Value-adaptive clinical trial designs for efficient delivery of research – actions, opportunities and challenges for publicly funded trials

Value-adaptive designs are a set of emerging methods for efficient clinical trial design that aim to maximise expected population health for the money being spent. They involve adaptive data collection processes that consider the costs of research, the expected value of information from data collection, and the health technology assessment decisions around cost-effectiveness. This topic is important to clinicians practising in publicly funded healthcare systems as they rely on evidence-based treatment strategies that have been shown to be effective in comparison to alternative interventions. Therefore, more efficient, and accurate research studies potentially offered by value-adaptive designs can feed into real decisions and implementation in the care provided by the National Health Service (NHS). Doing so offers the potential to save research costs, to bring the better technology to patients sooner, and to reduce the number of patients randomised into the trial. In this article, we review these emerging methodologies, summarise recent methodological advances, and assess the opportunities they offer for improving the efficiency of publicly funded trials. We also discuss the steps that might be taken by funders, clinicians, trial teams, the public and healthcare decision makers to successfully deploy these methods.