ideasIdea
Travel, lodging and meals reimbursed as a standard line in every trial budget
People should not have to pay to be in a trial. Sponsors would routinely cover travel, hotel and food costs, paid up front rather than claimed back, which is already accepted by regulators as fair rather than coercive.
Every trial budget includes a participant-cost line administered by a third party, prepaid where possible, covering travel, parking, lodging, meals and a companion. The FDA's position is that reimbursement for expenses is not undue influence. Charities such as the Lazarex Cancer Foundation have shown that covering these costs raises enrolment among low-income patients; the idea is to make sponsor funding of it universal, with ethics committees expecting it.
Hypothesis
Trials with prepaid participant-cost coverage will enrol a larger share of patients from low-income postcodes and have lower dropout than matched trials without it.
Rationale
Out-of-pocket costs are a documented barrier and fall hardest on poorer and minority patients. Reimbursement is cheap relative to per-patient trial cost.
What would test it
Sponsor-level natural experiment: compare enrolment demographics and retention before and after a portfolio-wide reimbursement policy, adjusting for indication.
Maturity
being tested at scale
Who has to act
industry
Cost to try
Medium ($1M to $50M)
Years to first evidence
1
Bottlenecks it attacks
- Trials enrol too few, too slowly · Fewer than one in ten adults with cancer joins a trial. Trials close for lack of patients, not lack of ideas.
- Trials do not represent the people who get cancer · Older, Black, Hispanic, Asian, rural, poor and multimorbid patients are under-represented, so results may not apply to them.