How digital patient recruitment can reduce enrollment costs in Major Depressive Disorder clinical trials

Depression is one of the most prevalent mental diseases, affecting millions of people worldwide. According to The World Health Organization (WHO), depression will be the most prevalent illness in high-income countries by 2030.

As 75% of mental health problems affect people between the ages of 14 and 24, in the modern digital era, it is becoming increasingly easier to digitally target anyone who suffers from depression on social media platforms.

The enormous growth of social media use has led to an increase in digital patient enrollment for clinical studies. Where it indeed presents an opportunity to reduce patient enrollment costs, it depends on a strategy based on understanding patient needs and proactively presenting lay-friendly clinical trial information to people who are likely to qualify. As costs and regulations increase, digital patient recruitment requires expertise and a well-prepared strategy based on previous experience and big data.

Typically, patient recruitment specialists provide various outreach services to help speed up clinical trial enrolment. At Clariness, as part of our global digital patient recruitment efforts, we focus on digital recruitment, and as such, use 40+ channels to recruit patients with major depressive disorder.

Based on 16+ years of experience, we’ve helped with the conceptualizing, setting-up and conducting of data-driven marketing strategies that reduce the overall cost of enrollment for patients with major depressive disorder. We build this strategy based on the study requirements of clients, and use a multichannel approach, combined with patient engagement and an understanding of the involved research centers’ needs and capabilities, to help reach and enroll a diverse group of patients. In terms of advertising channels and methods, we know how to reach patients based on various categories, including the directly and indirectly indication related interests, user behaviors, and particular keyword interests. This, in turn, can help cost-efficiently enroll patients for depression clinical trials.

In this blog, we discuss how customized digital outreach techniques with the right strategy can reduce enrollment costs for major depressive disorder studies. This includes:

1. Data to drive cost-efficient digital patient recruitment

A growing audience of digital patients

As of January 2021, 59.5% of the global population are active internet users, of this group, 92.6% access the internet via mobile devices. It’s clear to see with over half the world’s population online, and having mobile, remote access, why digital channels have become such a popular channel for patient recruitment specialists to reach and engage a growing audience.

Online advertising enables you to target patients with specific or multiple indications, making the recruiting process considerably more efficient than traditional channels.

Clariness has been leveraging digital channels since its creation in 2005, coincidentally the same year that internet users worldwide passed the 1 billion threshold. Over this time, Clariness has supported digital patient recruitment for over 1,200 clinical trials, across more than 100 indications. This experience has created an internal knowledge and database of which materials, creatives, and channels offer the most cost-efficient enrollment of patients with major depressive disorder.

Leveraging experience data to create efficient strategies

Knowing which adverts and channels are particularly effective for patient enrollment of major depressive disorder studies uniquely allows Clariness to create patient-centric recruitment strategies that deliver patients on time, and in some cases, under budget.

This can be evidenced by a recent major depressive disorder (MDD) campaign in which our online advertising channels outperformed other vendors’ traditional channels. In this, we were 6x more cost-efficient compared to the other vendor within the same trial (Figure 1).

Figure 1: Media cost per randomized patient in a recent MDD trial that Clariness supported

The true cost has been removed due to commercial sensitivity, however, Clariness’ online outreach strategy proved to be more cost-efficient in driving a significant number of patients with major depressive disorder compared to the other vendor.

Using data to optimize campaigns over time

Throughout the campaign, the Clariness team kept an eye on the performance data of all digital outreach to determine which channels provide the best return on investment. Over time, the data shows not only which channels perform best in terms of engagement and conversion rates, but also the creatives that perform best within them.

Campaigns, like the one mentioned, can be optimized by reinvesting more media budget into both the channels and advertisements that perform best. That’s why it’s essential to partner with a patient recruitment specialist that records performance, monitors the data over time, and optimizes campaigns to deliver high quality patients in a cost and time efficient manner. Clariness has been doing this for 16+ years, and so has an extensive knowledge of creative and channel performance of MDD, and other indications, across the globe.

2. Targeting and qualifying patients with major depressive disorder

Understanding the drivers and barriers to participating in major depressive disorder clinical trials:

Before starting any campaign, we build a qualitative and data-driven understanding of the study’s patient population, using insights we own and gather, in-house medical knowledge and past experiences. With depression, we understand that important factors that influence prevalence include age, social media usage, and socio-economic status.

While COVID-19 has highlighted the importance of clinical trials on a global scale, generally, there is still a stigma associated with participating in them. Further, mental health has only recently become more socially addressed, which combined with the aforementioned stigma, is one of the most common reasons for patients not seeking therapy or participating in depression clinical trials.

Overcoming barriers with patient-centricity

At Clariness, we focus on patient-centricity by providing lay-friendly educational content about the importance of clinical trials for society, but also how much time and effort it takes to participate, leading to higher participation rates and lower drop-out rates.

