By Graham Wylie, Chair and Chief Executive, Medical Research Network
I first wrote about valuing Home Trial Support (HTS) in May 2020. As a result of the global COVID pandemic, investigator sites were closing their doors, and home visits suddenly shifted from being viewed as an innovative luxury to the only viable way to keep clinical studies alive.
Six years on, the crisis phase has passed, but the core question remains: How do you truly value Home Trial Support?
What has changed today is that we no longer need to rely solely on estimates. We now have a robust 2026 ROI model, measured recruitment and retention data across MRN’s delivered portfolio, and independent, peer-reviewed health economics evidence.
Over the next two weeks, we are publishing a five-part blog series breaking down the primary ways sponsors evaluate HTS, walking through the top five drivers in reverse order:
- Speed of the trial
- Patient retention
- Putting the patient first
- Researching the drug where it will be used (in the home)
- Mitigating the risk of site fragility
We begin with the newest factor: site fragility.
The 2020 Perspective
During 2020, customer demand was driven by emergency mitigation. Sites were struggling because hospital visits were restricted, non-emergency clinics shut down, and patients stayed away out of caution. Beneath the immediate disruption lay a chronic, decade-long decline in site productivity – patient numbers per site had dropped from around ten to under five in the US, and roughly seven in Europe. The industry masked this drop simply by opening more sites at escalating cost. At the time, we noted that holding HTS back purely as an emergency fallback yielded a poor return; maximum ROI required offering it proactively across all sites and participants.
Where It Stands Today
Site fragility was never purely a pandemic issue; the events of 2020 simply brought a long-standing vulnerability to light.
Traditional investigator sites can only recruit the patients their local nursing teams have the bandwidth to support, and those resources remain constrained. Adding more sites to compensate for lower site volume drives up contracting, training, and monitoring budgets, leaving studies vulnerable if key centres underperform.
HTS treats the underlying operational bottleneck rather than just the symptom. By removing travel barriers and visiting patients in their homes, a single MRN-supported site does the recruiting work of 1.4 to nearly 2 traditional sites – averaging around 1.69 times across our central nervous system and neuromuscular portfolio. That means fewer centres to activate and monitor, and a trial resilient against unexpected site slowdowns.
Crucially, our operational data confirms our initial finding: using HTS as an ad-hoc safety net limits its economic value. Realising the strongest ROI comes from designing it into the protocol for every site and every eligible participant from day one.