Rethinking retention strategy: The ROI of proactive planning in paediatric trials

Within clinical trials, teams know retention matters. It’s tracked, reported, and flagged when dropouts exceed expected rates.  However, awareness alone does not drive outcomes. If retention is a key metric, then a retention strategy must be a key investment during the study design phase. 

Retention should be viewed beyond just the site level; it is a portfolio-wide driver of trial performance. Each patient who withdraws partway through a study represents more than lost date; it introduces protocol deviations, inflates monitoring costs, reduces statistical power, and can delay drug to market time.  When these impacts are considered across multiple studies, the cumulative financial burden becomes significant. Evidence shows that the combined cost of protocol deviations, additional monitoring, and participant loss can reach hundreds of thousands, and in some cases over a million pounds per trial, particularly in paediatric research. 

Beyond Metrics: Why Retention Deserves Proactive Strategic Planning 

Retention strategies are often reactive, rolled out when dropout rates increase or timelines slip, which is a missed opportunity. If we want to consistently accelerate trial delivery and reduce costs we must embed retention into study design, vendor selection, and operational planning from the start. 

This is especially true in paediatric trials, which face unique challenges including: parental consent, developmental variability, caregiver burden, and heightened sensitivity to procedures. Common barriers families face include frequent clinic visits, financial pressures, unclear communication, procedural anxiety, and logistical challenges like transport or scheduling conflicts. The more barriers a family face, and the compounding of barriers over time, increases the risk of reduced adherence and drop-out from the study. 

Dropout, adherence, and enrolment challenges are consistently cited as key drivers.  The evidence shows poor retention is more than an operational pain point but significant financial risk and lost opportunity to generate meaningful evidence for children’s health. 

How can proactive retention deliver return on investment? 

Proactive retention strategies, like digital engagement tools, tailored communication, and real-time feedback loops, can be cost saving. 

Here’s what strategic retention can deliver: 

• Reduced re-recruitment costs: Fewer dropouts mean fewer replacement participants and less site burden. 

• Shorter trial timelines: Higher retention reduces protocol deviations and accelerates trial completion. 

• Lower monitoring overhead: Engaged participants are more likely to adhere to schedules, reducing the need for costly follow-up. 

• Cleaner data: Fewer missing visits and deviations improve data quality and reduce queries. 

These benefits are magnified in paediatric trials, especially given that 25–40% of studies fail to meet safety and efficacy endpoints. Research highlights the impact of relationship-building with research staff, tailored communication, and sustained engagement between visits.  

Trials that embed inclusive design, flexible scheduling, and sustained engagement often report higher retention and improved outcomes. Not only does a good retention strategy support reduction in dropouts, but also can improve overall adherence and data quality. 

This table shows examples of the potential cost savings across trials in different therapy areas, with different participant numbers, if drop out rates were reduced by 45% (decreasing from 20% to 11%)

From a financial perspective, every retained patient safeguards the cost of recruitment, onboarding, and early data collection. Additionally, retention protects the ethical integrity of paediatric research, ensuring that children and families who commit to trials are supported throughout their journey.  

What Teams Can Do Now 

If retention is already on your dashboard, here’s how to elevate it from metric to strategy: 

• Track retention ROI across studies, not just within them. Look for patterns in dropout timing, site performance, and protocol burden. 

• Build retention into study planning, not just contingency budgets. Ask: what support do patients need to stay engaged? 

• Choose vendors who prioritize retention, offering scalable engagement tools and patient-centric design. 

• Make retention visible in executive reporting. Tie it to cost savings, timeline acceleration, and data quality. 

For teams looking to go further, we have outlined a practical framework for assessing the impact of digital strategies for engagement and retention. Our ‘Measuring the impact of innovation in pediatrics’ white paper explores how to define outcomes, measure value, and link patient engagement improvements to operational and financial performance across trials. 

How Little Journey can help 

Our early data from one paediatric trial demonstrates the power of this approach: an estimated 45% reduction in participant dropout was achieved through proactive engagement and tailored support. The financial implications are substantial. Even modest improvements in retention can yield significant savings. For example: 

• Retaining just 1% more participants in a 500-person trial for a chronic condition (e.g. asthma) could save around £500K. 
• In rare disease trials, where each participant may represent up to £1M, retaining 5–10% more participants could protect £5–10M in trial costs.  

These impactful savings can be applied to any therapeutic area, from an ultra-rare disease study to a large-scale vaccine trial. These saving are tangible returns on strategic investment. 

Turning retention into a strategic advantage 

If retention is a priority across your portfolio, the question is how to operationalise it in a way that delivers measurable impact without adding complexity to trial teams. 

At Little Journey, we work with sponsors and CROs to embed proactive, patient-centred retention strategies into trial design and delivery, supporting engagement, adherence, and data quality across studies. 

If you’d like to explore how a structured, scalable approach to retention could improve outcomes in your trials, speak to our team