This is the fifth and final instalment in our series exploring the true return on investment of Home Trial Support (HTS). Over the past two weeks, we have addressed Part 1: Site Fragility, Part 2: Patient-Centricity and Researching in the Home, Part 3: Retention and the Cost of Waiting, and Part 4: Recruitment Speed and Hard Evidence. Today, we bring these threads together to ask an essential practical question: who within a sponsor organisation should actually weigh these values and decide?
When assessing new clinical trial operating models, the friction is rarely about the clinical benefit. Almost everyone agrees that making trials easier for patients is a positive step. The challenge almost always lies in governance: where the cost is booked, who carries the operational perceived risk, and who actually reaps the commercial reward.
The 2020 Perspective
In the original 2020 blog, we acknowledged that while every one of the five core values can be translated into financial terms, doing so is complex and unique to each study and customer. MRN could reliably model recruitment and retention based on operational benchmarks, but broader commercial impacts – such as patent protection and launch timelines – are best evaluated by the sponsor.
We also argued that individual project teams are usually the wrong place to make this decision. Project managers are tasked with delivering studies strictly on time and to a fixed budget. To a project team, introducing an innovative delivery method often reads primarily as an operational unknown and an additional upfront line item. Innovation is routinely set aside in pursuit of budget certainty – even though portfolio-level savings are where the vast majority of decentralised clinical trial benefits actually sit. We concluded that senior executives owning a therapeutic area or clinical operations – portfolio directors – are far better placed to decide.
Where It Stands Today
What has changed in 2026 is that our ROI model is sharper, our recruitment and retention numbers are proven across our portfolio rather than modelled, and independent evidence from groups like Tufts anchors the business case.
What has not changed is who should be making the choice.
It remains common for study-level project managers to assess the balance of risk and immediate budget impact of an innovation as too high, preferring traditional paths for the sake of perceived certainty. The irony is that industry data shows the only certainty in traditional execution is a high likelihood of study delays.
The individuals best placed to weigh this decision are the senior leaders overseeing a whole therapeutic area or the entirety of clinical operations. These portfolio managers:
- Are measured on overall development velocity: They track aggregate programme timelines and total cost across multiple trials, rather than defending isolated line items.
- Can capture cross-functional value: They see the financial benefits of accelerated go/no-go milestones, preserved patent exclusivity, and earlier regulatory filings that single-trial budgets cannot reflect.
- Hold the organisational mandate: They can implement standard operating practices across an entire pipeline, rather than forcing individual teams to rediscover and re-evaluate solutions one study at a time.
Bringing the Value Home
Six years on, our conclusion is very similar to the one reached in 2020 – only now backed by hard operational delivery and independent validation:
- Design it in from the start: Home Trial Support delivers the highest ROI when offered to all sites and all eligible patients from day one, rather than kept on standby as an emergency contingency.
- Focus on cycle time: The real value of HTS is not a minor operational saving; it is compressed recruitment timelines, superior retention, and accelerated time-to-market.
- Decide at the portfolio level: Strategic returns unlock when governance sits with leaders who can look across programmes and recognise that compressing the development timeline is the most valuable outcome in drug development.
If you would like to run these numbers against your own protocol – testing your recruitment assumptions, retention targets, and timeline economics – contact our team using the button below. MRN will run your study parameters through our 2026 ROI model to reveal exactly where the value sits.