Cost analysis and efficacy of recruitment strategies used in a large pragmatic community-based clinical trial targeting low-income seniors: a comparative descriptive analysis

Sravya Kakumanu, Braden J Manns, Sophia Tran, Terry Saunders-Smith, Brenda R Hemmelgarn, Marcello Tonelli, Ross Tsuyuki, Noah Ivers, Danielle Southern, Jeff Bakal, David J T Campbell, Sravya Kakumanu, Braden J Manns, Sophia Tran, Terry Saunders-Smith, Brenda R Hemmelgarn, Marcello Tonelli, Ross Tsuyuki, Noah Ivers, Danielle Southern, Jeff Bakal, David J T Campbell

Abstract

Objective: One of the most challenging parts of running clinical trials is recruiting enough participants. Our objective was to determine which recruitment strategies were effective in reaching specific subgroups.

Study design and setting: We assessed the efficacy and costs of the recruitment strategies used in the Assessing Outcomes of Enhanced Chronic Disease Care Through Patient Education and a Value-based Formulary Study (ACCESS) in Alberta, Canada.

Results: Twenty percent of the study budget ($354,330 CAD) was spent on recruiting 4013 participants, giving an average cost per enrolled of $88 CAD. Pharmacies recruited the most participants (n = 1217), at a cost of $128/enrolled. "Paid media" had the highest cost ($806/enrolled), whereas "word of mouth" and "unpaid media" had the lowest (~$3/enrolled). Participants enrolled from "seniors outreach" had the lowest baseline quality of life and income, while participants from "word of mouth" had the lowest educational attainment.

Conclusion: The "health care providers" strategies were especially successful - at a moderate cost per enrolled. The "media" strategies were less effective, short lasting, and more costly. No strategy was singularly effective in recruiting our targeted groups, emphasizing the importance of utilizing a variety of strategies to reach recruitment goals.

Trial registration: ClinicalTrials.gov, NCT02579655 . Registered on 19 October 2015.

Keywords: Cost-effective; Low enrollment; Randomized controlled trials; Recruitment strategies; Seniors; Vulnerable populations.

Conflict of interest statement

Dr. Tsuyuki has received investigator-initiated grants from Merck Canada, AstraZeneca Canada, and Sanofi Canada. He has given paid presentations for Merck Canada and Sanofi Canada.

Figures

Fig. 1
Fig. 1
Flow diagram of potential ACCESS trial participants who made contact with the phone survey unit from November 15, 2015 to May 2, 2018
Fig. 2
Fig. 2
Proportion of callers from each method who enrolled. 1This data for the mail methods is excluded from this figure and presented separately (Table 4) due to its much larger sample size and known denominator. 2The individual strategies under Health Care Providers are analyzed separately due to their significant differences in sample size and the success and expenditure of pharmacies alone as a strategy
Fig. 3
Fig. 3
Number of people who called the survey unit during each week of the study’s recruitment period with duration of media strategy implementation

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