title: A system dynamics analysis determining willingness to wait and pay for the implementation of data standards in clinical research.
abstract: BACKGROUND
  Industry standards provide rigorous descriptions of required data presentation, with the aim of ensuring compatibility across different clinical studies. However despite their crucial importance, these standards are often not used as expected in the development of clinical research. The reasons for this lack of compliance could be related to the high cost and time-intensive nature of the process of data standards implementation. The objective of this study was to evaluate the value of the extra time and cost required for different levels of data standardisation and the likelihood of researchers to comply with these levels. Since we believe that the cost and time necessary for the implementation of data standards can change over time, System Dynamics (SD) analysis was used to investigate how these variables interact and influence the adoption of data standards by clinical researchers.
  
  
  METHODS
  Three levels of data standards implementation were defined through focus group discussion involving four clinical research investigators. Ten Brazilian and eighteen American investigators responded to an online questionnaire which presented possible standards implementation scenarios, with respondents asked to choose one of two options available in each scenario. A random effects ordered probit model was used to estimate the effect of cost and time on investigators' willingness to adhere to data standards. The SD model was used to demonstrate the relationship between degrees of data standardisation and subsequent variation in cost and time required to start the associated study.
  
  
  RESULTS
  A preference for low cost and rapid implementation times was observed, with investigators more likely to incur costs than to accept a time delay in project start-up. SD analysis indicated that although initially extra time and cost are necessary for clinical study standardisation, there is a decrease in both over time.
  
  
  CONCLUSIONS
  Future studies should explore ways of creating mechanisms which decrease the time and cost associated with standardisation processes. In addition, the fact that the costs and time necessary for data standards implementation decrease with time should be made known to the wider research community. Policy makers should attempt to match their data standardisation policies better with the expectations of researchers.
authors.affiliation: Department of Surgery, Duke University Health System, 2301 Erwin Road, Durham, 27705, USA. rpietro@duke.edu.
authors.forename: Luciana
authors.initials: L
authors.lastname: Cofiel
authors.forename: Guilherme R
authors.initials: GR
authors.lastname: Zammar
authors.forename: Amrapali J
authors.initials: AJ
authors.lastname: Zaveri
authors.forename: Jatin Y
authors.initials: JY
authors.lastname: Shah
authors.forename: Elias
authors.initials: E
authors.lastname: Carvalho
authors.forename: Meredith
authors.initials: M
authors.lastname: Nahm
authors.forename: Gustavo
authors.initials: G
authors.lastname: Kesselring
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon