The clinical research industry represents a significant source of healthcare innovationand economic prosperity for countries. As a primary gateway into Asia and a centralplayer in the region, Thailand is an emerging provider of clinical trials. World-classinfrastructure, a universal healthcare system, and national policies that supporta developing clinical research industry make Thailand well positioned to pursuefurther growth in the clinical research industry.
The current status of the industry suggests that these underlying benefits forconducting clinical research in Thailand have not been fully realised and that othercountries in the region, such as South Korea and Taiwan, have been able to moresuccessfully attract clinical trials. Over the 2010-2015 period, over 4,000 clinicaltrials commenced in South Korea, around 2,000 in Taiwan but fewer than 1,000 (967)in Thailand .
The Pharmaceutical Research and Manufacturers Association (PReMA) in Thailandcommissioned Deloitte Access Economics to provide a detailed and objective analysisof the economic and health related benefits of clinical research in Thailand. The teamadopted a mixed methods approach to the study which comprised a survey,interviews and desktop analysis.
The survey of PReMA members, clinical research organisations and universities ascertained trialemployment and cost data, the number of local participants and sites, and challenges andopportunities for Thailand based clinical research. Face to face stakeholder interviews wereperformed to further explore survey findings and collect qualitative information. Desktop researchand analysis sought to complement, triangulate and fill gaps. Sources referenced included clinicaltrial databases (clinicaltrials.gov, Thai Clinical Trials Registry)1, government departments (Ministryof Public Health, Office of the National Economic and Social Development Board) and publishedpapers.
20 surveys, representing 67% response rate amongst member companies (involved with research)
Several submitted surveys were populated with indequate cost data of conducting clinical trials in Thailand
A number of local face to face consultations were conducted:
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Discusstion focused on the current clinical research environment in Thailand, its challenges, impediments and pportunities
Publicly available information was sought to complement, triangulate and fill gaps indentified during the survey and consultation phases
Outcomes of consultations contributed to aStrengths Weaknesses Opportunities and Threats(SWOT) analysisand the development of policy recommendations.
This occurred in tandem with economic analyses. The costs and benefits investigated were:
These benefits are compared to the costs of conducting clinical trials in Thailand in 2015 using a cost benefit analysis framework.
1 As listed on www.ClinicalTrials.gov. Does not include trials only listed on domestic registries.
The SWOT analysis found the most important factors for attracting foreign clinical trial investment to Thailand are the large treatment-naïve patient population and the highly skilled workforce. The lengthiness of the independent ethical approval process and the import licence approval process were considered the biggest impediments to increased foreign investment in clinical research.
SWOT analysis for clinical trials in Thailand
Thailand is well equipped to be a strong contender in the international clinical research market.
Number of clinical trials commenced in
Thailand, by year and phase
Based on Deloitte Access Economics analysis, it is estimated that฿10.4 billion (USD 0.32 billion) was spent on clinical trials in Thailand in 2015. Of this, the majority, or 75% (฿7.8 billion, USD 0.24 billion) was on Phase 3 research. Phase 1 has the lowest cost (around 3% of total trial costs).
There wereover 111,000 Thai trial participants in 2015 and approximately 38% of clinical trials in Thailand had pharmaceutical companies as sponsors. It is estimated that expenditure on trials sponsored by private industry was ฿3.94 billion (USD 0.12 billion).
In 2015, there were an estimated 8,905 full time equivalents (FTEs) directly employed in clinical trials in Thailand, who were paid approximately ฿4.9 billion (USD 0.15 billion). Additionally,6,604 FTEs were employed in industries related to the clinical research sector. These include upstream industries such as: post and telecommunication; pulp, paper and cardboard; and electricity.2
Clinical trials contributed approximately ฿8.8 billion3 (USD 0.27 billion) to Thailand’s GDP in 2015which represents approximately 0.05% of Thailand’s GDP for 2015. Of this, ฿2.0 billion (USD 0.06 billion) resulted from contributions to upstream industries.
2 The three largest industries are ranked by value of the inputs they supply to research.
3 There is a positive contribution to GDP based on the following process: total expenditure on trials (฿10.4billion) represents direct gross output, which is larger than the contribution to GDP (฿8.8 billion), equalling the total (direct and indirect) contribution to value added.
Clinical trials conducted in 2015 are estimated to result in profits from future medicine sales sufficient to generate a 4.2% rate of return, in net present values. That is, future return will be 104.2% of current total trial costs (including successful and unsuccessful trials). Clinical trials conducted in Thailand in 2015 are expected to resultin net economic return of medicines produced of ฿436 million (USD 13.4 million).
Medical research also significantly improves the morbidity and mortality of a country, accounting for roughly half of the annual reduction in the burden of disease and injury. Using World Health Organization data, it is estimated that 3.01 million disability adjusted life years (DALYs) averted in Thailand in 2015 can be attributed to worldwide medical research. Given clinical research accounts for 75% of all medical research, 2.26 million DALYs per year were saved due to worldwide clinical trials. The DALY reduction that arose from Thailand based research equated to 8,326 DALYs. The dollar value of wellbeing gains attributable to local clinical research can also be estimated using the market-based value of a year of healthy life for Thailand (฿1.8 million, USD 0.06 million)). The net present value of expected health benefits arising from clinical research conducted in Thailand in 2015 is ฿10.5 billion (USD 0.32 billion).
All costs and benefits arising from clinical research in Thailand in 2015 were compiled and compared through a cost benefit analysis. Compare to total costs of ฿10.4 billion, total benefits sum to ฿30.0 billion (USD 0.9 billion), with a benefit-cost ratio of 2.9:1.This means that for every ฿1 spent on clinical trials in Thailand in 2015, the return was ฿2.9.
During consultations, key stakeholders considered that the main reason Thailand had been obtaining a decreasing share of regional multinational trials was the need for regulatory reform. In particular, Thailand needs to reduce regulatory review and approval timelines. Participants were universally willing to pay higher registration fees to achieve this outcome. There is also a pressing need for more accredited trial sites in the rural areas which are home to large treatment-naïve populations, one of Thailand’s key advantages.
Based on the experiences of Taiwan, Korea and Singapore after they streamlined their regulatory processes, Deloitte believes it should be possible for Thailand to achieve similar growth rates in numbers of multinational trials as its regional competitors. Some five years after reforming their clinical trials regulations, each of these countries were receiving around twice as many international trials as they had had five years before the reforms. Similarly Thailand’s competitors (those nations plus Vietnam, Malaysia, Cambodia, and the Philippines) have experienced combined average growth rates in international trials around one third higher than Thailand has over the five years to 2015.If Thailand streamlined its regulatory processes, like its competitors, it should be feasible to increase total trials in Thailand by around 20%, with an attendant increase of some ฿3.9 billion (USD 0.1 billion) annually in net benefits.
Overall, Thailand is in a good position for fostering new growth in the market for clinical trials and clinical research. However, the current status of the industry suggests that the underlying benefits for conducting clinical research in Thailand are not being fully realised. In order to realise these benefits, it is recommended that Thailand:
1. Address regulatory efficiencies to make Thailand more competitive.
2. Prioritise innovation enhancement policies that promote clinical research.
3. Implement sustained reforms by creating an inclusive multidisciplinary National Clinical Research Task Force to establish a detailed roadmap for the clinical research development in Thailand.
As shown by Wong (2011)4, implementation of such recommendations can bring about marked increases in clinical trial activities, particularly in the early stage clinical trials and R&D where opportunities to value add are greatest.