For major depressive disorder patient recruitment, we know that age is an essential demographic indicator, as depression affects both young and adult people. With this in mind, we place advertisements on websites popular with target age groups. Additionally, to enroll younger patients, we reach out to parents and caregivers as important influencers to promoting the enrollment of a clinical trial.

According to Google, mental health searches reached an all-time high globally last year, including a large rise in several related terms. This is why we at Clariness also provide patient-centric information surrounding not only the clinical trials, but key indications too, as part of the digital journey to enrolling more patients for major depressive disorder clinical trials.

The importance of location on depression prevalence

It’s important to understand where geography impacts the prevalence of depression and how it should influence the location targeting of digital patient recruitment campaigns.

For example, in Germany, rural areas, with a lower population, have a higher prevalence of depression than big cities, 34% vs. 25% respectively. So for German depression recruitment campaigns, we suggest digitally targeting, and appointing sites, in lower populated areas as it can provide higher conversion rates of trial advertisements. However, in the USA, there is seemingly no significant difference of prevalence driven by location, but depression plays a larger part in the distance a patient is willing to travel to a site to participate in a clinical trial. In American campaigns, we therefore reduce the location radius of our digital campaigns from clinical trial sites, using our understanding and data of how far patients of different ages are willing to travel. This is still relevant for Decentralized Clinical Trials (DCT) as these are not always fully virtual.

Clariness is an expert with a long-standing history of recruiting patients across all indications, including depression, across the globe. This provides us with a unique knowledge in patient understanding, and makes us more efficient in geotargeting to avoid budget waste and increase the randomization of referrals.

An example of geotargeting influencing enrollment

In one of our recent major depressive disorder campaign, depression ads were shown within a specific radius around the clinical trial center.

Patients living within a pre-designated radius around active sites were targeted, which provided referrals with a higher willingness to travel to sites. Also, the addition of remote targeting offered the following benefits:

The coupling of geographic and virtual targeting, continues to prove to be more effective and efficient when leveraged by a specialist with a deeper understanding of the patient population.

Qualifying patients with major depressive disorder

Along with the understanding and targeting of patients with major depressive disorder, it is essential to know how to best screen these patients. To assess the severity, change in depression symptoms and using this knowledge to boost clinical trial enrollment.

Leveraging the HDRS to ensure eligibility

At Clariness, we use the Hamilton Depression Rating Scale (HDRS) as part of our screening process, which is a proven, multiple-item questionnaire scoring used to diagnose depression. Ultimately, the severity of the condition is classified as mild, moderate, or severe, depending on the answers provided by the patient. This scale has proven very useful in accurately assessing depression for clinical trial patients and we input a minimum scoring as part of the inclusion criteria of the patient population we’re targeting. In most cases, this is a minimum score of at least 20+ points.

Clariness’ team of medical experts uses this questionnaire during online and phone screenings for our depression clinical trials. This helps us to validate the severity of depression before referring to a site, which in turn finds patients that are most likely to qualify for depression clinical study, reducing wasted patient and site time.

3. The importance of language in major depressive disorder patient recruitment

By interacting directly with patients throughout the recruitment and enrollment process, we’ve seen that advertising and communicating with patients in native language, and using familiar, patient-centric verbiage, results in overcoming patient hesitance and concerns, and drives much higher engagement, conversion and randomizations.

According to research, patients with depression use language differently than those without. People with depression use more first-person singular pronouns and “absolutist” terms, using an excessive number of words that reflect negative feelings. While it is important to understand that there is not one essentialist characteristic of a ‘’depressed person’’, at the same time it is important to understand the possibility of language impacts due to depression. This can be used to monitor, diagnose, and identify affective disorders in the real world through digital technology.

An understanding of language and culture

Clariness’ patient-centric platform, ClinLife®, is available in more than 35+ languages, and currently active in over 45 countries. In addition to our language capabilities, we also understand the cultural impacts of creatives on patients, by indication and region.

In a recent major depressive disorder campaign which run across several countries across Africa, Eastern and Western Europe, and Latin America, the language and style of our advertisements were different by region. Below, you can two different advertisements for the same major depression disorder study which were launched in Spain and the United States (Figure 2). While different in style and language, the relative performance was equal to that of Clariness’ high standards, as they were created with the local patient in mind.

Do you need help boosting enrollment for a current or future trial?

Clariness has deep-rooted patient population knowledge across all major indications and rare diseases, across the globe. We know how to leverage data-driven techniques to drive enrollment efficiencies in the shortest possible time.

We have worked with 7,000+ research sites worldwide, supporting 1,200 clinical studies across 100+ indications.

Find out how we can help you recruit patients through our digital patient recruit techniques by contacting us here.

Want to know how we can support your depression patient recruitment?

Simply get in touch with one of our experts, and we will review your study’s requirements, and develop a strategy to enroll more patients.