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Andersen JR, von Sehested C, Byrjalsen I, Popik S, Follin AB, Bihlet AR. Impact of monitoring approaches on data quality in clinical trials. Br J Clin Pharmacol 2022; 89:1756-1766. [PMID: 36478289 DOI: 10.1111/bcp.15615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/03/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022] Open
Abstract
AIMS Source data verification (SDV) has been reported to account for up to 25% of the budget in clinical trials (CT) and cost-benefit of SDV has been questioned. Guidelines for risk-based monitoring (RBM) were published in 2013 by agencies and in 2016, ICH-GCP-E6-(R2) added a requirement for risk-based approaches. This report will perform a comparison of the impact of RBM vs classic monitoring (CM) on data quality (defined as accuracy of data reporting from source data to final trial data) and expected impact on costs of CTs. METHODS Data on residual errors from four, large comparable randomised CTs were examined by post-trial SDV. Observed discrepancies were analysed in the categories of "overall" data, "major efficacy" and "major safety". In each category, the residual error rate was calculated as the number of discrepancies divided by the number of data-fields verified. RESULTS A total of 1 716 087 data points were verified using CM and 323 174 using RBM. The overall error rate was 0.40% for RBM and 0.37% for CM (P < 0.01). For major efficacy, defined by risk assessment, the error rate was 0.15% and 0.28% (P < 0.0001); in major safety, defined by risk assessment, the error rate was 0.49% and 0.67% (P = 0.15), both in favour of the RBM approach. CONCLUSION These empirical data, directly comparing RBM with CM, suggest that RBM improves data quality regarding data-points of major importance to trial outcomes, efficacy and major safety. Overall, the RBM approach showed a correlation to reduced amount of data collection errors with major relevance for interpretation of study results and subject safety as well as reducing on-site monitoring and data cleaning resources.
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Yamada O, Chiu SW, Takata M, Abe M, Shoji M, Kyotani E, Endo C, Shimada M, Tamura Y, Yamaguchi T. Clinical trial monitoring effectiveness: Remote risk-based monitoring versus on-site monitoring with 100% source data verification. Clin Trials 2020; 18:158-167. [PMID: 33258688 DOI: 10.1177/1740774520971254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIMS Traditional on-site monitoring of clinical trials via frequent site visits and 100% source data verification is cost-consuming, and it still cannot guarantee data quality effectively. Depending on the types and designs of clinical trials, an alternative would be combining several monitoring methods, such as risk-based monitoring and remote monitoring. However, there is insufficient evidence of its effectiveness. This research compared the effectiveness of risk-based monitoring with a remote monitoring system with that of traditional on-site monitoring. METHODS With a cloud-based remote monitoring system called beagle View®, we created a remote risk-based monitoring methodology that focused only on critical data and processes. We selected a randomized controlled trial conducted at Tohoku University Hospital and randomly sampled 11 subjects whose case report forms had already been reviewed by data managers. Critical data and processes were verified retrospectively by remote risk-based monitoring; later, all data and processes were confirmed by on-site monitoring. We compared the ability of remote risk-based monitoring to detect critical data and process errors with that of on-site monitoring with 100% source data verification, including an examination of clinical trial staff workload and potential cost savings. RESULTS Of the total data points (n = 5617), 19.7% (n = 1105, 95% confidence interval = 18.7-20.7) were identified as critical. The error rates of critical data detected by on-site monitoring, remote risk-based monitoring, and data review by data managers were 7.6% (n = 84, 95% CI = 6.2-9.3), 7.6% (n = 84, 95% confidence interval = 6.2-9.3), and 3.9% (n = 43, 95% confidence interval = 2.9-5.2), respectively. The total number of critical process errors detected by on-site monitoring was 14. Of these 14, 92.9% (n = 13, 95% confidence interval = 68.5-98.7) and 42.9% (n = 6, 95% confidence interval = 21.4-67.4) of critical process errors were detected by remote risk-based monitoring and data review by data managers, respectively. The mean time clinical trial staff spent dealing with remote risk-based monitoring was 9.9 ± 5.3 (mean ± SD) min per visit per subject. Our calculations show that remote risk-based monitoring saved between 9 and 41 on-site monitoring visits, corresponding to a cost of between US$13,500 and US$61,500 per trial site. CONCLUSION Remote risk-based monitoring was able to detect critical data and process errors as well as on-site monitoring with 100% source data verification, saving travel time and monitoring costs. Remote risk-based monitoring offers an effective alternative to traditional on-site monitoring of clinical trials.
