“The Clinical Trials Landscape can be seen as a visualization of the proprietary database transformation that sits behind www.TrialScout.com,” said Dr. Irfan Khan, CEO of Circuit Clinical. “With this project, we hope to increase awareness and understanding of clinical research as a care option for patients, providers, and healthcare administrators across the country.” Regarding this project, Craig Lipset, the former Head of Clinical Innovation for Pfizer and a current board member of Empirican Group Inc. (which owns Circuit Clinical), said "Pharmaceutical researchers rely on tremendous amounts of data to select locations for the conduction of multi-center clinical trials. The TrialScout Clinical Trials Landscape Project provides novel insights for study planners that improve decision-making and in turn accelerate the development of new medicines.” Detroit’s landscape reflects the notion that it has found the formula for long-term success in the clinical trial industry, as its trial volume is both already quite sizeable for the area’s population and primed for further acceleration.
The Detroit Combined Statistical Area (CSA) exceeds expectations in the clinical trial industry. Despite being the country’s 13th-largest Designated Market Area (DMA) as per Nielsen3 and its 12th-largest CSA5, it ranks eighth amongst all CSAs in the U.S. in regards to clinical trial volume1. The greater Detroit area also encompasses Ann Arbor and Flint, and extends to Adrian, Monroe, and Sarnia as well. According to the TrialScout database, a total of 20,877 trials has been conducted in the greater Detroit area, placing it well ahead of most DMAs with similar rankings. For instance, Detroit’s clinical trial output more than doubles those of Tampa (ranked 11th by Nielsen, and having 9,636 trials) and Phoenix (ranked 12th by Nielsen, and having 9,775 trials), while also outpacing Seattle (ranked 14th by Nielsen, and having 16,534 trials) and Minneapolis (ranked 15th by Nielsen, and having 15,094 trials)1,3.
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It is worth noting that the Detroit CSA has a greater population than all of the aforementioned DMAs. With a population of 5,336,286, the greater Detroit area has more residents than Tampa (3,091,399), Phoenix (4,737,270), Seattle (4,764,736), and Minneapolis (3,946,533), so the differences in trial volume are somewhat understandable4,5. On the other hand, Detroit has more trials, despite a smaller population, than several other markets; Houston has a population roughly 300,000 greater than Detroit’s (5,641,077), yet has had almost 3,500 fewer trials conducted than Detroit has. In addition, Detroit has conducted upwards of 6,000 more trials than both Dallas and Atlanta despite having a population approximately 2.5 million and 1.2 million residents fewer, respectively1,5. Both of these markets also have higher DMA rankingss than Detroit; Dallas ranks fifth in the country whereas Atlanta is ranked tenth3.
Regarding trial volume, Detroit has two very close comparables that reflect well upon its performance in the industry. Totals of 20,087 and 20,934 clinical trials have been conducted in the Washington D.C. and San Jose CSAs, respectively, with Detroit in that mix with 20,8771. These three CSAs have very similar trial outputs even though both San Jose and D.C. have higher DMA rankings (sixth and seventh, respectively) and significantly higher populations (8,837,789 and 9,765,772, respectively) than Detroit1,3,4.
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The University of Michigan Health System has historically been the most active health system in the greater Detroit area for clinical trials. Last year, the University had 1,214 active* trials, accounting for 19.4% of all such trials in the area. Beyond the University of Michigan, Detroit’s top five health systems in clinical trial activity are rounded out by four evenly matched entities: Saint Joseph Mercy Health System (771 active trials in 2018, 12.3% of all in Detroit), Henry Ford Health System (724 active trials in 2018, 11.5% of Detroit’s total), the McLaren Health Care Corporation (664 active trials in 2018, 10.6% of Detroit’s total), and Ascension Health (627 active trials in Detroit last year, 10% of such trials in the area). In addition to these, six additional health systems in the Detroit area contributed at least 100 active trials to its landscape; these include Beaumont Health Systems (398 active trials last year), Great Lakes Cancer Management Specialists (178 active trials in 2018), Detroit Medical Center (157 active trials), ProMedica Health System (148 active trials), Prime Healthcare Services (115 active trials), and the Hurley Medical Center (105 active trials)1.
The single-most active location in the greater Detroit area is the University Hospital of the University of Michigan Medical Center, with 844 active trials last year. This hospital alone accounted for 13.5% of active trials in the CSA as well as 69.5% of its health system’s active trials in 2018. The next-most active locations include Henry Ford Hospital (523 active trials last year), the Karmanos Cancer Institute at Detroit Medical Center (424 active trials last year), Ascension St. John Hospital (223 active trials last year), and Beaumont Hospital in Royal Oak (206 active trials last year). Additional locations in the greater Detroit area that had at least 100 active clinical trials in 2018 include St. Joseph Mercy Ann Arbor (153), Ascension Macomb-Oakland Hospital (141), St. Joseph Mercy Ann Arbor Cancer Center (139), St. Joseph Mercy Oakland (116), C. S. Mott Children’s Hospital (107), Saint Mary Mercy Hospital (106), and the Hurley Medical Center (see above). The depth that Detroit has in the clinical trial industry is perhaps best conveyed by the fact that a total of 52 individual locations in the CSA had 30 or more active clinical trials in 20181.
