Emerging Clinical Trial Locations: Market dynamics and the changing healthcare and regulatory environment

Published: June 2009
No. of Pages: 287
  

Emerging Clinical Trial Locations
Market dynamics and the changing healthcare and regulatory environment

Report Overview

Pharma and biotech companies are attempting to combat escalating R&D costs and lengthy clinical trial timelines by improving patient recruitment and the efficiency of clinical trial analysis/reporting. The biopharmaceutical market has recognized the opportunities and advantages that exist by conducting clinical trials in emerging markets. Although these markets offer a number of significant benefits over traditional clinical trial settings, there remain a variety of challenges and problems associated with conducting trials in emerging regions.

‘Emerging Clinical Trial Locations’ is a report published by Business Insights that provides a comprehensive examination of the clinical trial landscape in emerging countries, with specific focus on China, India, Central and Eastern Europe and Latin America. It identifies the major drivers and barriers to conducting clincial trials in emerging regions and profiles key issues for consideration when selecting a trial site. For each featured region, this report provides an assessment of pharma market dynamics, the heathcare system and CRO-related infrastructure, leading CROs established within the region and the regulatory and legislative frameworks that govern the conduct of clinical trials.            

Key Findings

Russia is one of the world leaders in patient enrolment - the average patient recruitment rate in 2006 exceeded 4.7 patients per site per month. For some nosologies, this figure is 10 times higher than in Western Europe and the US.

The Chinese Clinical Trial Register (CHiCTR) and The Clinical Trials Registry in India (CTRI) have helped to encourage all clinical trials in these regions to be registered before the enrolment of the first participant, and to disclose the mandatory 20 items of the WHO International Clinical Trials Registry Platform (ICTRP) dataset.                

By the end of May 2009, 895 clinical trials were registered in India. By comparison in 2006, 150 clinical trials had been approved by the Drug Controller of India (DCI).

India is able to offer significant cost savings compared with conducting clinical trials in western countries. Phase I trials are approximately 50% cheaper than western equivalents, while Phase II and Phase III are 60% less expensive.

The Chinese CRO market was valued at $250m in 2008. The market is expected to grow at a CAGR of 33% over the next four years to reach $791m in 2012. By that time, Chinese CROs will account for an estimated 2.3% of the global CRO market.

China’s IP protections systems still have a number of serious flaws, despite attempts to conform with international IP protection standards through amendments of the Patent Law and restriction of product approvals by the SFDA.

The number of clinical trials in Brazil has increased from 9 in 2000, to 1177 by 2008. In Argentina the number of trials has risen from 6 to 801 over the same period, while Mexico has witnessed an increase from 63 to 2014.

The costs of conducting clinical trials in Latin America vary from substantially less expensive than the US to slightly more expensive. In recent trials, the cost per patient for Latin America has varied from savings of 50% to relative cost increases against US per patient costs.

The value of the Polish clinical trial market for Phase I to Phase IV clinical trials and bioequivalence studies has been estimated to be worth K167m ($224m) in 2008, having increased in value by 10% from the    

Use this report to...

Assess the viability of key emerging clinical trial locations including China, India, Eastern Europe and Latin America by analyzing each region based on:

  •  Pharma market dynamics
  •  Drivers of CRO market growth
  •  Barriers to CRO market growth
  •  Healthcare systems and hospital resources
  •  Related regulation and legislation 


Examine the phases of the clinical trial process with analysis of clinical trial protocols, related ethical issues, clinical trial study design and planning, patient identification and recruitment, and the influence of regulatory authorities and agencies.

Understand how new technology platforms are enhancing clincial trial effectiveness and identify the issues and challenges associated with these innovations.

Analyze the major market drivers and barriers for clinical trials in emerging markets with analysis of the key benefits and challenges associated with trial sites in emerging countries and the key considerations for site selection.

