Paper COAs In 2026? It's Not "Cheaper," It's Riskier

Paper-based clinical outcome assessments are often perceived as a cost-saving fallback, but that assumption no longer holds in 2026. Rising regulatory expectations, increased protocol complexity, and growing scrutiny around data quality have significantly changed the risk profile of paper COAs. Manual workflows introduce delays, transcription errors, missing data, and audit challenges that can undermine study timelines and confidence in results. At the same time, hybrid and decentralized trial designs demand faster access to reliable data and greater operational oversight — needs paper processes struggle to meet.

This perspective explores why paper COAs now represent a hidden risk rather than a budget-friendly option, examining their impact on compliance, patient experience, and long-term study costs. It also highlights how modern digital approaches can reduce variability, improve data integrity, and support more resilient trial execution. Read on to understand why clinging to paper may cost more than expected.