title: Cost-effectiveness of health research study participant recruitment strategies: a systematic review.
abstract: BACKGROUND
  A large fraction of the cost of conducting clinical trials is allocated to recruitment of participants. A synthesis of findings from studies that evaluate the cost and effectiveness of different recruitment strategies will inform investigators in designing cost-efficient clinical trials.
  
  
  OBJECTIVE
  To systematically identify, assess, and synthesize evidence from published comparisons of the cost and yield of strategies for recruitment of participants to health research studies.
  
  
  METHODS
  We included randomized studies in which two or more strategies for recruitment of participants had been compared. We focused our economic evaluation on studies that randomized participants to different recruitment strategies.
  
  
  RESULTS
  We identified 10 randomized studies that compared recruitment strategies, including monetary incentives (cash or prize), direct contact (letters or telephone call), and medical referral strategies. Only two of the 10 studies compared strategies for recruiting participants to clinical trials. We found that allocating additional resources to recruit participants using monetary incentives or direct contact yielded between 4% and 23% additional participants compared to using neither strategy. For medical referral, recruitment of prostate cancer patients by nurses was cost-saving compared to recruitment by consultant urologists. For all underlying study designs, monetary incentives cost more than direct contact with potential participants, with a median incremental cost per recruitment ratio of Int$72 (Int$-International dollar, a theoretical unit of currency) for monetary incentive strategy compared to Int$28 for direct contact strategy. Only monetary incentives and source of referral were evaluated for recruiting participants into clinical trials.
  
  
  CONCLUSIONS
  We did not review studies that presented non-monetary cost or lost opportunity cost. We did not adjust for the number of study recruitment sites or the study duration in our economic evaluation analysis.
  
  
  CONCLUSIONS
  Systematic and explicit reporting of cost and effectiveness of recruitment strategies from randomized comparisons is required to aid investigators to select cost-efficient strategies for recruiting participants to health research studies including clinical trials.
authors: Analysis Group, Inc., Boston, MA, USA lhuynh@analysisgroup.com.
authors: Lynn
authors: L
authors: Huynh
authors: Department of International Health, Abt Associates, Inc., Bethesda, MD, USA.
authors: Benjamin
authors: B
authors: Johns
authors: Department of Family Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Su-Hsun
authors: SH
authors: Liu
authors: Department of Computer Science, The Johns Hopkins University, Baltimore, MD, USA.
authors: S Swaroop
authors: SS
authors: Vedula
authors: Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Tianjing
authors: T
authors: Li
authors: Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
authors: Milo A
authors: MA
authors: Puhan
mesh_terms: D035843:Biomedical Research / Q000191:economics*; D015709:Correspondence as Topic; D003362:Cost-Benefit Analysis; D006801:Humans; D009042:Motivation; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics; D013689:Telephone
keywords: Cost of conducting health research studies; clinical trial efficiency; economic evaluation; recruitment; recruitment effectiveness