Illustrative worked example · not a real company recommendation
Trial geography: where should the next study actually run?
Illustrative example of comparing jurisdictions without treating an entire country as one price.
The decision
Should an early clinical study run in the U.S., Australia, or a mixed geography?
The answer should depend on the actual protocol, sites, startup path, recruitment pool, incentives, regulatory route, and evidence required for the next decision.
Evidence to collect
What must be known before deciding
- Protocol-specific site capability
- Actual site budgets and startup timelines
- Patient availability and competing trials
- Regulatory path and sponsor requirements
- Travel, lab, pharmacy, monitoring, and data costs
What could overturn the thesis
Disconfirming evidence matters
- A nominally cheaper country may have slower enrollment
- Tax incentives do not erase operational costs
- A fast startup can still produce weak evidence if the site mix is wrong
Cheapest credible next truth
Price a small set of capable sites apples-to-apples before choosing the country.
Do not substitute “Australia costs 50%” or any other countrywide heuristic for actual capable sites.
Alternative paths
| Path | What it buys | Primary risk |
|---|---|---|
| U.S.-first | Maximum familiarity and domestic execution | Higher cost or slower contracting |
| Australia-first | Potential startup and incentive advantages | Site-specific capability still has to be proven |
| Hybrid | Preserve multiple enrollment pools | More operational complexity |
Decision gate
GOOne geography clearly dominates on decision-quality evidence per dollar and month.
MODIFYNo single country dominates; use a hybrid or redesign the protocol.
KILLThe study cannot reach a credible answer within the available capital/window.
What I would do Monday morning
Three actions, in order.
- Lock the protocol assumptions that drive cost.
- Obtain comparable quotes from capable sites in each geography.
- Set the decision rule before negotiating broadly.