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Central and Core Laboratories: The Definitive Guide to the Current Status and Future Prospects of Central Clinical Pathology, ECG and Imaging Laboratories

Published by: Biopharm Knowledge Publishing

Published: Oct. 1, 2007 - 250 Pages


Table of Contents


Chapter 1 Overview of Central Clinical Laboratories Capabilities & Facilities

By Richard Barrett

1. Introduction

2. Apparatus

3. Data Handling

3.1 Protocol

3.2 Analytical Plan

3.3 Kit Manufacture

3.4 Shipments of Kits to Investigator Site

3.5 Sample Collection

3.6 Sample Transport

3.7 Sample Reception

3.8 Sample Analysis

3.9 Reflex Testing

3.10 Data Reporting

3.11 Abnormal Data Reporting

3.12 Data Transfer Protocols

3.13 Data Interpretation

3.14 Archiving

4. Courier Liaison

Chapter 2 Role of Central Laboratories in Clinical Trials

By Richard Barrett

1. Introduction

2. Definition of Clinical Trials

3. The Four Phases of Clinical Trials

3.1 Phase I

3.2 Phase II

3.3 Phase III

3.4 Phase IV

4. Clinical Program Design

5. Clinical Trial Design

6. Protocol

6.1 Inclusion / Exclusion Criteria

6.2 Safety & Efficacy

6.3 Measurement

7. Reporting

Chapter 3a History of Pathology

By Graham Hughes

Chapter 3b History of Central Laboratories

By Graham Hughes, Richard Barrett, David Cocker

Chapter 4 Contracting Considerations

By Richard Barrett

1. Introduction

2. Patient Population

3. Track Record

3.1 Ownership

3.2 Length of Time in Business

3.3 Number of Clients

4. Financial Information

4.1 Costs

4.2 Turnover

4.3 Financial Stability

5. Analytical Capabilities

5.1 In-house Analytical Capability

5.2 Capacity

5.3 Instrument Age, Replacement Strategy & Back-up

5.4 Method Evaluation

5.5 Sub Contracting Arrangements

6. Geographic Coverage

6.1 Location

6.2 Coverage

7. Service

7.1 Study Management

7.2 Kit Production

7.3 Investigator Instructions

7.4 Courier Arrangements & Sample Tracking

7.5 Turn Around Time

7.6 Language Capability

7.7 Emergency Procedure

8. Science

8.1 Appropriateness & Maintenance of Equipment

8.2 Methodology

8.3 Reference Ranges & Panic Values

8.4 Qualification of Staff

8.5 Staff Turnover

8.6 Quality Control

9. Quality Assurance

9.1 GCLP Compliance

9.2 CAP/CPA/ISO Accreditation

9.3 Inspection History

10. Data Management

10.1 Validated IT System Inc 21 CFR Part 11

10.2 Project ID

10.3 Sample ID

10.4 Reporting

10.5 Electronic Data Transfer

10.6 Access to Data

11. Flexibility

12. Communication

13. How to Contract

13.1 Study

13.2 RFI

13.3 RFP

13.4 Audit

13.5 Bid Defence

13.6 Contract or Master Service Agreement / Work Order

13.7 Review

13.8 Study Close Out

14. Essentials of a Contract

15. Terms and Conditions

16. Laboratory Protocol

16.1 Price Build Up

16.2 Communication

16.3 Task Ownership Matrix (TOM)

17. Negotiation

17.1 Basis

17.2 Understanding the Price Build Up

17.3 Volume

Chapter 5 The Central Laboratory Market

By Graham Hughes

1. Introduction

2. Calculation of Market Size

3. Growth of Central Laboratories

4. Geographical Distribution

Chapter 6 Clinical Logistics & Its Role in Central Laboratories Operations

By David Cocker & Graham Hughes

1. Background

2. Clinical Protocol to Project Deliverable

3. Evolution of Central Laboratories in the 80’s and 90’s

4. Research and Development Structures

5. Selecting a Central Laboratory with Logistics in Mind

5.1 Organisation

5.2 Company Ethos

5.3 Track Record & Endorsements

5.4 Logistics

5.5 Procedures

5.6 Accreditation

5.7 Flexibility

5.8 Medical Supervision & Knowledge

6. Optimizing Logistics

7. Regulatory Environment

8. Packaging Regulations

9. Shipping Regulations

9.1 Basic Checklist For Dangerous Goods (UN 2814)

9.2 Diagnostic Specimens (Clinical Specimens): UN 3373

10. Costs

11. Electronic Enhancement of Logistics

12. Convergence of Logistic Needs

13. Conclusion

Chapter 7 Review of Leading Companies

By Graham Hughes

1. ACM Pivotal Global Central Laboratory

2. BARC

3. BioReliance Corporation

4. Bioscientia - Institut für medizinische Diagnostik GmbH

5. Capio Diagnostik a.s.

6. CentraLabS Ltd

7. Charles River

8. Cirion Clinical Trial Services Inc

9. Covance

10. CRL Medinet Europe

11. Esoterix Clinical Trials Services

12. Eurofins Medinet

13. Fleury SA

14. ICON Laboratories

15. INTERLAB Central Lab Services - Worldwide GmbH

16. LabConnect LLC

17. Laboratoire Marcel Mérieux

18. Laboratorio Dr Echevarne Analisis SA

19. LBM - Laboratorio Bioquima Medica SRL

20. Mayo Clinical Trial Services Central Laboratory

21. MDS Pharma Services

22. PPD Global Central Laboratories LLC

23. Quest Diagnostics Clinical Trials

24. Quintiles Laboratories Ltd

25. Simbec Research Ltd

26. Southern Research Institute

27. SydPath Central Laboratory

28. TDL Trials

29. Wickham Laboratories Limited

Chapter 8 Regulatory & QA Issues

By Tim Stiles

1. Background to Current Regulations

2. Regulatory Scene

2.1 Directive 2001/20/EC Clinical Trials Directive

2.2 Directive 2005/28/EC Good Clinical Practice Directive

3. European Medicines Agency (EMEA)

4. USA & Japan

5. Other Countries

6. Regulatory Summary

7. Good Clinical Laboratory Practices (GCLP)

