In clinical research, size hasoften been mistaken for strength. Large global contract research organizations(CROs) have long dominated the industry, offering expansive infrastructure, international networks, and standardized systems. Yet an increasing number of small and midsize biopharmaceutical companies are turning toward smaller CROs.This shift is not sentimental or nostalgic; it is a strategic adjustment to a structural problem.
Large CROs are designed for volume. Their systems and hierarchies are built to handle hundreds of concurrent studies across continents, prioritizing consistency and throughput. Smaller biotechs operate under different conditions. They have limited budgets, condensed timelines, and depend on precision rather than scale. Within this context, smaller CROs provide what many large organizations cannot: focus, adaptability, accountability, and intelligent use of resources.
Agility in smaller CROs is not a slogan but an inherent feature of their structure. With fewer layers of management, decisions are made quickly and directly. When challenges arise, whether related to recruitment, data quality, or safety, project leads can address them immediately without waiting for multiple internal approvals.
This ability to act decisively matters for sponsors because it shortens the distance between a problem and its solution. In drug development, every delay has financial and strategic consequences. Agility ensures that adjustments to protocol, country mix, or recruitment strategy occur at the speed of need rather than the pace of process. It also reduces uncertainty for sponsors, who can count on rapid feedback and real-time collaboration instead of formal correspondence through several corporate tiers.
Large CROs mitigate delivery risks by expanding scale, more sites, more countries, more processes. Smaller CROs do the opposite. They rely on precision and depth of engagement with each site. Site selection is not based solely on geography or volume but on actual performance indicators such as investigator engagement, regulatory readiness, and patient accessibility.
For sponsors, this focused approach leads to fewer inactive sites, lower operational waste, and higher-quality data. Smaller CROs invest in tailored training and sustained communication with investigators. Because the same personnel oversee feasibility, start-up, and conduct, knowledge continuity is preserved. This consistency directly benefits sponsors by minimizing the disruptions that occur when large organizations rotate staff or reassign projects.
The assumption that scale ensures faster study initiation is misleading. The true driver of start-up speed is coherence. Smaller CROs achieve efficiency through tight coordination and direct involvement of experienced regulatory professionals in dossier preparationand authority communication. Their teams are compact, which allows for unified oversight and clear accountability.
This approach benefits sponsors in two ways. First, it accelerates regulatory timelines because communication with authorities is consistent and well-prepared. Second, it enhances submission quality since senior experts remain engaged throughout the process, anticipating challenges before they become barriers. Smaller CROs also design regulatory pathways that align with the sponsor’s funding milestones, avoiding unnecessary expenditure before critical investment stages.
The financial advantage of smaller CROs is not simply lower pricing. It stems from a fundamentally different cost structure. With limited overhead and focused project portfolios, resources are deployed where they create real value. There are no layers of non-billable management or redundant administrative systems.
For sponsors, this translates into a higher percentage of their budget directed toward scientific and operational activities. Smaller CROs also help reduce development waste by controlling the number of activated sites, aligning supply chains precisely with recruitment, and monitoring drug utilization closely. Sponsors benefit from lower burn rates, fewer unnecessary expenditures, and a stronger correlation between spending and progress. Economic precision protects financial sustainability and allows more funds to be redirected to innovation rather than inefficiency.
At People Value Research (PVR), these principles define how every project is built. Operating across Georgia, Türkiye, Ukraine, and Israel, our in-house teams provide the agility, precision, and tailored regulatory oversight that enable sponsors to move faster and more intelligently. Each project benefits from direct leadership engagement and rapid decision-making, ensuring that resources are spent where they matter most — on science, patients, and results.
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