Reducing The Cost Of Recruitment


Mark Taggart, Cenduit’s Head of Patient Reminders, discusses the costs of patient recruitment and retention and how inexpensive it is to incorporate a patient reminder program in relation to recruiting new patients.



Lex Raleigh: Hi, and welcome back to Cenduit Quickcasts. I'm your host, Lex Raleigh. Today, I'm excited to welcome back to the show Mark Taggart, Cenduit's head of patient reminders. Mark, how have you been?

Mark Taggart: Hey, Lex. Good to see you again.

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Lex Raleigh: Great to see you. I'm pleased you could make it back, because I wanted to spend some time talking to you about something that I'm sure is interesting to all of our listeners, and that's ways to cut costs when it comes to patient recruitment and retention.

Mark Taggart: Great, yeah. Let's look at the costs.

Lex Raleigh: I was actually made aware recently of a study by Cutting Edge Information about patient recruitment, and it indicated that the number one cost driver in a clinical trial is patient recruitment. Does this track with your own experience?

Mark Taggart: It does. It really does. Recruiting patients in a clinical trial is incredibly difficult. It's timely, and it's outrageously expensive. In addition to patient recruitment, it's the failure to retain patients in a clinical trial that drives costs upward. Because don't forget, the clinical trial lasts a while, and so you've got to keep patients engaged, motivated, doing all the things you need them to do - and some of those can be unpleasant and time consuming - throughout the duration of the study.

Then you also need patients to adhere to the demands of the clinical protocol. That, too, can sometimes be upsetting. Costs are pretty big.

Lex Raleigh: Maybe give me an example of that. What I've heard you say is, basically we have ... Yeah, it costs a lot. Let's dig into one of these more specifically. What are some of the costs involved in recruiting someone to begin with?

Mark Taggart: I think the simplest way of actually calculating cost of a clinical trial is to take the whole study budget and divide it by the number of patients enrolled, and that's the cost per patient. It's a very simplistic model of looking at it. It's amazing that a lot of people I speak to at the study level don't really understand or fully appreciate the cost per patient. That might be one of the reasons why it's not so heavily investigated. Senior people know they need to cut costs, and study teams are doing a great job of trying to cut costs. Vendors are supporting that with their drive for efficiency, so that's great, too.

Costs are, I think in real terms, being cut. Sometimes, they don't really know where to cut the costs. Some things, like patient reminders, we're finding as being great mathods to drive down the clinical trial costs. When we look at the numbers, which we'll do in a minute, I think it's quite interesting. We're talking to senior management at some organizations, and they know that there are issues across all clinical trials. It's generally around patient recruitment, retention, compliance, and adherence. Those are the problems we at Cenduit are focused on solving.

Lex Raleigh: Fantastic. One of the things I wanted to hear your take on is this recruitment aspect. As you mentioned, you can divide the clinical study budget by the number of patients, but that's really just an up-front cost, right? Over the course of the study, I assume people are going to come in and out of that study. Does that factor into it in any way?

Mark Taggart: It does, and it depends how simplistically you want to look at it. I've looked at it in a very simplistic way, which is the total spend of the study versus the total number of patients that are going to be enrolled in that study. If you could actually retain more patients by making sure that every single thing they needed to do was done and they were compliant at the site visit, that's going to drive down cost significantly.

Lex Raleigh: Very interesting point. Tell us specifically how patient reminders can help reduce these costs.

Mark Taggart: Okay. With patient reminders, we help patients turn up on time, in the correct state, doing the things they need to do: dosing correctly, on time, maybe fasting, and doing things like this. These reminders are sent via SMS, text, email, voice message, and through calendar reminders.

Let's look at some of the costs. Let's take an imaginary study, 1,000 patients, with a budget of $7 million, across a few countries. As we all know in the industry, that would be quite a low budget to run a study like that. Let's work on the low side, so that hopefully people understand, really, the high cost.

