Top 10 CROs to watch in 2024

Contract research organisations – also called clinical research organisations (CROs) – are essential to the pharma, biotech, and medtech industries, supporting their efforts to test, refine and market their latest drugs and devices. According to , reports show the global CRO market was estimated to be worth anywhere from US$48.19 billion to US$82.55 billion in 2023 and is expected to reach anywhere up to US$148.76 billion by 2028. Over the years, growth has been driven by investment in research and development expenditures and activities, a significant rise in the number of clinical trials with the need for medical advancements, and patent expiration of blockbuster drugs.

M&A in the CRO marketplace

M&A activity has slowed down in the CRO marketplace whilst organic consolidation growth has been prioritised.

Some of the notable CRO moves in the market recently include:

• Thermo Fisher Scientific acquiring PPD in 2021 and as a group consolidating with the addition of CorEvitas, LLC (“CorEvitas”), a leading provider of regulatory-grade, real-world evidence for approved medical treatments and therapies, from Audax Private Equity (“Audax”) 
•  Fortrea divesting from Labcorp and returning to its Covance reminiscent roots, with the further divesture of Endpoints.

The CRO market in 2024

Whilst throughout the height of Covid years (2020 -2022) we saw record numbers of hires across the industry, it has become apparent that the pandemic-driven unprecedented acceleration has slowed down. The year of 2023 was peppered by consolidation, reorganisations and cautious hiring. Whilst in 2024 we find ourselves neither at the height of volume-based hiring, or in the depths of layoffs, we are still navigating challenging times.

The dramatic shift in the market is designed not just by the lack of funding and investment, interest rates skyrocketing and talks of recessions globally, but also by the slowdown in R&D in certain areas such as vaccines and by ramifications of geopolitical changes, which shape the dynamics of the global markets.

With expansions, partnerships, and innovations continuing throughout the CRO industry, 2024 is set to be another interesting year. The top ten CROs to watch in 2024 are listed below, this list is based on our knowledge of the industry and is in no particular order but includes both industry leaders by market share and revenue, and up-and-comers who are steadily increasing their presence through strategic collaboration and innovative service offerings.

1. Parexel

Founded over 40 years ago and providing the full range of Phase I to IV clinical development services to help speed up and ensure the drug approval process runs smoothly, Parexel remains one of the biggest CROs in the world. With a team of more than 21,000 professionals worldwide, the company has a wide range of service offerings, covering nearly every type of clinical trial service to assist sponsors in running successful clinical studies.

At the end of 2021, Parexel was acquired by EQT Private Equity and Goldman Sachs for $8.5 billion. Together, Parexel and Goldman Sachs remain committed to delivering on the patient-first trajectory and driving advancements in drug development. . The partnership combines clinical research expertise with artificial intelligence capabilities to help drug developers better understand the probability of clinical success for their innovation medical advancements.

Later this year the company will undergo a big change as CEO of 6 years, Jamie Macdonald, hands over the baton to Peyton Howell, who is set to become the first female CEO of a large CRO, a huge step forward for women in leadership in this sector. Howell, who currently serves as chief operating and growth officer, commented in a , “With a focus on the patient, a commitment to our customers and the CRO industry’s best colleagues, we have an exciting future ahead. I’m proud of our growth and accomplishments and look forward to working with Jamie on the transition and with the Board and our leadership team to build on this momentum as we execute on our strategic initiatives, continue profitable growth and generate value for our stakeholders”.

2. IQVIA

In 2016, Quintiles and IMS Health came together and rebranded as IQVIA. As the largest CRO in the world, IQVIA is a leading global provider of advanced analytics, technology solutions, and clinical research services to the life sciences industry. After a string of further acquisitions of smaller specialist companies, the company is going from strength-to-strength and remains truly at the forefront of the CRO world.

Despite concerns that the biotech sector would cut back on drug development, , up by 4% on a reported basis and 4.1% at constant currency, compared to 2022. IQVIA’s R&D solutions division, its largest segment, saw growth increase by 4.5%, while its second largest unit, technological and analytical solutions, saw growth rise by 2%. Looking forward, as a global leader in healthcare intelligence, IQVIA is expected to continue playing a key role in shaping the CRO landscape.

3. PPD

Pharmaceutical Product Development, also known as PPD is a leading global CRO that employs over 30,000 people worldwide. They are considered a premium CRO provider for many pharma and biotech companies, and pride themselves on their “4I values” - integrity, innovation, intensity and involvement.

After acquiring Evidera in 2016, PPD solidified itself as a leader in real-world research. The company has leveraged Evidera’s real-world evidence expertise to provide life science companies with an increasingly crucial element of the clinical development process, helping PPD to remain competitive.

In 2021, PPD was officially acquired by ThermoFisher, becoming part of ThermoFisher's Laboratory Products and Services Segment. This means PPD are still operating as a CRO with traditional CRO services, as well as their accelerated site solutions. Together, PPD and ThermoFisher are able to further leverage their capabilities to bring life-changing therapies to market and are set for a very promising future with an established drug development platform, patient enrolment expertise and robust laboratory services.