Emerging Clinical Trial Locations: Market dynamics and the changing healthcare and regulatory environment

Table of Contents

  • Emerging clinical trial locations - Executive summary 16

Introduction 16

  • Conducting clinical trials in emerging markets 17
  • India 18
  • China 19
  • Latin America 20
  • Central and Eastern Europe 21

Chapter 1 Introduction 24

  • Summary 24
  • Introduction 25
  • Generic competition 25
  • Intellectual property protection 25
  • Managing regulatory compliance 27
  • Cost containment and government funding restrictions 28
  • Obtaining and maintaining competitive advantage 28
  • Recruitment and retention of a skilled workforce 29
  • Improvement to R&D productivity 30
  • High risks and costs associated with drug development 30
  • Escalating costs of clinical trials 30
  • Global increase in the number of clinical trials conducted 34
  • Longer R&D timelines 34
  • Increased attrition rates during R&D 37
  • Clinical trial study design and planning 38
  • Clinical trial study design 38
  • Clinical trial study protocol 38
  • Clinical trial sponsors 38
  • Identifying and recruiting patients 39
  • Role of CROs 39
  • Information technology and new technology platforms 40
  • Drivers of development 40
  • Advantages associated with EDC 40
  • Advantages of electronic Clinical Trial Management Systems
  • (CTMS) 41
  • Cost saving 42
  • Issues and challenges 42
  • Electronic records and signatures 42
  • Integration and linkage of electronic systems 43
  • Security and confidentiality of patient data 43

Chapter 2 Conducting clinical trials in emerging markets 46

  • Summary 46
  • Introduction 47
  • Market drivers 49
  • Rapid recruitment of patients and clinical trial investigators 49
  • Significant cost benefits 51
  • Improving transparency and efficiency of regulatory systems 52
  • Harmonization and standardization of regulatory requirements 53
  • Expansion of CROs 54
  • Conducive hospital infrastructure and healthcare systems 56
  • Enhanced clinical site effectiveness 57
  • Future commercial value 58
  • Key barriers 59
  • Concerns over the clinical trial transparency 60
  • Publication bias 61
  • Selective reporting 62
  • Duplicate publication 62
  • Conflict of interest 62
  • Availability of demographic and epidemiology data 62
  • Critical components concerning capacity building 63
  • Assimilation of individual national regulations and guidelines 66
  • United States 66
  • Japan 67
  • European Union 68
  • Language translation 69
  • Ethical challenges 69
  • Health needs of the population under study 70
  • Respect for potential and enrolled subjects 70
  • Ethical oversight 71
  • Lack of review by institutional review board (IRB) 71
  • Absence of informed consent 72
  • Scientific validity 73
  • Inadequate protection of intellectual property 73
  • Clinical trial logistics 74
  • Import licenses and applications 74
  • Customs regulations 75
  • Storage, handling and distribution 75
  • Selecting an appropriate CRO 76
  • Patient enrolment 79
  • Site selection 80
  • Site activation 80
  • Patient recruitment 80

Chapter 3 India 84

  • Summary 84
  • Introduction 85
  • Geographic 85
  • Political 85
  • Economic 85
  • Market dynamics 85
  • Vital statistics 85
  • Population statistics 87
  • Epidemiology and prevalence of major disease 88
  • Pharmaceutical market 89
  • Biotechnology market 92
  • CRO market 94
  • Clinical trial market 97
  • Geographic focus of the Indian clinical research industry 97
  • Market drivers 100
  • Population ethnicity and genetic diversity 100
  • Large complement of trained medical specialists in India 101
  • Significant cost savings 102
  • Government incentives 103
  • Creation of the Clinical Trials Registry – India (CTRI) 103
  • Sophisticated logistics and clinical research infrastructure 104
  • Comprehensive IT and IT enabled support (ITES) base 105
  • Key barriers 106
  • Ethical issues 106
  • Lack of experienced investigators 107
  • Inability to detect and monitor ADRs 107
  • Bribery and corruption 107
  • Healthcare 108
  • Healthcare system 108
  • National level 108
  • State level 108
  • Regional level 108
  • District level 109
  • Sub-divisional/Taluka level 110
  • Community level 110
  • Primary health centre (PHC) level 110
  • Sub health centre (SHC) level 110
  • Hospital resources 110
  • Regulation and legislation 112
  • Regulatory authorities 112
  • The Ministry of Health and Family Welfare 112
  • Central Drug Standard Control Organization (CDSCO) 115
  • Drug Controller General of India (DCGI) 115
  • Indian Council of Medical Research (ICMR) 116
  • Clinical trial regulation 116
  • Harmonization of the clinical trial approval process 118
  • Legislation 120
  • Patent law and WTO TRIPS 120
  • Schedule Y Drugs and Cosmetics Act and Rule 122
  • Summary of the recent regulatory and legislative changes 123
  • Evolution of the regulatory environment 124
  • Expected improved collaboration: DCGI with international agencies 125
  • Anticipation of approval for early phase studies in India 126
  • Registration and regulation of CROs in India 126
  • Future reform and emphasis on improved pharmacovigilance in
  • India 127
  • India to implement an electronic management system 128
  • Outlook 129

