“The Clinical Trials Landscape Project is a product of the proprietary database transformation that helps give utility to www.TrialScout.com,” said Dr. Irfan Khan, CEO of Circuit Clinical. “Our goal with this project is to provide patients, providers, and healthcare administrators across the country with new information that will help them understand clinical research as a care option.” According to Craig Lipset, the former Head of Clinical Innovation for Pfizer and a current board member of Empirican Group Inc. (which owns Circuit Clinical), "Pharmaceutical researchers rely on vast amounts of data to select the locations at which multi-center clinical trials will be conducted. TrialScout’s Clinical Trials Landscape provides novel insights for study planners to improve this decision process, and thus expedite the development of new medicines and treatments." The landscape of the San Jose Combined Statistical Area (CSA) in the clinical trial industry is very balanced, with the performances of four major players standing out.
The San Jose CSA (which, importantly, includes San Francisco) is performing somewhat in accordance with its market size in the clinical trial industry. Since the inception of the tracking of clinical trials, there have been 20,934 conducted in the CSA, placing it seventh among U.S. metropolitan areas in this department1. As a parallel, Nielsen ranked the San Jose CSA as the sixth-largest Designated Market Area (DMA) in the country in 20173. However, despite an objectively high trial volume and innovation prevalent in the area, comparisons to similar markets yield mixed evidence for the San Jose CSA’s performance.
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San Jose does compare somewhat favorably to the DMAs ranked immediately below it. The San Jose CSA has a larger trial output than the Washington D.C. CSA (ranked seventh by Nielsen, and having 20,087 clinical trials conducted) despite the latter having a larger population than San Jose (9,765,772 residents compared to San Jose’s 8,837,789). In addition, Houston, ranked eighth by Nielsen, is significantly outpaced by San Jose in clinical trial volume (17,431), but this is in spite of the fact that the San Jose CSA has a population more than three million greater than the Houston CSA (5,641,077). As for the DMAs ranked immediately above, San Jose compares favorably to Dallas, which has a significantly lower trial output (14,309 trials) than San Jose despite Nielsen ranking it one spot higher and boasting a sizeable population of 7,847,110 residents. However, the fourth-ranked DMA, Philadelphia, has both a larger trial output (22,308 trials) and a smaller population (7,206,807) than San Jose1,3,5.
Despite comparing relatively well to the aforementioned markets in regards to trial volume and population, other cities balance the scale. San Jose’s most immediate comparables on the basis of trial volume are Washington D.C. and Detroit. Although San Jose compares well to the former (see above), the Detroit CSA has a very similar output (20,877 trials) yet a significantly smaller population (5,336,286)1,5. Further, Detroit was ranked by Nielsen as the nation’s 13th-largest DMA in 2017, seven spots lower than San Jose3. In addition, there are other cities besides Detroit and Philadelphia with smaller populations than San Jose that are outperforming it in the clinical trial industry, namely Miami (21,625 trials and 6,832,588 residents) and Boston (26,732 trials and 8,233,270 residents1,5. Both of these cities also have lower DMA rankings than San Jose; Miami and Boston were ranked 16th and ninth, respectively3.
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The health system with the most clinical trials in the San Jose CSA in 2018 was Stanford Health Care with 1,518 active* trials, accounting for nearly a quarter (24.6%) of all active trials in the CSA last year. Not far behind are University of California San Francisco (UCSF) Health with 1,373 active trials last year (22.2% of the CSA’s total) and Kaiser Permanente with 1,218 active trials (19.7% of all in the CSA last year). The top five is rounded out by Sutter Health (792 active trials last year, 12.8% of the CSA’s total) and the U.S. Department of Veterans’ Affairs (199 active trials last year, 3.2% of the CSA’s total). Surprisingly, only one other health system in the area had more than 100 active trials last year: the San Francisco Health Network (with 106, all of which were accounted for by the Zuckerberg San Francisco General Hospital and Trauma Center)1.
Despite several health systems comprising significant portions of the clinical trials landscape in the San Jose CSA, the top five individual locations in the area for clinical trial activity are either Stanford- or UCSF Health-owned facilities. The most active individual location in the region last year was the Stanford Hospital, with 677 active clinical trials, accounting for 44.6% of Stanford’s active trials and 11% of all active trials in the CSA alone. In a similar vein to the health systems, UCSF’s most active individual location is not far behind that of Stanford; the UCSF Helen Diller Medical Center at Parnassus Heights is the next-most active location in the San Jose area with 619 active trials last year. This medical center alone accounted for 45.1% of UCSF Health’s active trials as well as 10% of all active trials in the CSA in 2018. The top five individual locations in the greater San Jose area is rounded out by Stanford’s Lucile Packard Children’s Hospital (415 active trials in 2018), Stanford’s Cancer Institute in Palo Alto (213 active trials in 2018), and the UCSF Medical Center at Mount Zion (194 active trials in 2018). A total of six additional locations in the CSA conducted at least 100 active clinical trials last year; this group includes the UCSF Medical Center at Mission Bay (184 active trials), Kaiser Permanente Oakland Medical Center (156 active trials), California Pacific Medical Center’s Pacific Campus (127 active trials), the VA Palo Alto Health Care System’s Palo Alto Division (116 active trials), Zuckerberg General Hospital (see above), and UCSF Benioff Children’s Hospital in Oakland (100 active trials)1. The concentration of San Jose’s clinical trials landscape among the top health systems in the area, in conjunction with its high overall trial volume, suggests that there is strong depth within these health systems. Indeed, of the 53 individual locations in the San Jose CSA to have at least 30 active trials last year, 43 belong to either Stanford Health Care, UCSF Health, Kaiser Permanente, or Sutter Health1.
