10 Tips for selecting high-performing clinical sites

Investigative sites are the heart and soul of clinical trials, essential to ensuring the efficacy and safety of pharmaceutical compounds in humans. Site selection is pivotal to the successful execution of clinical trials, which are not only long and bureaucratic, but are also experiencing diminishing returns.

Studies estimate that it costs upwards of $2B dollars to bring a new drug to market (PDF), with daily revenue losses in the range of $1M to $8M due to delayed market entry.

Key to reining in budget overruns and delays, often resulting in fueling the growing rescue studies industry, is the selection of high performing sites that are ideally suited to running the study under investigation. The selection process is, however, often manual, cumbersome and error prone.

The numbers tell a sobering tale.

According to research from the Tufts Center for the Study of Drug Development (CSDD), 37% of sites selected for clinical trial studies under-enroll, and 11% fail to enroll a single subject. Eventually, 89% of studies meet enrollment goals, but often at the expense of sponsors faced with doubling the original timeline due to poor enrollment.

The industry has responded to these issues by engaging more sites than required for trials, in anticipation that some of these sites will underperform and may subsequently will be dropped. This dubious business practice has fueled a lack of trust and transparency between sites and sponsors/contract research organizations (CROs) and needlessly increased costs and timelines.

According to Tufts CSDD about 40% of investigators each year choose not to conduct any further clinical trials, at a time when typical multi-center studies require 30% new investigative sites, and the clinical research industry is experiencing a concerning global shortage of experienced clinical research associates (CRAs), professionals whose main function is to monitor clinical trials.

Other research cites slow patient enrollment as the top reason clinical trials are behind schedule. Overall, poor site selection, the inability of sites to predict the rate of enrollment, and the subsequent need for study rescue may increase cost of trials by 20% or more. And perhaps most disturbing is the fact that cycle time has not changed in more than two decades.

Sponsors and CROs, often lack a transparent, evidence-based strategy for this task. Instead, they frequently rely on archaic paper-based or spreadsheet methods to identify sites across the globe with a reasonable chance of enrolling the contracted number of patients on schedule, and the ability to generate quality data.

What criteria can be used to help optimize site selection?

Ten tips for selecting investigative sites ideal for your trial:

  1. Investigative site infrastructure: Does the site have the required infrastructure needed to fulfill the requirements as specified in the protocol?
  2. Experience of site staff: What staff (and what is their level of experience) does the site have on-hand to monitor the trial and ensure compliance?
  3. Past performance of the site with clinical trials (of related size and complexity): Having a deep keel is important. Experience is relative and a sites’ past experience should always be reviewed to ensure that their recent performance is on par with historical results.
  4. Affinity of the site to the target disease under investigation: Sites that specialize in the target disease under investigation are less likely to experience difficulties implementing the trial protocol.
  5. Disease target population proximity to the site: Selecting sites that are in close proximity to subjects with the disease target under investigation is a factor to consider with regards to how quickly the site anticipates to complete enrollment.
  6. Enrollment of subjects: Have they previously met their enrollment targets? Provides a performance indicator and potential validation of site enrollment claims.
  7. Startup cycle times lower than industry benchmarks What cycle times can the site provide? What cycle times do they measure? For example, Site activated to enrollment cutoff (a measurement of time to full enrollment of subjects, that the site has committed too), enrollment cutoff to LPO (last patient in) (a measurement of the trials completeness at the site with subjects.) Are these on par or better than industry benchmarks?
  8. Has patients in target disease under investigation Does the site currently treat patients for the disease target under investigation? If so, how many? And would they be prepared to enroll these patients in the trial?
  9. Has the Principal Investigator (PI) published on the target disease under investigation? A thought leader with connections acting as a site advocate will ensure timely engagements and commitment to the study and may be a source of other potential sites of interest to contact.
  10. Does the site embrace a process of continual innovation? Does the site perform post-mortems on studies to gauge areas for process improvements? What new processes/systems have they recently adopted? Why? And what was the result?

One of the biggest factors contributing to lengthy cycle times is the inability of sponsors and CROs to engage investigative sites in a manner that supports effective patient recruitment and retention.

In practice, site engagement is a critical success factor in clinical trials and these tips should be considered when conducting site feasibility assessments and the pre-study visit (PSV), a critical event that sets the stage for an open, collaborative relationship to last throughout the study – imperative to the overall success of a study as many crucial tasks are accomplished during these visits. Getting these ten factors right could eliminate or reduce the need for extensive surveys and pre-study visits.

Optimizing site selection results in a strategic operating model, where teams act as a united front with shared goals and aligned structures and processes. This translates to increased resource productivity, cost savings, and ultimately, more successful studies.

Explore Oracle Life Sciences to learn you you can accelerate your clinical trials.