The global contract research organization market value reached $39 billion in 2018 and is expected to exceed $51 billion by 2024. The market is becoming competitive, with large CROs going for acquisitions and mergers to increase the portfolio and reach, whereas small and medium CROs are becoming more prominent with their personalized approach, contact flexibility, and budget-friendly services.

The drug discovery process is complex and critical while clinical development is more crucial with the requirement of huge resources and efficiency for optimal outcomes.

Here is where the contract research organizations form a bridge between the discovery and launch of the drug substance for manufacturers by handling this burden. Data research, project management, tests, and trials that are run post-approval, pre-clinical, and clinical are just some of the activities covered. CROs add value to the research.

Before you choose a CRO, questions need to be answered

  • Can the CRO offer the services that the sponsor exactly needs?
  • Does the CRO have related experience and a good track record of similar projects?
  • Is the CRO financially stable and handles the crisis movements?
  • Does the CRO have the key staff members, training support, and can it set up an experienced team to deliver qualified results?
  • Does the CRO have the required infrastructure for your trial?
  • Does the CRO have a robust quality assurance system?

Click here to learn how to choose a CRO as a small & mid-size pharma

Sponsors or drug developers need to look for partners who deliver reliable outcomes with comprehensive data and add support to their research. Hence choosing a CRO is a crucial and complex process and should be evaluated cautiously.

The following points need to be thought before you partner with a CRO

  • The regional potentiality of a CRO: It’s not obvious that the CRO established or reputed in a country holds the same reputation & experience as it does in another country. This means the choice of CRO selection differs from country to country. 
  • CRO capabilities: Sponsor or manufacture need to understand the complete portfolio of the contract research organization with their level of experience, reputation, contract flexibility, and global reach
  • Project execution: Contract research organization should be efficient to handle the hurdles that arise during the clinical research process such as patient recruitment, site management, reliable data extraction and global applicability of data, and regulatory expertise.
  • Quality of service: It’s crucial to understand the quality of service and data extracted from a study as per the required standards of regulators and the global applicability of data. 

Now next comes the question, which CROs you should prefer? Big CROs or small and medium-range CROs? This would be an arguable answer, however, each of them has its own advantages. 

Top Contract Research Organizations (CROs) for clinical trials

The large CRO marketplace is becoming increasingly competitive: A trend of mergers and acquisitions enhances larger companies’ service capabilities and international reach.

In 2018 the global CRO market stood at $38,396.4 Mn and projected to reach $90,926.3 Mn by the end of 2026, exhibiting a CAGR of 11.4% in the forecast period with top 10 companies controlling 56% of the market.

Advantages with top CROs

  • A global CRO provides personnel training and maintains a depth in background and experience that can be used to accommodate the resourcing challenges in a large-scale global clinical trial.
  • Well-established crisis management strategies.
  • Global multiregional clinical trials 
  • Experience and better approaches for handling regulatory hurdles.
  • Quality and comprehensive clinical data with global acceptability.

Along with advantages, there are also some challenges while choosing large CROs compared to small and medium scale CRO.

Challenges with top CROs

  • The budget may be the rethinking factor for most of the sponsors and especially the small and medium scale pharmaceutical companies.
  • Point of contact and flexibility in communication.
  • Collaborate with a sponsor’s program from a strategic and cultural perspective.

Here is the list of top CROs worldwide based on terms of total revenue, net income, and expenses,  growth between 2018.

List of top CROs worldwide

  1. Covance (Lab. Corp.)
  2. IQVIA
  3. Syneos Health
  4. Parexel
  5. PRA Health Sciences
  6. PPD
  7. Charles River
  8. ICON
  9. Wuxi AppTec
  10. MedPace

Let’s briefly overview the top CRO from the above list one by one in detail.


Covance Inc. is a contract research organization (CRO) headquartered in Princeton, New Jersey, providing nonclinical, preclinical, clinical, and commercialization services to pharmaceutical and biotechnology industries. It is one of the largest companies of its kind in the world, with annual revenues of over $4.5 billion.


