“The Clinical Trials Landscape is a product of the proprietary database transformation that sits behind www.TrialScout.com,” said Dr. Irfan Khan, CEO of Circuit Clinical. “The goal of this project is to provide patients, providers, and healthcare administrators country-wide with new knowledge that will help them understand clinical research as a care option and in turn inform choices involving it.” Craig Lipset, the former Head of Clinical Innovation for Pfizer and a current Empirican Group Inc. (which owns Circuit Clinical) board member, adds “Pharmaceutical researchers utilize vast amounts of data to select the locations at which multi-center clinical trials will be conducted. TrialScout’s Clinical Trial Landscape Series provides novel insights for study planners to optimize this decision-making process and thus accelerate the development of new medicines and treatments.”
Boston has historically had a tradition of excellence in healthcare, so it makes sense that the city as a whole is one of the top performers in the U.S. clinical trial industry. Despite being ranked as the ninth-largest Designated Market Area (DMA) by Nielsen in 2017 as well as the sixth-most populous Combined Statistical Area (CSA) in the country, the greater Boston area (which, as seen from the map below, also encompasses southern New Hampshire and the entire state of Rhode Island) ranks third among U.S. cities in clinical trial performance according to the TrialScout database1,3,5. Since they have been recorded, a total of 26,732 clinical trials have been conducted in Boston; this is a significantly higher total than those of markets with similar DMA rankings, such as Washington D.C. (20,087 trials and ranked seventh by Nielsen), Houston (17,431 trials and ranked eighth by Nielsen), Atlanta (14,477 trials and ranked 10th by Nielsen), and Tampa (9,636 trials while being ranked 11th by Nielsen). In fact, the only markets that have larger trial volumes than Boston’s are New York City and Los Angeles, which are ranked first and second by Nielsen, respectively1,3.
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Boston’s high performance in the clinical trial industry is further reinforced when population is taken into account. The Boston CSA has a smaller population (8,233,270 residents) than the Chicago (9,901,356 residents), San Jose (8,837,789 residents), and Washington D.C. (9,765,772 residents) CSAs, yet more clinical trials have been conducted in the greater Boston area than all of them1,5. Compared to Boston’s 26,732 trials, Chicago has 24,610, San Jose has 20,934, and Washington D.C. has 20,0871. Each of these cities has higher DMA rankings than Boston as well: while Boston is ranked ninth, Chicago is ranked third, San Jose sixth, and Washington D.C. seventh3. The most comparable CSAs to Boston on the basis of population are San Jose and Dallas; while Boston has approximately 6,000 more trials despite roughly 600,000 fewer residents than San Jose, these differences are even more pronounced when compared to Dallas. Despite having a population about 300,000 residents greater than that of the Dallas CSA, Boston boasts nearly double the amount of trials (Dallas has 14,309)1,5.
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The top-performing health system in the greater Boston area for clinical trials is Partners HealthCare System, with 2,384 active* trials in 2018. This total comprised an astonishing 30.1% of active trials in the area last year. Partners’ total nearly doubled the output of the next-most active health system, Dana-Farber Cancer Institute, which had 1,234 active clinical trials in Boston in 2018 (15.6% of all active trials in the area). Rounding out Boston’s top five health systems for clinical trials last year are Beth Israel Deaconess Medical Center (709 active trials in 2018, 8.9% of all in Boston), Boston Children’s Hospital (449 active trials last year, 5.7% of Boston’s total), and Lifespan (345 active trials last year, 4.4% of all in Boston). Beyond these, an additional six health systems had at least 100 active clinical trials in the Boston CSA in 2018; these include Boston Medical Center (340 active trials), Wellforce Health System (324 active trials), UMass Memorial Health Care (267 active trials), Lahey Health System (227 active trials), Care New England Health System (162 active trials), and the U.S. Department of Veterans Affairs (126 active trials)1.
At the hospital level, Massachusetts General Hospital was the most active location in the Boston CSA for clinical trials last year, and the primary reason why Partners HealthCare stands where it does in the clinical trials landscape of the city. In 2018, Massachusetts General Hospital had 1,485 active clinical trials; this total is greater than Dana-Farber’s entire output in Boston last year, and accounted for 62.3% of Partners’ active trials as well as 18.7% of all of Boston’s active trials alone. Dana-Farber’s Yawkey Center for Cancer Care is not far behind Massachusetts General, however, with 1,164 active clinical trials in 2018. This center alone accounted for an astonishing 94.3% of Dana-Farber’s active trials in Boston, as well as 14.5% of all such trials in the area last year. Similarly to Massachusetts General, Dana-Farber’s Yawkey Center alone boasted more active trials in 2018 than the entire next-most active health system in Boston. Rounding out the top five clinical trial locations in Boston last year are the Beth Israel Deaconess Medical Center (694 active trials), Brigham and Women’s Hospital (581 active trials), and Boston Children’s Hospital (445 active trials). Additional locations with significant contributions to Boston’s clinical trials landscape in 2018 include the Boston Medical Center (340 active trials), Tufts Medical Center (259 active trials), Rhode Island Hospital (228 active trials), University of Massachusetts Memorial Medical Center University Campus (228 active trials), and Lahey Hospital and Medical Center (146 active trials)1.
