecule or prototype is safe and effective, the stability of the regulatory standards to which clinical trials are designed, and the likelihood that large follow-on investments for commercial development can be secured. Regulatory and reimbursement policies have a profound impact on the amount of capital and the types of life science projects that investors pursue. In this article I analyze several recent trends in early-stage venture capital funding, describe how these trends are influenced by regulatory and reimbursement policies, and discuss the role of policy makers in bringing new treatments to market. Policy makers can foster renewed private investment into critically needed early-stage products by increasing Small Business Innovation Research (SBIR) funding and public support for clinical trials in targeted areas of interest; creating regulatory pathways to enable early testing of experimental compounds in limited populations; and offering economic incentives for investors and developers in designated therapeutic areas.

Towards the long-term sustainable development of the northern foothills of the Qilian Mountains, the design of migration motivation mechanisms is a key issue. Considering motivation perspectives and social exchange theories, a framework and measurement scale were constructed to analyze the influence of government incentives on Wuwei’s relocated immigrants. ANOVA and generalized linear regression models were employed to analyze the differences among regions and groups, along with the influence of various incentives. The results of the study indicate: (1) In Wuwei City, non-economic incentive factors were rated higher than economic incentives. The overall evaluation value for the negative behavior of immigrants was 0.369, and the incentive effect score was 0.633, with significant regional variation. (2) Based on cultural types, Wuwei City was found to have a high percentage of hierarchists, egalitarians and individualists, comprising 39.22%, 23.85% and 21.54%, respectively. Among cultural types, motivation factors and the incentive effect of the government made no difference except for the index of communication and opportunistic behavior. (3) Immigrants’ negative behavior was significantly affected by their cultural types. An economic incentive from the government increased the likelihood that immigrants would adopt negative behavior, whereas a participation incentive effectively eliminated those behaviors. (4) The government’s economic incentives appear significantly better at promoting the incentive effect than non-economic incentives, but in dispelling the negative behavior of immigrants, non-economic incentives have played a significantly greater role than economic incentives. Incentives associated with relocation provide a new objective basis for determining a policy scheme for the relocation of migrants in the Qilian Mountains, and departments can formulate corresponding incentive models and support policies accordingly as a consequence.

Based on 804 samples of farmers in Hubei Province, a typical major grain-producing area in China, this study empirically analyzed the effects of two different policy tools, i.e. economic incentives (subsidies) and order enforcements (regulatory restrictions), as well as the effects of their interaction, on farmers’ chemical fertilizer reduction and substitution behaviors. Samples were grouped according to the degree of concurrent employment to analyze the effects on different groups. The results show that (1) the influences of these policies on the behaviors were significantly positive; (2) after constructing the interactive variables of the policies, the influence of the order enforcement policy was no longer significant, but the influence of the interaction was significantly positive; (3) the low-degree concurrent employment farmers were more likely to be affected by the order enforcement policy, whereas the high-degree ones were more affected by the economic incentive policy; and (4) the behaviors of the low-degree ones were strongly affected by family management characteristics, whereas the high-degree ones were more affected by the farmers’ individual characteristics.