IQVIA, formerly Quintiles and IMS Health, Inc., is an American multinational company serving the combined industries of health information technology and clinical research. It provides biopharmaceutical development and commercial outsourcing services with a network of more than 58,000 employees in more than 100 countries.

Syneos Health

Syneos Health (formerly InVentiv Health and INC) is a NASDAQ listed American multinational contract research organization based in Morrisville, North Carolina. Syneos Health is a fully integrated end-to-end clinical and commercial solution organization.


Parexel International is a global provider of biopharmaceutical services. It conducts clinical trials on behalf of its pharmaceutical clients to expedite the drug approval process. It has helped develop approximately 95% of the 200 top-selling biopharmaceuticals on the market today and provides services like clinical trial management, data management, medical writing, biostatistics, pharmacovigilance, regulatory consulting.

PRA Health Sciences

PRA Health Sciences is a contract research organization (CRO) with headquarters in Raleigh, North Carolina. PRA Health provides a long list of services in clinical research, Phase I-IIa, Phase II-III, post-approval, safety & risk management, therapeutic expertise, biosimilars, bioanalytical Laboratories, Rare Disease, Oncology, Immunology, Infectious Disease, Neuroscience, pain, pediatrics, vaccines, data & technology solutions,


PPD, Inc. (PPD) headquartered in Wilmington, North Carolina, United States is a global contract research organization (CRO) providing comprehensive, integrated drug development, laboratory, and lifecycle management services. PPD has offices in 46 countries and approximately 23,000 professionals worldwide,

Charles River

Charles River Laboratories, Inc., is an American corporation specializing in a variety of preclinical and clinical laboratory services for the pharmaceutical, medical device, and biotechnology industries. It specializes in Research Models & Services, Preclinical Services, Discovery Research Services, Biologics Testing Solutions, Microbial Identification, Endotoxin Testing, LAL, Early Discovery, Safety Testing, and Agrochemical.


ICON is an Irish-headquartered developer of drugs to the pharmaceutical, biotechnology, and medical device industries. ICON offers to consult in clinical development and commercialization services in a broad range of therapeutic areas from a global network of offices. ICON is spread over 98 locations across 40 countries.

Wuxi AppTec

Wuxi AppTec a Chinese company is a contract researcher for most of the largest pharmaceutical, biotech, and medical device companies, and many smaller companies. The company covers the development cycle through five core operations, including small molecule R&D and manufacturing, biologics R&D and manufacturing, cell therapy and gene therapy R&D and manufacturing, medical device testing, and molecular testing and genomics.


Medpace is a midsize, clinical contract research organization (CRO) based in Cincinnati, Ohio. It provides services for Phase I-IV of drug and medical device development, including regulatory services and central laboratory services. Medpace employs approximately 3,600 people across 37 countries.

Small and mid-range CRO

Even though the major share of approximately 56% is occupied by large CRO companies, the small and medium-range CRO are slowly gaining their market size and surprising experts.

Small and medium-range CRO have their own advantage over large CRO and are the preferred choice for many pharmaceutical and biopharmaceutical companies.

In the subsequent Part II article, we will be discussing in detail the small and medium-range CRO, their advantages, and details based on the region, phase of the study, and therapeutic area.

Contract Research Organizations For Your Clinical Trials: Small and Mid-Sized CRO

How to choose the best CRO for your clinical trial?

Finding the right CRO partner is as crucial in the success of clinical trials, as probably the site or investigator. That’s why it is important to perform this selection on the basis of carefully selected criteria and parameters.

Credevo has extensive experience and expertise in performing such selection for our clients. Credevo often works as an extended arm of pharma / biotech companies in building clinical development strategy and selecting the right kind of vendors (including CROs) for successful and accelerated completion of clinical trials.

Discuss your clinical development needs for free with us today. We can help you in developing a successful strategy and selection of the most suitable CRO for your clinical trial.

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