The Future of Clinical Trials Will Require a Focus on the “Long Tail”

Clinical Researcher—December 2020 (Volume 34, Issue 10)


Kourosh Davarpanah, MS


Traditionally, the clinical trial industry has long followed the Pareto principle (or 80/20 rule), in which clinical research has relied heavily on a finite number of large sites to provide the vast majority of patients. With 5% of sites running 70% of trials, only a small percentage of patients with privileged access to these sites have had the opportunity to participate.

At the same time, there has never been more trial opportunities for patients: Key therapeutic areas such as oncology and immunology are experiencing unprecedented innovation, with late-stage oncology trial pipelines increasing 77% since 2008. Still, 85% of trials fail to retain enough patients. On top of this, the coronavirus pandemic is upending the logistics of recruiting and engaging with patients, who are less willing and able to travel long distances to participate in trials.

We are fast approaching a supply-demand issue that will have significant, long-term impact on trial delays and costs—and ultimately further impact patients. Addressing increasing competition and decreasing patient participation will require a reimagining of the way sites and sponsors collaborate on clinical trials.

Focusing on the Long Tail

Traditionally with inventory management, suppliers have focused on the 20% of products that contribute to 80% of their revenue. However, this limits choice and access, while significantly driving up competition.

In the last 20 years, the concept of an online “marketplace” has emerged to transform and resolve similar supply-demand issues in multiple industries. Whether it’s providers of e-commerce (such as Amazon), vacation rentals (such as AirBnB), or regulated industries like insurance and mortgage services, many sectors have found success leveraging a marketplace model to bridge the gap between supply and demand.

The reason that marketplaces work is they allow the end user to explore the potential of the other 80% of products: the “long tail.” Established in 2004, the long tail concept theorizes that the future of business is selling less of more in order to eliminate the bottlenecks between supply and demand. Rather than focusing on a few key offerings, this new economics of distribution allows suppliers to turn their focus to the many more products throughout the “tail,” which can collectively create a new market as big as the one we already know. At the same time, as you go farther down the tail, the less competition you have.

By adapting this approach to clinical research, sponsors can select sites with specific attributes (access to diverse or research-naïve patients, low competition) that make them a great fit for their study while making it easier for community sites to offer the trials for their patients.

A New Model for Sponsor-Site Collaboration

To overcome current clinical trial challenges and ensure the industry’s efficacy in the future, we need to apply the same long tail concept to the sponsor-site collaboration model.

Many community sites have extensive research experience, tight-knit relationships with their community, low competition, and the desire to offer more care options to their patients. However, limitations of the current collaboration model inadvertently prevent sponsors from broadening access to many such sites. Community sites struggle to showcase their strengths and get on sponsors’ radars, while sponsors are actively trying to decrease costs by reducing the number of sites selected per trial.

A marketplace enables us to refocus on the long tail of underutilized sites by:

  1. Empowering sponsors to discover—in an efficient and cost-effective manner—the hundreds of community sites that have strong enrollment potential and the right clinical research experience to deliver on their commitments.
  2. Equipping sites to successfully market their capabilities and reach a wider audience.
  3. Encouraging organic growth in site activities and patient referrals.
  4. Centralizing and streamlining processes between sponsors and sites to reverse the challenging economics of clinical trials.

At the same time, a marketplace can also empower sponsors to quickly identify the right balance between large academic research sites and untapped community sites to meet trial requirements. Similar to how an e-commerce marketplace provides a balance between large marquee products and niche offerings, a clinical trial marketplace can provide the greatest visibility to match the right sites to the right trial and ultimately broaden access to patients.

Ultimately, focusing on the long tail allows us to reimagine the sponsor-site collaboration model, providing increased opportunities to bring clinical research to each and every patient regardless of who they are and where they live.

Kourosh Davarpanah, MS, is Cofounder and CEO of Inato, which helps biopharmaceutical companies and contract research organizations match studies to sites, and helps sites increase their patient pools.