Incentives and payments in pragmatic clinical trials: Scientific, ethical, and policy considerations

Andrew Garland, Kevin Weinfurt, Jeremy Sugarman

Research output: Contribution to journalArticlepeer-review


Pragmatic clinical trials are increasingly used to generate knowledge about real-world clinical interventions. However, they involve some distinctive ethical and regulatory challenges. In this article, we examine a set of issues related to incentives and other payments to patients in pragmatic clinical trials. Although many of the ethical concerns related to incentives and payments in explanatory trials pertain to pragmatic clinical trials, the pragmatic features may introduce additional challenges. These include those related to the risk of incentives and payments undermining the scientific validity and social value of pragmatic clinical trials, the sources of data used in pragmatic clinical trials, and when the pragmatic clinical trials are conducted under waivers of consent. Based on our examination of these matters, we offer some preliminary recommendations regarding incentives and payments in pragmatic clinical trials, recognizing that additional data and experiences are needed to refine them.

Original languageEnglish (US)
Pages (from-to)699-705
Number of pages7
JournalClinical Trials
Issue number6
StatePublished - Dec 2021


  • Pragmatic clinical trials
  • ethics
  • incentives

ASJC Scopus subject areas

  • Pharmacology


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