OBJECTIVES: The standard paper consent (PC) pathway can be associated with missing information, error, and inadequate patient comprehension. Digital consent (DC) presents an alternative approach to address this unmet need. However, limited research has been conducted to examine costs associated with paper-based consent forms.

METHODS: A micro-costing study was conducted from the UK NHS perspective. Multi-stakeholder involvement (interviews with clinicians and non-clinicians) helped to better understand how the PC pathway varies by department and hospital setting. First, necessary process steps and resources used were identified. Second, time required for each process step was simulated. Third, resources were quantified by calculating labour, purchasing and overhead costs. Lastly a model with different scenarios was constructed to calculate the cost per patient per form. OWSA analysis was performed to identify the key cost drivers and scenario analyses explored aspects such as litigation and digitalisation already in place. A time trial is underway to estimate if there is any variation in consultation time between PC and DC.

RESULTS: Preliminary results show, in a representative department with 110 consenting procedures per month, the cost per consent prior to the day of surgery obtained using paper forms is approximately £2.01 per form. 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 DC. OWSA indicates however that if consultation time varies between paper consent and DC this would be the biggest driver of a cost difference. Preventing a single litigation claim with a primary cause of ‘fail to warn – informed consent’ could save £202,735.

CONCLUSIONS: PC pathway presents a non-negligible cost to the UK NHS. Future comparative analyses are needed to inform net cost and consequence impact associated with adoption of DC.