In this episode of the KLF Deep Dive, Darshan Kulkarni and Edye Edens engage in a practical discussion around one of the most debated issues in clinical research: Should clinical trial sites be paid differently based on who they are, where they’re located, or what they bring to the table?

The conversation challenges the idea of flat-rate, standardized budgets for all sites and explores the concept of Fair Market Value (FMV) from both sponsor and site perspectives. Edye and Darshan break down how location, site type (academic vs. independent), operational capacity, and even patient population size can significantly affect the true cost of running a clinical trial. They also address common misconceptions—like whether having more patients always justifies higher pay—and emphasize the importance of effort tracking and cost documentation as tools for sites to advocate for reasonable compensation.

The two also examine the wide variability in how sites are funded, including differences driven by grants, institutional policies, and pass-through rules. They explore why attempts to equalize payments across the board—though well-intentioned—may backfire, creating unintended inequities that hurt both high-performing sites and trial timelines.

Darshan draws a parallel to J. Paul Getty’s famous quote, “Just a little bit more,” noting that many sites, regardless of how much they’re paid, still want more—while sponsors often feel they're already paying generously. This leads to a larger issue: the lack of transparency and shared understanding around how FMV is calculated. Sites are often expected to justify every line item with data, while sponsors rarely share the assumptions and benchmarks they use in return.

This episode explores key questions like:

• What does fair really look like in site budgeting?
  
  
• Should sponsors be more transparent about their FMV calculations?
  
  
• How do we balance standardization with the real-world variability in site operations?
  
  

The discussion sets the stage for a follow-up episode exploring whether sponsors should disclose their FMV methodologies—and how that could impact trust and negotiation dynamics across the clinical trial ecosystem.

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