Chapter 4 China 132

  • Summary 132
  • Introduction 133
  • Geographic 133
  • Political 133
  • Economic 134
  • Market dynamics 136
  • Vital statistics 136
  • Population statistics 136
  • Epidemiology and prevalence of major disease 136
  • Pharmaceutical market 138
  • CRO market 140
  • Overseas CROs 142
  • Joint venture companies 143
  • Local CROs 144
  • Clinical trial market 146
  • Market drivers 147
  • Rapid patient recruitment from large pool of treatment naïve patients 147
  • Well-trained and motivated clinical trial investigators 147
  • Major cost savings 147
  • Increasing importance of the pharmaceutical market in China 148
  • US government opens FDA offices in China 149
  • Financial support and incentives from the Chinese government 149
  • Creation of the Chinese Clinical Trial Register (CHiCTR) 150
  • Key barriers 152
  • Cultural and linguistic 152
  • Delays to application and gaining approval 152
  • Due diligence required to ensure intellectual property protection 152
  • Issues over importation and importation licenses 153
  • Monitor compliance of SFDA GCP with ICH GCP 153
  • Healthcare 154
  • Healthcare system 154
  • Overview 154
  • Healthcare reforms 156
  • Healthcare institutions 157
  • Hospital resources 158
  • Regulation 160
  • Regulatory authorities 160
  • State Food and Drug Administration (SFDA) 160
  • Department of drug registration 161
  • Clinical trial regulation 161
  • Application and approval of the new drug clinical trial study 162
  • Registration approval for the manufacture of the new drug for market 163
  • Legislation 165
  • Patent Law and WTO TRIPS 165
  • Drug Administration Law of the People's Republic of China 168
  • Outlook 172

Chapter 5 Latin America 174

  • Summary 174
  • Introduction 175
  • Geographic 175
    • Brazil 175
    • Argentina 175
    • Mexico 176
    • Political 176
    • Brazil 176
    • Argentina 176
    • Mexico 177
    • Economic 177
    • Brazil 177
    • Argentina 177
    • Mexico 177
  • Market dynamics 178
  • Vital statistics - Brazil 178
  • Population statistics 178
  • Epidemiology and prevalence of major disease 178
  • Vital statistics - Argentina 179
  • Population statistics 179
  • Epidemiology and prevalence of major diseases 179
  • Vital statistics - Mexico 180
  • Population statistics 180
  • Epidemiology and prevalence of major disease 180
  • Pharmaceutical market 182
  • CRO market 185
  • Clinical trial market 186
  • Market drivers 188
  • Significant cost savings 188
  • High concentration of population in urban centers 188
  • High ethnic diversity 189
  • High patient enrolment, compliance and retention rates 189
  • A major growing Latin American pharmaceutical market 190
  • Reverse seasons advantages 190
  • Commonality of Spanish language 190
  • Accessibility to medical professionals and clinical trial investigators 190
  • National clinical trials register – Argentina 191
  • Key barriers 191
  • Concerns over intellectual property protection 191
  • Inconsistent regulatory environment 192
  • Cultural challenges and issues 193
  • Healthcare 194
  • Healthcare system- Brazil 194
  • Hospital resources - Brazil 194
  • Healthcare system - Argentina 195
  • Hospital resources - Argentina 195
  • Healthcare system - Mexico 196
  • Hospital resources - Mexico 197
  • Regulation and guidelines 198
  • Regulatory authorities 198
  • The Pan American Network for Drug Regulatory Harmonization
  • (PANDRH) 198
  • ANVISA - Brazil 198
  • Brazilian Research Ethics Commission (CONEP) 199
  • ANMAT - Argentina 201
  • SSA - Mexico 202
  • COFEPRIS - Mexico 202
  • Clinical trial regulation 203
  • Brazil 204
  • Argentina 206
  • Mexico 208
  • Guidelines 209
  • Good Clinical Practices: Document of the Americas 209
  • The Buenos Aires Declaration on Ethics and Clinical Trials 212
  • Import licenses for drugs in clinical trials - Mexico 215
  • Outlook 216
Published By: Business Insights
Product Code: Business Insights1063


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