Digital Versus Paper-Based Consent from the UK NHS Perspective: A Micro-costing Analysis

Rachel Houten, Mohammad Iqbal Hussain, Antony P. Martin, Nick Ainsworth, Claudia Lameirinhas, Alexander W. Coombs, Simon Toh, Christopher Rao and Edward St John ()
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Rachel Houten: QC Medica
Mohammad Iqbal Hussain: Portsmouth Hospitals University NHS Trust
Antony P. Martin: QC Medica
Nick Ainsworth: QC Medica
Claudia Lameirinhas: Portsmouth Hospitals University NHS Trust
Alexander W. Coombs: Portsmouth Hospitals University NHS Trust
Simon Toh: Portsmouth Hospitals University NHS Trust
Christopher Rao: Imperial College
Edward St John: Portsmouth Hospitals University NHS Trust

PharmacoEconomics - Open, 2025, vol. 9, issue 1, No 4, 27-39

Abstract: Abstract Background The paper-based consent pathway can be associated with missing information, error, and inadequate patient comprehension. Digital consent addresses some of these limitations. However, limited research has been conducted to understand relative costs and consequences associated with adopting digital consent pathways. The aim of this study was to compare the relative costs of digital consent pathways with paper-based consent pathways in UK National Health Service (NHS) clinical practice. Method A micro-costing study was conducted from the UK NHS perspective. Multi-stakeholder involvement contributed to understanding how the paper-based consent pathway varies by department and hospital setting. Sensitivity analyses were conducted to identify the key cost drivers and scenario analyses explored the effect of consent timing and hospital digital readiness. Potential advantages and disadvantages of digital consent were also considered, such as possible impacts associated with consent-related litigation. Results The cost per consent episode is approximately £0.90 more expensive when completed on paper. The ordering or printing of paper consent forms, and the transportation of forms to storage and back to clinic are process steps that would not be necessary with digital consent. Sensitivity and scenario analyses indicated consultation duration had the greatest impact on the relative costs of both pathways. Per litigation claim prevented, an average of £201,590 could be saved. Conclusions Digital consent is potentially cost saving for the NHS. Consent for elective procedures is recommended in advance of the day of surgery, and digital consent used in this scenario demonstrated the greatest savings. Consultation duration was estimated to have the greatest impact on the relative costs of both pathways, which should be a focus of further investigation.

Date: 2025
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DOI: 10.1007/s41669-024-00536-0

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