Objectives: Applications to run clinical trials in Europe fell 25% between 2007 and 2011. Costs, speed of approvals, and shortcomings of European Clinical Trial Directive are commonly invoked to explain this unsatisfactory performance. However, no hard evidence is available on the actual weight of these factors, nor has it been previously investigated whether other criteria may also impact clinical trial site selection. Design: The SAT-EU StudyTM was an anonymous, cross-sectional Web-based survey that systematically assessed factors impacting European clinical trial site selection. It explored 19 factors across investigator-, hospital-, and environment-driven criteria, and costs. It also surveyed perceptions of the European trial environment. Setting and Participants: Clinical Research Organizations (CROs), academic Clinical Trial Units (CTUs), and Industry invited to respond. Interventions: None Outcome Measures: Primary: Weight assigned to each factor hypothesized to impact trial site selection and trial incidence; Secondary: Desirability of European countries to run clinical trials Results: Responses were obtained from 485 professionals in 34 countries: 49% from BioPharma, 40% from CTUs or CROs. Investigator-, environment-, and hospital-dependent factors were rated highly important, costs being less important (P<0.0001). Within environment-driven criteria, pool of eligible patients, speed of approvals, and presence of disease-management networks were significantly more important than costs or government financial incentives (P<0.0001). The pattern of response was consistent across respondent groupings (CTU vs. CRO vs. Industry). Considerable variability was demonstrated in the perceived receptivity of countries to undertake clinical trials, with Germany, United Kingdom, and the Netherlands rated the best trial markets (P<0.0001). Conclusions: Investigator-dependent factors and ease of approval dominate trial site selection, while costs appear less important. Fostering competitiveness of European clinical research may not require additional government spending/incentives. Rather, harmonization of approval processes, greater visibility of centres of excellence, and reduction of “hidden” indirect costs, may bring significantly more clinical trials to Europe.

SAT-EU SurveySummary_Survey Monkey_10172013_EUROPE_Dryad_UploadVersion 2Original source of information is an excel download from Survey Monkey, which was used to collect the survey data.