By Dr Graham Wylie, Chair and Chief Executive, Medical Research Network
This article is the third instalment in our five-part series evaluating the true return on investment of Home Trial Support (HTS). If you have not read the earlier pieces, you can catch up on Part 1: Site Fragility and Part 2: Patient-first and Researching in the home.
When looking across trial budgets, participant retention is where substantial value quietly resides. However, the operational model you choose dictates whether that return is ever realised.
The 2020 Perspective
In the original 2020 blog, we highlighted two very different ways to approach study retention:
- The Reactive Approach: Setting up an in-home service on standby, deploying it only when a participant announces they want to leave the study, in an effort to rescue a single critical visit. This produces a poor ROI: full setup costs are absorbed across a handful of visits, implementation is cumbersome, and sub-contract nurses are understandably reluctant to take on extensive protocol training and coordination for a single, isolated visit.
- The Proactive Approach: Offering HTS to all eligible participants from the outset, systematically lowering participation burden so patients never reach the point of wanting to quit.
In 2020, we noted that proactive delivery kept MRN retention consistently above 95 per cent, and frequently above 98 per cent. Furthermore, if initial study design had assumed a high dropout rate when sizing the trial, better retention meant fewer patients had to be enrolled to hit the evaluable target, lowering the total cost of the study.
Where It Stands Today
Retention is where the money sits, and the numbers now make the strategic choice clear.
Holding HTS back as a reactive rescue mechanism remains inefficient and costly. By contrast, when in-home support is offered to everyone from the start, MRN studies consistently achieve retention rates above 95 per cent, and often above 98 per cent, once non-discretionary dropouts (such as safety or lack of efficacy) are set aside.
That is not a rescue figure; it is a prevention figure. Crucially, it links directly to trial budgeting:
- When high attrition is factored into original sample size calculations, sustained 95%+ retention means you can recruit fewer patients to reach statistical power.
- Fewer patients recruited translates into fewer sites activated and reduced monitoring and laboratory costs across the entire lifecycle of the study.
- It protects timelines from the compounded delays of recruiting replacement participants mid-study.
Our 2026 ROI model makes this financial saving explicit, transforming retention from an article of faith into a measurable budget advantage.