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Affiliation(s)
- Osamu Yamada
- Division of Biostatistics, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Shih-Wei Chiu
- Division of Biostatistics, Graduate School of Medicine, Tohoku University, Miyagi, Japan.,Clinical Research Data Center, Tohoku University Hospital, Miyagi, Japan
| | - Munenori Takata
- Division of Biostatistics, Graduate School of Medicine, Tohoku University, Miyagi, Japan.,Clinical Research Data Center, Tohoku University Hospital, Miyagi, Japan
| | - Michiaki Abe
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Miyagi, Japan
| | - Mutsumi Shoji
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Miyagi, Japan
| | - Eri Kyotani
- Clinical Research Data Center, Tohoku University Hospital, Miyagi, Japan
| | - Chiyo Endo
- Clinical Research Data Center, Tohoku University Hospital, Miyagi, Japan
| | - Minami Shimada
- Clinical Research Data Center, Tohoku University Hospital, Miyagi, Japan
| | | | - Takuhiro Yamaguchi
- Division of Biostatistics, Graduate School of Medicine, Tohoku University, Miyagi, Japan.,Clinical Research Data Center, Tohoku University Hospital, Miyagi, Japan
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Sudo T, Sato A. Investigation of the Factors Affecting Risk-Based Quality Management of Investigator-Initiated Investigational New-Drug Trials for Unapproved Anticancer Drugs in Japan. Ther Innov Regul Sci 2018; 51:589-596. [PMID: 30231689 DOI: 10.1177/2168479017705155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND With an increase in the complexity and cost of clinical trials and the advances in information technology, monitoring guidance issued by regulatory authorities recommends risk-adapted monitoring. To introduce the monitoring method for investigator-initiated investigational new drug (IND) trials using unapproved anticancer drugs, we performed exploratory retrospective analyses to identify risk factors for data quality. METHODS To select investigator-initiated IND trials using unapproved anticancer drugs, we set the trial selection criteria. Data collection was performed by using audit trails and monitoring reports. Collected data were analyzed by univariate and multivariate analyses to identify the independent risk factors related to error. RESULTS By trial selection criteria, 5 investigator-initiated IND trials using unapproved anticancer drugs were selected. The error rates of the total data, critical data, and noncritical data were 7.4%, 9.7%, and 5.9%, respectively. There was no difference between clinical research core hospitals certified by the Ministry of Health, Labour and Welfare and other hospitals in univariate analysis (odds ratio [OR], 1.00; 99% confidence interval [CI], 0.96-1.05; P = .9179). As the main independent risk factors related to error, critical data in the importance of data (OR, 1.28; 99% CI, 1.24-1.33; P < .0001) and groups with ≤3 patients after registration (OR, 1.12; 99% CI, 1.10-1.15; P < .0001) were significantly related to errors in multivariate analysis. CONCLUSIONS The results of this research suggest that the feasibility of risk-based monitoring and sampling source data verification was indicated for noncritical data and patients after the third case.