Let's say we have 1,000 patients that have to do ten visits over a course of two, three, or four years. That's actually 10,000 visits. What is the likelihood that everybody will remember to turn up on time for 10,000 visits? It's quite low, and there's a lot of research out there that indicates it's very low. Let's say, across the board, there's a 20% rate of non-compliance. That's 2,000 visits. That means doctors have been sitting there, waiting, 2,000 times to investigate and prove the efficacy of the patient data. That means there's 2,000 bits of data missing. That's a lot.

Let's assume it's $250 per patient visit. Well, $250 times 2,000 visits equals $500,000. I just don't think that many people really realize the wastage of those valuable resources, and the time of the site staff. It must be really frustrating for those guys when patients don't turn up.  They don't mean not to turn up, they just haven't because they lead busy lives, and things like that. $500,000 could be better spent in other ways, and study teams are starting to grasp that. I think senior management are starting to realize that it's a big area for saving.

Lex Raleigh: That's a fantastic point, Mark. One of the things that occurred to me as you're talking, so you mentioned the study cost. The cost of the site visit, rather. What about to the overall protocol? I'm thinking from a statistical basis, if they didn't then have enough data because enough of their patients dropped out, then what if they drop below that statistical significance? What about then? Do they have to recruit more people, then it's out of time sync? What sort of factors do you have with that?

Mark Taggart: That's a really good point. Imagine you're the global head of a clinical trial, this happens to them all the time. Imagine you're that person. What do you think would happen?

Lex Raleigh: I imagine I'd have to go back to the drawing board and see if I can get some more people into my study, and then it's going to extend the deadlines. Bottom line is I wouldn't have, necessarily, all the information I need to make the case on drug efficacy.

Mark Taggart: Yeah. This is why we're starting to see really senior executives realize that from the start of the clinical trial, doesn't it make sense that while we're doing our randomization of patients into the clinical trial, that we actually also queue up the reminders automatically because it's so easy, and low cost to do? We can do that. That's like an insurance policy, like all good insurance policies, you might not need it. But, if you do, and it helps, and that's a big saving ... What [inaudible 00:07:03] teams are doing is incredibly complex, and really difficult. They're dealing with humans, at the end of the day.

Lex Raleigh: Right. One more way to maybe put this cost in focus. This is something that you and I have talked about before. What if we go about comparing, what's the cost of having a patient reminder system set up in the beginning compared to the cost of recruiting new patients at the end of a study?

Mark Taggart: It's very simple. A reminders program starts at about $40,000 for a year, and maybe a bit longer, across countries. Let's look at an imaginary scenario where we've got our $7 million budget, and we're trying to recruit 1,000 patients. That's a very low cost of $700 to run that patient. Our listeners out there will have their own numbers. Let's say, for instance, we had a 25% retention issue. 25% of the patients dropped out of the study. That would equate to 250 patients. That's a big hole in your data, isn't it? How can you really prove efficacy across the various arms of the study, and how can you truly prove that everything is as good as it should be? I think reminders are pretty important. At $700 per patient, times 250, that equates to $175,000. That's $175,000, added to the $500,000 we could have saved earlier, $675,000. It's mind boggling, really.

Lex Raleigh: What I loved about the way you just explained that, and what I take away, is this idea of an insurance policy. Maybe for as little as $40,000 or $50,000, you can have this insurance policy on your protocol, and save you the cost of $675,000 or more down the road. To me, it seems like a pretty obvious answer.

Mark Taggart: Yeah, and I've seen it. I've seen study teams who've called us up, wishing that they'd put this in place. They are hemorrhaging patients. You might not think you need it today, but you'll be really grateful you had it tomorrow.

Lex Raleigh: That's one of the reasons, Mark, I love talking to you about the costs involved in patient retention, because it really drives home the point of how valuable it is, how relatively inexpensive it is to set it up up front, how much it streamlines the process in study design down the road, and just bottom line how much it saves money. Thanks for coming to talk to us today, Mark. I really appreciate your time.

Mark Taggart: Thank you, Lex, and thanks for your time. It's awesome to see you again.