Quantitative assessment of the impact of standard agreement templates on multisite clinical trial start up time

Transformation of the Algorithm for Prioritising Clinical Trial Development in Kazakhstan Based on Practical Significance

The research relevance is determined by the need for rational use of limited resources in the healthcare sector and the importance of implementing the results of scientific research into medical practice to improve the quality of medical care. The study aims to identify key criteria and develop a system for evaluating clinical trials to prioritise the most promising areas based on their practical applicability in healthcare. The expert evaluation method of 17 research projects in the field of clinical medicine funded by government grants, involving 37 experts, was used to achieve the objective. The experts conducted the assessment using a multi-criteria system, including 4 categories and about 20 individual indicators. The results showed that 58.8% of the projects required a change in the composition of the teams, and in 70.6% of cases, third-party organisations were involved for methodological support. About 41.2% of applications had a solid scientific basis, but the demand for the results of 17.6% of projects decreased due to the COVID-19 pandemic. For 23.5% of projects, the proposed topics were of low public demand. Only 47.1% of the projects demonstrated interest in addressing national health issues. In 17.2% of fundamental projects, assessing the economic efficiency was difficult. In 23.5% of cases, projects could have been financed from other sources. The timeframe of 3 years was assessed as insufficient for 76.5% of highly specialised projects. Based on the analysis, recommendations for improving processes to increase the practical significance of research are formulated. The study contributes to developing an evaluation methodology and improving the efficiency of grant funding in medicine.

Navigating the challenges of initiating pediatric device trials - a case study

Introduction

Pediatric medical devices lag behind adult devices due to economic barriers, smaller patient populations, changing anatomy and physiology of patients, regulatory hurdles, and especially difficulties in executing clinical trials. We investigated the requirements, challenges, associated timeline, and costs of conducting a multi-site pivotal clinical trial for a Class II pediatric physiologic monitoring device.

Methods

This case study focused on the negotiation of clinical trial agreements (CTAs), budgets, and Institutional Review Board (IRB) processing times for a pediatric device trial. We identified key factors contributing to delays in clinical trial execution and potential best practices to expedite the process while maintaining safety, ethics, and efficacy.

Results

The total time from site contact to first patient enrollment averaged 14 months. CTA and budget negotiations were the most time-consuming processes, averaging nearly 10 and 9 months, respectively. Reliance and local IRB processing also contributed significantly to the timeline, overall adding an average of 6.5 months across institutions. Nearly half of all costs were devoted to regulatory oversight. The COVID-19 pandemic caused significant slowdowns and delays at multiple institutions during study enrollment. Despite these pandemic-induced delays, it is important to note that the issues and themes highlighted remain relevant and have post-pandemic applicability.

Conclusions

Our case study results underscore the importance of establishing efficient and standardized processing of CTAs, budget negotiations, and use of reliance IRBs to expedite clinical trial execution for pediatric devices. The findings also highlight the need for a national clinical trials network to streamline the clinical trial process.

Leveraging the Expertise of the CTSA Program to Increase the Impact and Efficiency of Clinical Trials

Importance

Multicenter clinical trials play a critical role in the translational processes that enable new treatments to reach all people and improve public health. However, conducting multicenter randomized clinical trials (mRCT) presents challenges. The Trial Innovation Network (TIN), established in 2016 to partner with the Clinical and Translational Science Award (CTSA) Consortium of academic medical institutions in the implementation of mRCTs, consists of 3 Trial Innovation Centers (TICs) and 1 Recruitment Innovation Center (RIC). This unique partnership has aimed to address critical roadblocks that impede the design and conduct of mRCTs, in expectation of accelerating the translation of novel interventions to clinical practice. The TIN's challenges and achievements are described in this article, along with examples of innovative resources and processes that may serve as useful models for other clinical trial networks providing operational and recruitment support.

Observations

The TIN has successfully integrated more than 60 CTSA institution program hubs into a functional network for mRCT implementation and optimization. A unique support system for investigators has been created that includes the development and deployment of novel tools, operational and recruitment services, consultation models, and rapid communication pathways designed to reduce delays in trial start-up, enhance recruitment, improve engagement of diverse research participants and communities, and streamline processes that improve the quality, efficiency, and conduct of mRCTs. These resources and processes span the clinical trial spectrum and enable the TICs and RIC to serve as coordinating centers, data centers, and recruitment specialists to assist trials across the National Institutes of Health and other agencies. The TIN's impact has been demonstrated through its response to both historical operational challenges and emerging public health emergencies, including the national opioid public health crisis and the COVID-19 pandemic.

Conclusions and Relevance

The TIN has worked to reduce barriers to implementing mRCTs and to improve mRCT processes and operations by providing needed clinical trial infrastructure and resources to CTSA investigators. These resources have been instrumental in more quickly and efficiently translating research discoveries into beneficial patient treatments.