Size Associations in the CRO Outsourcing Relationship - Pharmaceutical Technology

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Size Associations in the CRO Outsourcing Relationship
The author provides results and commentary on a survey analyzing outsourcing strategies, practices, challenges, and outcomes in the selection of a CRO. This article is part of a special issue on outsourcing.

Pharmaceutical Technology
Volume 36, Issue 8, pp. s54-s58

Size does matter

Avoca's data certainly suggest that there is a feeling in this industry that size does matter. It is important to consider what is at play behind the issue of size in organizations, such as the belief that infrastructure and training at a large global CRO are better, especially in emerging markets. There are already concerns about having trained staff in these parts of the world and investigators who really understand the clinical trials. The large CROs have invested in these regions, and they have hired big teams, and have a big global footprint and an infrastructure already in place. So if Big Pharma is looking for a strategic partnership, they tend to pick from the top five CROs. Big sponsors are consolidating their relationships and creating strategic relationships.

On the surface, it might appear that the small- to mid-sized CROs would have a difficult time competing against the larger CROs. Yet, according to the survey, many pharmaceutical executives stated that on a day-to-day, project-team basis, the small to mid-sized CROs provide better service because they're able to be flexible and provide better teams. This explains why respondents from Big Pharma, medium-sized pharmaceutical companies, and small, revenue-generating pharmaceutical companies were all most likely to feel best served by mid-sized CROs as opposed to the top five CROs or smaller providers.

For a mid-sized CRO, this is great news, because while the top pharmaceutical sponsors are spending most of their money in the top-sized CROs, it does not mean they necessarily feel the biggest CROs are the best service providers. And that perception creates opportunity for the smaller CRO, which does specialty work in its realm of expertise with any size company.

Investing in the relationship. No matter what size organizations work with each other, it is going to come down to being clear about expectations, building trust, and taking time to invest in the relationships so that no matter what size the organizations are, they are optimal relationships and outcomes. As long as the organizations have the resources and capabilities to be able to run the trial, success depends on the relationship that sponsor companies and providers build with each other. If the relationship between the two partners is strong, the trials are going to run better—no matter what size organizations are working together on a given project.

Bidirectional, mutual respect. It is important that there be a continued shift in Big Pharma's relationship with CROs toward one that demonstrates respect for the fellow professionals they are working with on a given project. The attitude that "you are my vendor—do as I say" has been moving toward "we should have respect for each other." More sponsor organizations are examining themselves and asking if their team is doing its best to foster these mutually respectful relationships with clinical service providers. They are acknowledging that it is crucial to provide training on how to manage effectively, and respectfully, the CROs and to collaborate to build trust and transparency.


There is a difference among sponsor companies and CROs on which companies contracts with each other, and there is a difference in perceptions about capabilities, resources, infrastructure, and expertise. Despite these differences, they share common interests for safety and efficiency, and the drug is likely to be tested in clinical trials globally, making the CRO-sponsor relationship adaptable to companies of varying sizes.

Janice Hutt is chief operating officer of The Avoca Group.


1. Avoca Group, State of Clinical Outsourcing Survey (Princeton, NJ, 2011).


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