Like most CSAs discussed in the Clinical Trials Landscape series, Detroit has seen significant growth in its trial output over the past decade. 6,269 clinical trials were active in the Detroit CSA in 2018; this figure has grown from a total of 3,860 in 2008. The most demonstrated overall growth in Detroit’s clinical trial industry on a year-to-year basis occurred from 2008 to 2009 and 2016 to 2017, with active trial increases of 552 and 580, respectively. In addition, growth in trial volume is evident across a wide variety of locations in the Detroit area, both at the top level and throughout. According to the TrialScout database, the most demonstrated of these growth patterns is seen at the University of Michigan Medical Center’s University Hospital, which has more than doubled its trial output over the past decade (totals of 334 active trials in 2008 and 844 in 2018). Also of note are Henry Ford Hospital (growing from 309 active trials in 2008 to 523 in 2018), the Karmanos Cancer Institute at Detroit Medical Center (258 active trials in 2008 to 424 in 2018), and C.S. Mott Children’s Hospital (nearly doubling from 56 active trials in 2008 to 107 in 2018). Also of note is the growth seen throughout the hospitals of the Saint Joseph Mercy Health System; while St. Joseph Mercy Ann Arbor has nearly tripled its output from 57 active trials in 2008 to 153 in 2018, significant growth is also seen for St. Joseph Mercy Chelsea, Brighton, and Canton (which grew from two active trials each in 2009 to 87, 84, and 83 in 2018, respectively). Beyond this, an additional 25 locations in the greater Detroit area saw growth of at least 30 active trials over the course of the past ten years1.
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Several of these 25 locations fall into the category of alternative clinical trial sites. The most active of these sites in the Detroit area in 2018 was Huron Gastro at St. Joseph Mercy Ann Arbor, with 46 active trials (up from one in 2008). Following Huron Gastro are the Digestive Health Center of Michigan (four active trials in 2008 to 41 in 2018), Great Lakes Cancer Management Specialists at the Van Elslander Cancer Center and Macomb Professional Building (from one trial each in 2009 to 37 and 36 last year, respectively), and Newland Medical Associates at St. Joseph Mercy Oakland (one trial in 2009 to 36 in 2018). In addition, Newland Medical Associates’ Clarkston location, Hematology Oncology Consultants in Clarkston, and the MHP Radiation Oncology Institute in Pontiac all have the same growth figures as the former. To further demonstrate the impact that Detroit’s alternative clinical trial sites have on its landscape in the future, six more sites have grown from a single trial in 2009 to 35 last year. These include the Genesee Cancer and Blood Treatment Center and Genesee Hematology Oncology at Genesys Hurley Cancer Center, the Hope Cancer Clinic at Saint Mary Mercy Hospital, and Great Lakes Cancer Management Specialists’ locations at the Macomb Medical Campus, SJHMC Doctors Park, and SJHMC Rochester Hills1.
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More recent analyses of the TrialScout database provide a current look at the clinical trials landscape of the Detroit area and also lend more evidence to the trends seen in the growth data. First, there are currently 9,753 active trials (5,115, or 52.4%, of which are recruiting for participation) in the Detroit CSA. In line with the growth in trial volume seen within its hospitals, Saint Joseph Mercy now has the most active clinical trials among all health systems in the greater Detroit area, with 1,446, making up 14.8% of all such trials in the area. Saint Joseph Mercy’s recruiting trials also speak to its growth; while it does not have the most recruiting trials among Detroit’s health systems (the University of Michigan does, with 769) it is not far behind, with 723 (14.1% of Detroit’s total). The University of Michigan is the next-most active health system in Detroit, with 1,346 currently active clinical trials (13.8% of Detroit’s total). 769, or 57.1%, of these studies are currently recruiting, and this total accounts for 15% of such trials in Detroit. Despite its health system now ranking second in Detroit’s clinical trial activity, the University of Michigan Medical Center’s University Hospital is still the most active individual location in the CSA, with 775 currently active trials (443, or 57.2%, of which are recruiting). This hospital accounts for 57.6% of both the University of Michigan’s active and recruiting trials, as well as 7.9% of active trials and 8.7% of recruiting trials in the entire CSA alone. Ascension Health also comprises a significant portion of Detroit’s current clinical trials landscape, with 1,217 active trials (528, or 43.4%, of them recruiting), not far behind the University of Michigan. This health system accounts for 12.5% of Detroit’s active trials and 10.3% of its recruiting trials. The Henry Ford Health System has 961 active trials currently (545, or 56.7%, of which are recruiting), comprising 9.9% and 10.7% of Detroit’s active and recruiting trials, respectively. Lastly, McLaren Health Care has a current total of 887 active clinical trials (435, or 49%, of which are recruiting), making up 9.1% of Detroit’s active trials and 8.5% of its recruiting trials2.
The Detroit CSA is performing admirably in the clinical trial industry, ranking eighth in TrialScout’s Clinical Trials Landscape series despite being the smallest market (in terms of population) in the top ten5. With several large health systems, such as the University of Michigan and Saint Joseph Mercy, leading the way and notable growth across a wide variety of institutions, it is possible that Detroit will become an even more significant contributor to the clinical trials landscape of the country in the future than it already is now.
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)