7.1 Introduction

7.2 Scope

7.3 Good Laboratory Practice (GLP)

7.4 Good Clinical Laboratory Practice (GCLP)

7.5 Quality Assurance

7.6 Proficiency Schemes

7.7 Trial Sponsors

7.8 Accreditation

7.9 National Clinical Requirements

8. Conclusion

Chapter 9 Central ECG Laboratories

By Eileen Daniel

1. Introduction

2. ECG Fundamentals

3. The ECG in Clinical Research

4. The ECG Laboratory

4.1 Background

4.2 Clinical Trials

5. Central ECG Laboratory Operations

5.1 ECG Integrity

5.2 Routine ECG Processing

5.3 Qualitative ECG Services

6. Central ECG Laboratory Equipment & Technology

6.1 ECG Devices

7. ECG Management Systems

8. Regulation

9. Service Differentiation - Late Phase Clinical Trials

10. Service Differentiation - Early Phase Clinical Trials

10.1 Rationale

10.2 Site Considerations

10.3 Thorough Qt (TQT) Studies or Definitive Qt (DQT) Studies

11. Interval Measurement & Interpretation

11.1 Assignment of a Single Reader

12. Other Specialized Services

12.1 Holter Monitoring

12.2 Discrete ECGs From Holter Monitoring

12.3 Endpoint Management

12.4 Echocardiograms, Event Monitoring & Other Tests

13. People in the ECG Laboratory

13.1 Project Manager

13.2 ECG & Holter Technicians

13.3 Data Manager

13.4 Reader

14. FDA Digital Submission Requirements

15. The Landscape

16. Market Sizing

17. Customer Segmentation

18. The Future

19. Drivers of Change

20. Summary

Chapter 10 Central Imaging Core Laboratories

By Dr Colin G Miller

1. History

2. Description of their Operations

3. State-of-the-Art Technology

4. Regulatory Background

5. Imaging Core Laboratories

6. Financial Market Size

7. Imaging Technology

8. Considerations in Selecting an Imaging Core Laboratory

9. References

Chapter 11 Future Trends & Challenges

By Graham Hughes, Richard Barrett, Tim Stiles

1. Biologics & Biopharmaceutics

2. LIMS & Data Collection

3. CDISC

4. Regulatory & Quality Issues

5. The FDA Critical Path Initiative (CPI)

6. ICH E2E Pharmacovigilance Planning

6.1 Background

7. Limitations of the Human Safety Database

8. Pharmacovigilance Plan

9. Genomics

10. Proteomics

11. Metabolomics

12. Key Applications

13. Biomarkers

14. Point of Care Testing

15. Lab-on-a-Chip (LOC)

16. Esoteric Testing

17. The Impact of the Internet

18. Cost Pressures

19. Offshoring Drug Development

20. The Future of the Central Laboratory Business




Appendices

Appendix A - Master Service Agreement

Appendix B - Generic Work Order

Appendix C - Lab Protocol

Appendix D - Lab Price Build Up

Appendix E - Useful Websites

Appendix F - List of Central Laboratories

Abstract

This report will show that the central laboratory business is today a global business worth over $1.5 billion. It is a business that is indispensable to the research based pharmaceutical industry. The report traces the fascinating history of clinical pathology and shows how this medical analysis "lab tests", has come to form the basis of the global central laboratory business.

Today much of the clinical development of new drugs is outsourced by the pharmaceutical industry. This outsourcing is managed by hundreds of contract research organisations world-wide ranging from global industry leaders such as Covance to small two person niche companies. The proportion of the work outsourced continues to grow at a healthy double digit rate and today approaches 30% on average. Laboratory pathology analysis of blood, urine and other patient specimens is on the other hand, outsourced at a virtually 100% level with few parameters, usually biomarkers, being analysed in the pharmaceutical companies’ laboratories.

The central laboratory business is by its very nature a global business now that the pharmaceutical industry has moved to global drug development. Unlike contract research organisations a small pathology laboratory cannot compete and the vast majority of the business is concentrated in the hands of relatively few, perhaps 20, large players. The report provides a detailed review of these companies.

For those whose daily work does not bring them into close proximity with central laboratories this report is a useful primer on what the laboratories do, how they are equipped and how they fit into clinical drug development programmes.

Choosing a central laboratory and then contracting with it are vital to the successful outcome of a clinical trial. How these are best accomplished is addressed in the report. It is not often appreciated how important logistics are to the success of a clinical trial and to the role of the central laboratory in it. Up to 40% of the cost and, some would say 100% of the difficulties of safety analysis lie in the transportation of specimens from the patient to the central laboratory. The authoritative chapter on logistics addresses this issue in some detail and provides invaluable help in traversing this particular minefield.

Pathology was the first analytical discipline to be centralised and this report concentrates on the central laboratory. However imaging and electrocardiology measurement have both in recent years been centralised and this report has not neglected these topics.

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