Illustrative worked example · not a real company recommendation
Site selection: the cheapest site is rarely the cheapest answer.
Illustrative example of ranking sites by decision speed and evidence quality rather than fee schedule alone.
The decision
Which sites should receive scarce startup and monitoring resources?
A low site budget can be expensive if startup is slow, enrollment is weak, or data quality requires rescue.
Evidence to collect
What must be known before deciding
- Eligible patient pool
- Competing studies
- Startup history
- PI engagement
- Contracting timeline
- Per-patient and fixed costs
- Data/monitoring burden
What could overturn the thesis
Disconfirming evidence matters
- Prestigious centers can be slow
- Fast private sites can overstate enrollment forecasts
- Geographic concentration can reduce diversity or resilience
Cheapest credible next truth
Run a small, comparable feasibility challenge before activating a broad site network.
Force each site to answer the same protocol-specific questions and rank by expected time-to-decision.
Alternative paths
| Path | What it buys | Primary risk |
|---|---|---|
| Few high-confidence sites | Lower management burden | Concentration risk |
| Broad network | More recruitment options | Higher startup/monitoring overhead |
| Staged activation | Learn before expanding | Requires active kill discipline |
Decision gate
GOSite has credible patients, fast startup, and acceptable cost-to-enrolled-patient.
MODIFYSite is useful only under changed terms or staged activation.
KILLRepeated missed milestones or unsupported recruitment assumptions.
What I would do Monday morning
Three actions, in order.
- Standardize feasibility questions.
- Score startup and enrollment separately from price.
- Predefine the kill date for low-enrolling sites.