The San Jose CSA has seen relatively significant growth in active trial output over the past decade, going from 3,950 active trials in 2008 to its 2018 total of 6,1801. In accordance, this growth is distributed across a wide array of locations, but the largest jumps are mostly concentrated in the most active ones. The most demonstrated instance of growth over this period is seen for Lucile Packard Children’s Hospital, which has grown from totals of 98 active trials in 2008 to its 2018 total of 415. Over the same span, the UCSF Helen Diller Medical Center has grown from 368 active trials to 619, Stanford Hospital from 485 to 677, UCSF Medical Center at Mission Bay from six to 178, UCSF Medical Center at Mount Zion from 54 to 194, and the Stanford Cancer Institute in Palo Alto from 100 to 213. Other locations with notable growth over the past decade include the Kaiser Permanente Oakland Medical Center (78 active trials in 2008 to 156 last year), California Pacific Medical Center’s Pacific Campus (56 active trials in 2008 to 127 in 2018), Kaiser Permanente Santa Clara Medical Center and Medical Offices (26 active trials in 2008 to 90 last year), Kaiser Permanente San Francisco Medical Center and Medical Offices (42 active trials in 2008 to 98 in 2018), and the VA Palo Alto Health Care System’s Palo Alto Division (61 active trials in 2008 to 116 in 2018) among others. These, however, only scratch the surface; a total of 30 individual locations in the CSA saw growth of at least 30 active trials over the last ten years1.
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The greater San Jose area also has several alternative clinical trial sites outside of larger health systems that contribute to its landscape. The most active of these locations in the area in 2018 was Marin Cancer Care at the Marin Cancer Institute, with 41 active trials, growing slightly from a total of 31 in 2008. Next in this regard is The Bay Area Tumor Institute, with 36 active trials last year; however, this location has decreased its active trial output, as it had 98 in 2008. San Jose’s top five alternative clinical trial locations is rounded out by Epic Care in Emeryville (35 active trials last year, growing from 11 in 2008), the Rohnert Park Cancer Center (33 active trials in 2018, growing from two in 2008), and Diablo Clinical Research (28 active trials in 2018, growing from nine in 2008). Additional locations of this sort that appear to be on the rise include Pacific Research Partners’ Clay Street location (23 active trials last year, growing from one in 2011), as well as three others with 20 active trials last year: Epic Care in Dublin (growing from one in 2010), Northern California Retina Vitreous Associates in Mountain View (growing from two in 2010), and the Center for Dermatology Clinical Research (growing from a single active trial in 2008)1.
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More recent analyses of the TrialScout database, which were conducted to provide a current look at the overarching clinical trials landscape in the San Jose CSA, indicate that Kaiser Permanente is now the most active health system in the area. There are currently 8,721 active clinical trials in the greater San Jose region (4,116, or 47.2%, of which are currently recruiting for participation); at the moment, Kaiser Permanente accounts for 2,069 (23.7%) of the CSA’s active trials and 921 (22.4%) of its recruiting trials. Additionally, 44.5% of Kaiser Permanente’s active trials in San Jose are recruiting. Following Kaiser Permanente, in order, are the area’s three very evenly-matched health systems: Sutter Health, Stanford Health Care, and UCSF Health. Sutter is the most active of the three by a hair; this system currently has 1,653 active clinical trials while Stanford has 1,641. Sutter’s total comprises 19% of active trials in the CSA, and its recruiting trials (691, or 41.8%, of its total) account for 16.8% of all in the region. Despite trailing Sutter in active trial count by only 12 (1,641), Stanford has about 200 more recruiting trials (896). Stanford’s active trial count makes up 18.8% of all such trials in San Jose, and its recruiting trials make up 54.6% of its own trials in addition to 21.8% of all recruiting trials in the CSA.
The Stanford Hospital, however, is still the most active individual location in the CSA for clinical trials, with 650 active trials (380, or 58.5%, of which are recruiting). This medical center alone accounts for 39.6% of Stanford’s active trials and 42.4% of its recruiting trials, as well as 7.5% and 9.2% of active and recruiting trials in the entire CSA. UCSF Health is not far behind Sutter and Stanford, with 1,502 active trials (822, or 54.7%, of which are recruiting), accounting for 17.2% of active trials in San Jose and 20% of its recruiting trials. Within UCSF Health, the UCSF Helen Diller Medical Center at Parnassus Heights is on the heels of Stanford’s Medical Center, with 633 active trials (339, or 53.6%, of which are recruiting. The UCSF Medical Center at Parnassus Heights alone accounts for 42.1% of UCSF Health’s active trials and 41.2% of its recruiting trials, as well as 7.3% of active trials and 8.2% of recruiting trials in the entire CSA2.
Although the San Jose Combined Statistical Area is anchored in the clinical trial industry by four robust health systems, it is still outperformed by several similar markets. Objectively, however, having lynchpins in Stanford, UCSF, Sutter, and Kaiser Permanente, along with an ever-modernizing state, bode well for the area’s future in the industry.
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)