Table 5 Recommendations to funders to encourage increased appropriate use of innovative designs

We would advise that funders:

1. Develop easily accessible funding schemes that can cover the more intensive development pre-funding work-up period;

2. Recognise that ADs can provide benefits to research and do not necessarily mean that the trial will always be cheaper to run than non-ADs;

3. Become willing to accept that some aspects of supporting an AD may be more resource-intensive than with traditional trials, particularly as units build their experience in running these trials;

4. Consider ways to allow more flexibility in specifying resources required by ADs, including more space in application forms to describe how resources are impacted by adaptations, and space for multiple funding estimates;

5. Consider supporting more methodology research that could investigate reducing this additional cost (e.g., through Studies Within A Trial which are currently funded in National Institute for Health Research (NIHR, UK) trials [37]);

6. Introduce more funding for shared infrastructure (e.g., platform trial infrastructure and innovative design advice) for developing and efficiently delivering innovative trials;

7. Have more cross-panel and cross-funder opportunities for funding seamless trials and master protocols rather than operating in fixed phases of trials;

8. Consider appropriate funding mechanisms for dealing with changes to trial costings due to adaptation;

9. Avoid financially penalizing organisations for the efficiency achieved in studies stopped early by allowing flexible use of the saved resources (e.g., to cover the cost for the development of subsequent investigations).