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Clinical Evidence Behind a Paywall: An Analysis of Randomised Clinical Trials Included in Cochrane Reviews

Year: 2026

Type: article

Abstract: ABSTRACT Open access to health evidence is essential for informed decision‐making, yet many randomised controlled trials (RCTs) remain behind paywalls. This study assessed the accessibility of RCTs cited in Cochrane intervention systematic reviews, focusing on open access availability and alternative access options. We analysed 491 RCTs from a random sample of 50 Cochrane reviews published in early 2023. Overall, 43.0% required payment for access, but this proportion declined over time, from 60.0% for articles published between 1980 and 1999 to 20.7% for those from 2020 to 2023. Among paywalled articles, the lowest fee provided 24‐h access in 37.0% of cases. However, 49.8% of these studies were available in full text via Google Scholar, and 95.3% of the remaining could be accessed through Sci‐Hub. Despite the persistent presence of paywalls, access barriers have decreased over time, and alternative platforms provide widespread availability of restricted articles.

Source: Learned Publishing

DOI: 10.1002/leap.2058

Authors: Leonardo J. Uribe‐Cavero, Ana Brañez‐Condorena, Alexander M. Parra‐Huaroto, Patricia J. Vera‐Maccha, Alvaro Taype‐Rondan

Institutions: Universidad Nacional San Luis Gonzaga, Universidad San Ignacio de Loyola

Language: English

Topic: Academic Publishing and Open Access

Subfield: Information Systems and Management

Field: Decision Sciences

Domain: Social Sciences

SDG: Reduced inequalities

Open Access status: hybrid

Estimated APC paid: $2,080