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Affiliation(s)
- Tomohisa Sudo
- 1 Division of Clinical Research Support, National Cancer Center Hospital East, Chiba, Japan.,2 Medical Science Program, Graduate School of Medicine, Keio University, Tokyo, Japan
| | - Akihiro Sato
- 1 Division of Clinical Research Support, National Cancer Center Hospital East, Chiba, Japan
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Olsen R, Bihlet AR, Kalakou F, Andersen JR. The impact of clinical trial monitoring approaches on data integrity and cost--a review of current literature. Eur J Clin Pharmacol 2016; 72:399-412. [PMID: 26729259 DOI: 10.1007/s00228-015-2004-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Monitoring is a costly requirement when conducting clinical trials. New regulatory guidance encourages the industry to consider alternative monitoring methods to the traditional 100 % source data verification (SDV) approach. The purpose of this literature review is to provide an overview of publications on different monitoring methods and their impact on subject safety data, data integrity, and monitoring cost. METHODS The literature search was performed by keyword searches in MEDLINE and hand search of key journals. All publications were reviewed for details on how a monitoring approach impacted subject safety data, data integrity, or monitoring costs. RESULTS Twenty-two publications were identified. Three publications showed that SDV has some value for detection of not initially reported adverse events and centralized statistical monitoring (CSM) captures atypical trends. Fourteen publications showed little objective evidence of improved data integrity with traditional monitoring such as 100 % SDV and sponsor queries as compared to reduced SDV, CSM, and remote monitoring. Eight publications proposed a potential for significant cost reductions of monitoring by reducing SDV without compromising the validity of the trial results. CONCLUSIONS One hundred percent SDV is not a rational method of ensuring data integrity and subject safety based on the high cost, and this literature review indicates that reduced SDV is a viable monitoring method. Alternative methods of monitoring such as centralized monitoring utilizing statistical tests are promising alternatives but have limitations as stand-alone tools. Reduced SDV combined with a centralized, risk-based approach may be the ideal solution to reduce monitoring costs while improving essential data quality.
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Affiliation(s)
- Rasmus Olsen
- Nordic Bioscience Clinical Development A/S, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | - Asger Reinstrup Bihlet
- Nordic Bioscience Clinical Development A/S, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | - Faidra Kalakou
- Nordic Bioscience Clinical Development A/S, Herlev Hovedgade 205-207, 2730, Herlev, Denmark
| | - Jeppe Ragnar Andersen
- Nordic Bioscience Clinical Development A/S, Herlev Hovedgade 205-207, 2730, Herlev, Denmark.
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van den Bor RM, Oosterman BJ, Oostendorp MB, Grobbee DE, Roes KCB. Efficient Source Data Verification Using Statistical Acceptance Sampling: A Simulation Study. Ther Innov Regul Sci 2016; 50:82-90. [PMID: 30236013 DOI: 10.1177/2168479015602042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND One approach to increase the efficiency of clinical trial monitoring is to replace 100% source data verification (SDV) by verification of samples of source data. An intuitive strategy for determining appropriate sampling plans (ie, sample sizes and the maximum tolerable number of transcription errors in the samples) is to use acceptance sampling methodology. Expanding upon earlier work in which the use of acceptance sampling strategies for sampling-based SDV was proposed, we describe an alternative acceptance sampling strategy that, instead of relying on sampling standards, evaluates all possible sampling plans algorithmically, thereby ensuring that selected sampling plans conform to prespecified criteria. METHODS Empirical trial data guided the design of the proposed strategy. In addition, extensive simulations, also based on the empirical data, were performed to assess the performance in terms of workload reductions and the post-SDV error proportion of applying the proposed strategy. RESULTS 13 different scenarios were simulated, but results of the default scenario show that the average pre-SDV error proportion per trial of .056 was reduced to .023 by inspecting only 40.5% of the case report form entries. Of the inspected data entries, almost half (18.0/40.5) was, on average, SDV-ed as part of the sampling process; remaining entries were inspected during full inspections after too many errors were observed in the samples. CONCLUSION Our results suggest that major reductions in workload can be achieved, while maintaining acceptable data quality levels. However, the results also indicate that the proposed strategy is conservative and further improvement is possible.