Most recently, ThermoFisher Scientific, strengthened its Laboratory Products and Biopharma Services segment with the . In light of the news, Marc N. Casper, chairman, president and chief executive officer of Thermo Fisher, commented “CorEvitas expands our clinical research business with highly complementary real-world evidence solutions, which is an increasingly important area and will help to enhance decision-making as well as the time and cost of drug development. We are excited by the opportunity to further accelerate innovation and advance productivity for our pharma and biotech customers in their work to deliver new medicines and therapeutics to benefit patients”.

4. ICON

In 2021, ICON bought PRA and 2023 saw them further solidify and harmonise their joined teams. Operating from 40+ countries across the world, the top-tier CRO, ICON, offers a full range of consulting, clinical development and commercialisation services.

In recent years, ICON has worked to advance the speed and efficiency of clinical development which has supported a growing number of customer partnerships. In 2023, ICON generated full year revenues of US$8.1bn, a year-on-year increase of 4.9%. , chief financial officer of Icon, Brendan Brennan, who recently announced he would be stepping down in Q4 2024, said that the contract research giant plans to go on a M&A spree in 2024, and is expecting to spend $500 million (€462 million) a year on acquisitions to grow the business.

5. Syneos Health

Formerly known as InVentiv Health Incorporated and INC Research, Syneos Health specialises in assisting companies with late-stage clinical trials. Headquartered in Northern Carolina, USA, Syneos Health operates in over 110 locations worldwide.

Over the last few years, Syneos Health has levelled up with a number of collaborations, investments and initiatives to further accelerate their strategy, enhance their scalability and improve the efficiency of their operations.

Michelle Keefe, who prior to joining Syneos Health spent 20 years at Pfizer, became CEO in 2022, succeeding Alistair Macdonald who had led the company since 2017. This kick-started a new era for Syneos Health as a data- and insights-driven organisation, addressing market opportunities with a product development mindset and in 2023, the company signed a multi-year in development of a platform to leverage machine learning for the optimisation of clinical trials.

6. Fortrea

In 2022, Labcorp announced its plans to spin off its CRO segment. A year later, Fortrea, which stands for “forward trials with ease”, became an independent public trade CRO. Evolving over 30 years – with a long-standing history of product development expertise – the company provides drug and medical device services, including clinical trial management and commercialisation offerings. Assisting clients in biotech, pharma and medtech, Fortea employs over 19,000 people worldwide.

In early 2024, Fortrea announced plans to sell its Endpoint Clinical and Fortrea Patient Access businesses to private equity firm, Arsenal Capital Partners for US$345 million. The sale will position Fortrea to focus on growing as a “pure-play CRO, with added financial flexibility,” Tom Pike, who previously stood as Quintiles CEO through the merger with IMS Health, chair and CEO at Fortrea, said in the earnings .

7. Medpace

A mid-sized CRO, Medpace focuses on clinical research for drugs and devices globally. Unlike many of the larger CROs, Medpace has not invested in acquisitions but instead chosen to reinvest in their own workforce and grow organically.

Headquartered in Cincinnati, Ohio, Medpace employs over 5,000 people across 40 countries. Even with a general shift towards hybrid working models after the pandemic, Medpace’s smaller size helps it retain the intimacy of a cohesive office culture in contrast to much of the rest of the sector which is heavily home-based. This is thought to directly affect how employees feel about the job and how they interact with clients on a daily basis, offering a unique service and collaboration with their partners.

For the full year 2023, to $1.89 billion. The company has grown from strength to strength since going public in 2015. In 2022, CEO Dr. August Troendle, announced the company planned to add 1,500 jobs over the next six years in Cincinnati and invest $150 million to expand its offices and business operations, solidifying the company’s commitment to growth.

8. PSI

PSI is a fast-growing CRO that specialises in a range of fields such as oncology, haematology, infectious diseases and multiple sclerosis. Organically grown since 1995 with 3,000 staff in 60 countries, PSI has expanded into new locations rapidly over the last few years. With an exceptionally high repeat and referral business rate and low staff turnover, PSI remains committed to being the best CRO in the world as measured by its employees, customers, investigators, and vendors.

For the sixth year in a row, in June 2023, PSI received CRO Leadership Awards in the categories of Expertise, Quality, and Reliability in the Overall (combined Big and Small Pharma) respondent group.

9. Ergomed

With over quarter of a century in business and a global footprint covering over 100 countries, Ergomed provides specialised services to the pharma industry and the development of new drugs.

Ergomed services over 300 clients, from top 10 pharma companies and generics organizations to small and mid-sized drug development companies. The company has successfully completed 9 acquisitions since IPO in 2014, including Ashfield PV, USA MedSource and most recently, in 2022, ADAMAS a leading global regulatory compliance provider. With a growing presence, Ergomed has grown its teams by employing people from top CRO companies whilst maintaining a small company feel.

10. Precision for Medicine

As a dedicated precision medicine clinical research organisation, Precision for Medicine has over 3000 employees based across 40 offices worldwide. With expertise in Oncology & Immuno-Oncology, Rare & Orphan Disease, and Cell & Gene Therapy, the company has 5 core principles: Client Service, Purpose, Accountability, Mutual Respect, and Collaboration.

In 2023, Precision for Medicine acquired Baseline Controls, expanding the company’s end-to-end manufacturing solutions. Baseline Control’s expertise becomes part of “Project Farma”, Precision for Medicine’s existing biomanufacturing strategy and execution group, driving greater speed and efficiency in bringing new drugs to market.

Is your CRO aiming to grow this year?

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