The Boston CSA, like most discussed in the Clinical Trials Landscape Series, has seen significant growth in active trial output over the past decade, growing from totals of 4,791 active trials in 2008 to 7,924 last year. Most of this growth has occurred within the top-performing locations; Massachusetts General Hospital, for example, more than doubled in active trial count over this period, from totals of 678 in 2008 to 1,485 last year. Notably, the trial growth of this hospital alone accounts for 25.8% of the entire CSA’s growth. Demonstrable growth is also seen over this span for Dana-Farber’s Yawkey Center (from 585 active trials in 2008 to 1,164 in 2018), Beth Israel Deaconess Medical Center (from 373 active trials in 2008 to 694 in 2018), Brigham and Women’s Hospital (from 315 active trials in 2008 to 581 in 2018), Boston Children’s Hospital (182 active trials in 2008 to 445 last year), and Tufts Medical Center (154 active trials in 2008 to 259 last year). Surprisingly, only 14 different locations in the Boston CSA saw overall active trial growth of at least 30 from 2008 to 2018; this is a low total considering Boston’s position in the U.S. clinical trial industry, and suggests increasing concentration of clinical trials among the top health systems as time has passed. Beyond the top performers in the greater Boston area, notable growth is also seen for the Massachusetts Eye and Ear Hospital (18 active trials in 2008 to 51 in 2018), Massachusetts General Hospital Back Bay HealthCare Center (11 active trials in 2008 to 43 in 2018), Women and Infants Hospital of Rhode Island (51 active trials in 2008 to 82 in 2018), and the Catholic Medical Center in Manchester, New Hampshire (nine active trials in 2008 to 36 in 2018) among others.
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The Boston CSA also has a contingent of alternative clinical trial sites outside of major health systems that contribute to its clinical trials landscape. The most active of these sites in Boston last year was the Joslin Diabetes Center, with 52 active trials (up from 36 in 2008). Following this are New Hampshire Oncology-Hematology in Hooksett (47 active trials, but decreasing slightly from 51 in 2008), Boston Clinical Trials (34 active trials, up from a single trial in 2008), Ophthalmic Consultants of Boston in Boston (30 active trials, up from 21 in 2008), and New Hampshire Oncology-Hematology in Concord (25 active trials, up from four in 2009). Also of note are the contributions of Omega Medical Research in Warwick, Rhode Island (23 active trials in 2018, from 11 in 2008), Clinical Partners in Johnston, Rhode Island (20 active trials in 2018, from 10 in 2008), and ActivMed Practices and Research in Methuen (19 active trials in 2018, from one in 2009)1.
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According to more recent analyses of the TrialScout database, there are currently 8,691 active clinical trials in the Boston CSA. Of these, 4,442 (51.1%) are currently recruiting for participation. Partners HealthCare is still the most active health system in the Boston area by far with 2,491 active clinical trials at the moment (1,381, or 55.4%, of which are recruiting), and its totals account for 28.7% of Boston’s currently active trials as well as 31.1% of its recruiting trials. In accordance, Massachusetts General Hospital is still the most active clinical trial location in the Boston CSA with 1,518 currently active trials (865, or 57%, of which are recruiting); this hospital alone currently accounts for 60.9% of Partners’ active trials and 62.6% of its recruiting trials, as well as 17.5% and 19.5% of all active and recruiting trials in Boston, respectively. While Dana-Farber is still the second-most active health system in the Boston area for clinical trials, it does appear to be closing the gap between itself and Partners slightly. The health system as a whole currently has 1,424 active clinical trials (698, or 49%, of which are recruiting), comprising 16.4% of Boston’s active trials and 15.7% of its recruiting trials. Additionally, Dana-Farber’s Yawkey Center continues to dominate in clinical trials within the health system, with its totals of 1,297 active trials and 640 recruiting trials (49.3% of its total) accounting for 91.1% of Dana-Farber’s active trials as well as 91.7% of its recruiting trials. In regards to all of Boston, the Yawkey Center accounts for 14.9% of its active trials and 14.4% of its recruiting trials. The Beth Israel Deaconess Medical Center is the next-most active health system for clinical trials in Boston currently, with 709 active trials (348, or 49.1%, of which are recruiting). This system currently accounts for 8.2% of Boston’s active trials, in addition to 7.8% of recruiting trials in the area. Lastly, Boston Children’s Hospital currently has 424 active clinical trials (286, or 67.5%, of which are recruiting), accounting for 4.9% of active trials and 6.4% of recruiting trials in the Boston CSA. Aside from the aforementioned, other notable contributions to Boston’s current clinical trials landscape come from Lifespan (420 active trials), Wellforce Health System (363 active trials), Boston Medical Center (345 active trials), and the Lahey Health System (315 active trials) among others.
Boston is well-deserving of its place in the top three cities in the country for clinical trials, as it outperforms several similarly-ranked and more heavily populated markets. With one of the top clinical trial hospitals in the country at its disposal along with two high-performance health systems leading the way, the Boston area will likely continue to be one of the best in the country for healthcare innovation moving forward.
To follow the clinical trial landscape series, visit the TrialScout Clinical Trials Landscape
*Active in 2018 = Active at any point in 2018 (Start date of study is before 12/31/2018 and end date is after 1/1/2018)