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Affiliation(s)
- Rutger M van den Bor
- 1 Julius Clinical Ltd, Zeist, the Netherlands.,2 Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | | | | | - Diederick E Grobbee
- 1 Julius Clinical Ltd, Zeist, the Netherlands.,2 Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Kit C B Roes
- 1 Julius Clinical Ltd, Zeist, the Netherlands.,2 Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
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Tantsyura V, Dunn IM, Fendt K, Kim YJ, Waters J, Mitchel J. Risk-Based Monitoring: A Closer Statistical Look at Source Document Verification, Queries, Study Size Effects, and Data Quality. Ther Innov Regul Sci 2015; 49:903-910. [PMID: 30222374 DOI: 10.1177/2168479015586001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data quality within the clinical research enterprise can be defined as the absence of errors that matter and whether the data are fit for purpose. This concept, proposed by the Clinical Trials Transformation Initiative, resulted from a culmination of collaboration with industry, academia, patient advocates, and regulators, and it emphasizes the presence of a hierarchy of error types, resulting in a more efficient and modern data-cleaning paradigm. While source document verification (SDV) is commonly used as a quality control method in clinical research, it is disproportionately expensive and often leads to questionable benefits. Although the current literature suggests that there is a need to reduce the burden of SDV, there is no consensus on how to replace this "tried and true" practice. METHODS This article proposes a practical risk-based monitoring approach based on published statistical evidence addressing the impact of database changes subsequent to SDV. RESULTS The analysis clearly demonstrates minimal effects of errors and error corrections on study results and study conclusions, with diminishing effect as the study size increases, and it suggests that, on average, <8% SDV is adequate to ensure data quality, with perhaps higher SDV rates for smaller studies and virtually 0% SDV for large studies. CONCLUSIONS It is recommended that SDV, rather than just focusing on key primary efficacy and safety outcomes, focus on data clarification queries as highly discrepant (and the riskiest) data.
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Affiliation(s)
| | | | - Kaye Fendt
- 3 Duke Clinical Research Institute, Durham, NC, USA
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Sheetz N, Wilson B, Benedict J, Huffman E, Lawton A, Travers M, Nadolny P, Young S, Given K, Florin L. Evaluating Source Data Verification as a Quality Control Measure in Clinical Trials. Ther Innov Regul Sci 2014; 48:671-680. [PMID: 30227471 DOI: 10.1177/2168479014554400] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
TransCelerate has developed a risk-based monitoring methodology that transforms clinical trial monitoring from a model rooted in source data verification (SDV) to a comprehensive approach leveraging cross-functional risk assessment, technology, and adaptive on-site, off-site, and central monitoring activities to ensure data quality and subject safety. Evidence suggests that monitoring methods that concentrate on what is critical for a study and a site may produce better outcomes than do conventional SDV-driven models. This article assesses the value of SDV in clinical trial monitoring via a literature review, a retrospective analysis of data from clinical trials, and an assessment of major and critical findings from TransCelerate member company internal audits. The results support the hypothesis that generalized SDV has limited value as a quality control measure and reinforce the value of other risk-based monitoring activities.
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Affiliation(s)
- Nicole Sheetz
- 1 Clinical Development Innovation, Eli Lilly and Company, Indianapolis, IN, USA
| | - Brett Wilson
- 2 Global Development Operations, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Joanne Benedict
- 3 Global Product Development, Roche, Genentech, San Francisco, CA, USA
| | - Esther Huffman
- 4 Global Development Operations, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Andy Lawton
- 5 Biometrics and Data Management, Boehringer Ingelheim, Bracknell, UK
| | - Mark Travers
- 6 Clinical Sciences and Operations, Sanofi, Bridgewater, NJ, USA
| | - Patrick Nadolny
- 7 Bioinformatics Operations and Systems, Allergan Inc, Irvine, CA, USA
| | - Stephen Young
- 8 Strategic Consulting Services, Medidata Solutions, Conshohocken, PA, USA
| | - Kyle Given
- 9 Strategic Consulting Services, Medidata Solutions, Edison, NJ, USA
| | - Lawrence Florin
- 10 Consulting Partnerships, Medidata Solutions, Conshohocken, PA, USA
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