Contributed Commentary by Liz Beatty

March 27, 2020 | Over the past decade, digital marketplaces have emerged as a transformative business model. In 2016, consumers conducted half of their e-commerce spending through marketplaces and according to Forrester Research, this could increase to two-thirds by 2022. By connecting supply with demand and eventually facilitating a financial transaction, marketplaces provide an online platform for supply and demand to efficiently find one another and transact seamlessly. Rarely do marketplace businesses own any supply or provide products or services directly, allowing for infinite scalability and nimbleness. 

Companies like Airbnb, Amazon, eBay, Postmates and Uber demonstrate the success and benefits of the marketplace model across a variety of industries. For instance, as Airbnb has brought supply and demand for the hospitality industry into one, inclusive marketplace, more lodgings—particularly lesser known and emerging ones—have been able to enter the equation and gradually chip away at the long-held dominance of market giants like Hilton or Marriott. Consumers benefit from online marketplaces, too, as the model provides more access to choice, affordability via greater competition, and tailored browsing and purchasing experiences. 

It’s Time to Reinvent the Expensive, Inefficient and Biased Clinical Trial Process  

Given marketplace momentum across most areas of business and the benefits this model can provide, it’s curious why the clinical trial sector hasn’t embraced it. Other highly regulated industries have adopted the model successfully, as witnessed by the financial services sector and the variety of the online loan marketplaces that have emerged in recent years. What’s more, the clinical trial industry so desperately needs reinvention. The current way clinical research is conducted, where sponsors repeatedly keep tapping the same doctors and research sites over and over, simply doesn’t work anymore. It’s too slow and expensive, plus trials are becoming more specialized into specific patient populations. Just look at oncology trials that are increasingly using biomarkers in the inclusion/exclusion criteria for studies, for example. 

In addition to its inefficiencies, the clinical trial industry is rife with biased processes. Less than 5% of patients with cancer currently participate in clinical trials, and just 5% of medical research sites do 70% of the clinical trials. This results in poor access rates for patients, and biopharma companies miss out on 95% of the patients who are also depending on new therapies because the same few research sites are continually being tapped. Perpetuating the bias problem further, clinical trial density (trial site-years/population) is 250x higher in the United States versus low-income countries. Additionally, in early-phase cancer trials, wealthier patients are almost twice as likely to be referred compared to the most deprived ones.

The Multi-Faceted Benefits of a Marketplace Business Model

To overcome its historically inefficient and biased tendencies and develop more effective therapies for more people, the clinical trial industry needs to embrace a patient-focused, marketplace model. In such a marketplace, doctors, their patients and research sites would represent the supply, and clinical trials (run by sponsors) would represent the demand. This more dynamic, inclusive approach would allow:

• Clinical trial sponsors to speed up the trial process and reduce waste by gaining access to more trial sites and patients. Currently, 37% of clinical trial sites don’t meet patient enrollment targets and ~10% don’t recruit a single patient. There’s also significant cost (upwards of $25K) involved to activate a site.
• Clinical trial sites—especially lower profile and untapped ones—to better promote themselves and gain access to a more level playing field so that the Mayo Clinics and Sloan Ketterings of the world don’t continue to hoard all the opportunities.
• Doctors to find clinical trials that most interest them and their patients, and more easily navigate the process of applying for them.
• Patients to gain greater access to more clinical trials, and have the opportunity to stay within the care of their existing doctor and not have to travel for any clinical trials they participate in.

By Marrying Data with Human Perspective, Everybody Wins

Despite its undeniable areas in need of improvement, the clinical trial industry has already undergone a significant evolution. Biopharma companies no longer need to rely solely on who they know to identify research sites and/or doctors for trials, for instance. Today, data-driven tools and AI technology is widely available for biopharma companies and trial sponsors to leverage to help compare and select research sites. This technological advancement is admirable; however, the reality is there’s simply too much data out there to realistically capture and keep up with. 

Even more importantly, data and AI can’t convey a doctor’s interest in how a trial has been designed or how their motivation aligns with the specifics of a particular study. Ultimately, doctors decide if they (and their patients) want to participate in a clinical trial, so the subjective, human perspective must be taken into account. By adopting a marketplace model that prioritizes and incorporates doctors and their patients, the clinical trial industry can use data and AI to help determine what trials exist and which doctors and patients would best align with them, dynamically offering suggestions for potential matches.

Furthermore, by better catering to doctors’ personal perspectives and offering them greater access to trials that interest them and showcase their abilities, there’s a timely opportunity to convince doctors (i.e. the supply component) to commit to the marketplace model. Clinical trials and their sponsors (i.e. the demand component) would then follow suit, thereby preemptively solving the “chicken-and-the-egg” problem that’s one of the biggest hurdles for new marketplaces seeking scale and longevity. Perhaps most importantly, adopting a marketplace model would finally provide the below 5% of clinical trial research sites a voice, and at the same time, create entirely new channels of supply for the industry. In the end, it stands to be a win for all, as a marketplace model would allow the clinical trial industry to propel innovation and science forward by discovering more treatments for more people faster.

Liz Beatty is the Chief Strategy Officer at Inato, whose marketplace increases the pool of available patients engaged in clinical trials by unlocking research site potential. Liz is focused on advancing Inato’s corporate strategy, developing partnerships and driving growth in North America.  Previously, Liz was the Head of the Digital Clinical Trials team in Global Clinical Operations at Bristol-Myers Squibb. Her team leveraged innovative approaches to increase clinical trial awareness, transparency and participation, resulting in an enhanced clinical trial experience for patients, and their care team.  Liz was also the Chair of the Digital Acorn working group, which was a global, cross-functional team that brought digital innovation to clinical trials. Liz previously held positions in clinical operations including managing a global patient recruitment team, and various positions in protocol management and site management. She can be reached at  l.beatty@inato.com