摘要：In an era of severe funding constraints for public health research, more efficient means of conducting research will be needed if scientific progress is to continue. At present major funders, such as the National Institutes of Health, do not provide specific instructions to grant authors or to reviewers regarding the cost efficiency of the research that they conduct. Doing so could potentially allow more research to be funded within current budgetary constraints and reduce waste. I describe how a blinded randomized trial was conducted for $275 000 by completely automating the consent and data collection processes. The study used the participants’ own computer equipment, relied on big data for outcomes, and outsourced some costly tasks, potentially saving $1 million in research costs. Public health research is facing an unprecedented shortage of funds. 1,2 Although the percentage of applications that are successfully funded by the National Institutes of Health (NIH) has fallen by about half since 1999, the average cost of a research grant has roughly remained constant ( Figure 1 ). 3,4 The persistence of high grant costs in the face of severe shortages of funds is remarkable because virtually every other industry has realized significant savings by automating processes normally done by humans. Moreover, many techniques for automating public health research already exist—they just are not used. 5 Cost efficiencies in research design could result in more research being conducted under current research budget constraints. Open in a separate window FIGURE 1— Average grant size and success rate of grant applications: National Institutes of Health, united States, 1999–2014. Note . The figure includes all grant mechanisms except those associated with stimulus funding. Costs adjusted by author using the consumer price index. Data adjusted to constant 2014 US dollars by author. Source . National Institutes of Health. The increasing numbers of unfunded grant applications is harming public health research in a number of ways. Most apparently, as a result of the shortfall in funds, research laboratories are closing, and important public health research projects are being shelved. 6 However, the shortfall of funding is also creating other unforeseen problems. Foremost, the opportunity cost of conducting public health research is increasing. 7 Scientists must spend more time writing unsuccessful grant applications, and the time spent writing grants almost certainly crowds out time they could be devoting to research. 7,8 This wasted time may lead to even fewer public health research projects—most of which presumably save lives—than one would predict given current funding cuts. 7 One solution to these problems is to improve the cost-efficiency of research itself. There are various ways of potentially reducing research costs, including using existing data that can be linked to participants, automating the enrollment and data collection processes, outsourcing tasks to less expensive (and more competitive) organizations, and reusing expensive equipment. 8 Examples include: Personnel are needed to recruit participants, and consent for participation is nearly always accomplished with pen and paper rather than online. 5 Although computer-assisted personal interviewing (CAPI) has greatly increased the efficiency of data collection and storage, this method too often still requires interviewers, supervisors, and information technology personnel. 5,9 These data can sometimes instead be collected from linked billing databases, medical records data, or by asking participants to manually enter data themselves. Outsourcing research to private third-party research groups can sometimes reduce costs because (1) third parties must compete for clients for both quality and costs, and (2) the overhead for third parties is often lower than for major research institutions. Resources that are purchased during the course of an experiment (such as equipment) too often go unused rather than being made available for other research teams. Participants often possess many of the resources needed for an experiment—computers, smart phones, and Internet service. These can be used to collect survey data (as well as other forms of data such as GPS or accelerometric data). This equipment can often produce data that are sufficient for many research projects.
