Singh, Pritibha, Sverdlov, Alex, Beckman, Robert A. and Burden, Andrea M. (2025) Integrating environmental, economic, and social pillars for a holistic decision-making approach in optimal portfolio and trial decisions: results of an international multi-stakeholder survey. Clinical and Translational Science, 18 (5). ISSN 1752-80541752-8062

Abstract

The pharmaceutical industry is increasingly shifting to decentralized clinical trials (DCTs) conducted at the patient's home, sometimes including trial material home delivery. The traditional clinical trial (CT) is conducted at the investigational site. Research suggests that trials in centralized and decentralized settings have a large carbon footprint, with DCTS potentially providing patient-centric solutions. However, leaders must determine how to integrate environmental, economic, and social sustainability pillars into their portfolios and subsequent downstream trial-level decisions.

An online survey was designed and deployed via ETH’s SurveySelect software to capture international multi-stakeholder perceptions of priorities and tradeoffs when deciding between a DCT and a traditional CT for each pillar. The survey closed on 31st January 2023. A total of 447 participants responded. The findings revealed that the overall cohort prioritized greenhouse gas emissions (22.4%) for environmental impact, trial probability of success (15%) for economic considerations, and patient convenience (23.3%) for social criteria. Overall, the DCT setting was perceived as more sustainable in all pillars. Participants reported tradeoffs centered on patient engagement and bringing new medicines to the market.

The results from this survey provide initial insights into international multi-stakeholder perceptions of the priorities and tradeoffs when choosing between a traditional CT and DCT. The synthesized perceptions inform three key recommendations: the need (1) for simulation studies to guide holistic decision-making across all pillars as empirical data accumulates, (2) to protect the environment, and (3) to protect the supply chain. As empirical data accumulates, these recommendations provide directionality for further research.

Item Type:	Article
Keywords:	DCT, Decentralized Clinical Trial, Decision-making, Sustainability, Environment, Economic, Social, Survey, Quantitative Data, Qualitative Data
Date Deposited:	15 Jul 2025 00:45
Last Modified:	15 Jul 2025 00:45
URI:	https://oak.novartis.com/id/eprint/56041