All right. Good morning, everyone, and thanks for joining us today for the management presentation. My name is Max Mock, and I'm the research analyst here at William Blair who covers ICON. We're pleased to be joined this morning by CEO Dr. Steve Cutler and Kate Haven, Vice President, Investor Relations. Before we get into the presentation, I have to mention two things. First, the breakout session will be held in Adler on the second floor immediately following this presentation. Second, I'm required to inform you that for a complete list of research disclosures or potential conflicts of interest, please visit our website at william-blair.com. Again, very pleased to have ICON with us here today. With that, I'll turn it over to Steve.
Thank you, Max, and good morning to everybody. Nice to see you all here and looking forward to giving you a little bit of an insight onto ICON and what's happening with us at the moment. I'll flash the forward-looking statement up there. I'm sure you haven't seen that before, and we'll continue to move on. The CRO industry, I think, is going through something of a challenging time at the moment. That's not news to anybody. Ultimately, we do believe it's a very positive and strong industry. We do believe in the medium to long term, there's plenty of reason to be constructive and optimistic. Our market is in the vicinity of $60 billion. That's about half of what gets spent or outsourced, or at least spent on R&D in the pharma space.
We have a penetration of around 50%, which we believe can continue to increase. It has increased really over the last probably 20-25 years at about 100 bps - 200 bp s per year. We believe that can continue probably up to around about 70%. That is a source of market growth for us as we do more of our pharma customers' R&D, do more of their development. Of course, we also see opportunities for taking market share as we are one of the largest players in the industry. There is certainly some near-term challenge and some volatility as we work through the next 12-18 months or so. Overall, we do feel, as I say, a very strong market and a great opportunity for long-term value in our business and in our industry. There is certainly prioritization of late-stage development.
The biotech funding did improve in 2024 to the tune of about 30%-40%. That's a little bit volatile, certainly the first part of this year. We're not quite through some of the challenges around biotech funding. Overall, we do believe it's moving in the right direction. The rise of novel and complex therapies continues. Even beyond that, the GLP-1s, the cardiometabolic area offers us a significant opportunity to go back to doing very large-scale trials. When I came into the industry 20 or so, 30 years ago, we were doing very large-scale cardiovascular trials. More recently, those have gone away. We do tend to do more oncology work, rare disease. The GLP-1s and the GLP-1 agonists offer us the opportunity to go back to some of those large-scale trials, which of course are very good for our business.
The opportunities around innovation and technology also offer us an opportunity to be more efficient, to spend our customers' money more effectively. We believe we're on a good track to do that. I'll present a little bit of that as we go through today. Overall, a constructive longer medium- to long-term opportunity, I think, within our business and certainly within our industry. ICON is one of the largest players in the industry. We're in the top three. We're number one in a number of segments, number two in a number of others. We're about 41,000 people around the globe in 55 countries, almost 100 locations. In clinical development, you need to be a scaled organization. You need to be able to deliver patients and data from around the world. That's one of our key advantages, the scale of our operations.
We also have strategic partnerships with 17 of the top 20 and a number outside the top 20 as well. That has certainly been a benefit to us as we see the industry develop and those partnerships develop. We are a world leader in the full-service space. That is in the phase II, phase III, where we do all of the work, particularly for biotech companies. We do all of the work in large pharma. We are also a leader in functional service provision, that is FSP. That is where we do departmental or functional areas. We provide people in various forms to do data management, to do statistics, to do medical writing, to do monitoring on a functional departmental basis. That is an area of our business. Around about 20%-22% of our business, but it is an area of our business that is growing at a reasonable clip.
We're also one of the leading CROs in the biotech space as well. We have a group of about 6,000 people who are focused in on the biotechs and doing the work that the biotechs require. All full-service work. They don't have the ability or they don't have the infrastructure to manage functional service delivery. They are full-service customers. That's certainly an important part of our business. Early phase is an area that's been growing nicely for us in the recent past. Not a huge part of our business, but one that brings through opportunities in the phase II, phase III space. That's been going and moving along nicely. We're also number two in the more late phase area as well.
That's phase IV and commercialization, where we do trials that more lead towards developing key opinion leaders and developing the market for the drugs in terms of new indications. We are structured as an organization to deliver to our key segments. Our key segments being large pharma, of course, ICON being known as a large pharma CRO. We've also more readily, as we acquired PRA about four years ago, moved into the biotech space. Not that we weren't in that as ICON, but we really have a significant focus in the biotech space, where there's around 6,000-7,000 people focused in that area at the moment. And biotech is a different class of segment of customers. They are customers who are much more lighter, much more agile, much more willing to move fast and get things done. But of course, they do have some challenges at the moment.
In terms of our development solutions group, that's a group that looks after our early phase group, our labs, our imaging group, and some regulatory consulting. It's a group that has sort of periclinical services that support both our large pharma and our biotech segment. Underlying that, our global business support services, which I actually do believe is one of our key strategic selling points. We have a very strong global business services group around HR, IT, finance that works across our organization. It's one of the reasons we've been able to control our costs and mitigate any cost increases very significantly over the last 20 or 25 years or so. What are our competitive strengths in what is a very competitive industry? I think there are a number of them. I just mentioned the global business services area.
That's something I think we take very seriously. We manage our costs very effectively. That's partly through our global business services group. I also mentioned our global reach and global scale up there in the top right, 40,000 employees across 55 countries. You do need to be a scaled provider of services in this space. We often have to go and we have to be agile. We have to move in terms of where we do these trials. We do them in Asia. We do them in South America. We do them in Central East Europe, and sometimes even more esoteric and exotic locations as well when you're looking for patients with a rare disease or a particular indication. It's important that you're able to move around the world and do that with your own resources very effectively.
Many of our smaller competitors subcontract with others, but that introduces a level of complexity and a level of challenge that certainly our customers are not always keen to endure. We do have a singular focus in the clinical space. We're focused phase I to phase IV. We believe that's a source of comparative advantage to us. Some of our competitors go well beyond that into data into other parts of the pharma services business, either diagnostics, equipment, machines, etc., etc. We focus in the clinical space. We're the largest scaled provider in that space, as I said, around phase I to IV. We are able, as a large provider of functional FSP models and full-service models, we're also able to provide the blended models. Increasingly, customers, particularly large pharma, are looking for a blended model.
There's no one who actually does purely FSP or purely FSO, unless you're a biotech, of course. Particularly in the large pharma or the mid-sized space, it tends to be a blend of services and a blend of functions. That's an area that we're able to accommodate our customers and go where they want to go very effectively. We have a site and a patient network. That's something we've invested in significantly over the last few years. We continue to look for opportunities in that space. Again, integrating our services, making it more controllable. Bringing recruitment or giving us more influence over recruitment of clinical trials. Recruitment being the area that is most influenceable, if you like, in terms of shortening the time to do a clinical trial.
Often you're looking at a year, two years, even three years to recruit some of these trials, particularly when you're looking for large numbers of more rare disease patients. If we can do that more effectively and in a faster time frame through our network of sites, it gives us a competitive advantage. We also have a broad and vast expertise around the complex clinical trials. Clinical trials have become much more complex over the last probably 10 years as we've gone into cell and gene therapy, as we've gone into some of these rare diseases. Oncology is almost every oncology study is almost a rare disease study these days. You rarely do just a straight third-line non-small cell anymore. You're looking for subtypes. You're looking for genomic types. It's always important to be able to find those patients and have expertise in those particular areas.
Of course, finally, we also have integrated technology and a decentralized solution. The talk of decentralized clinical trials, not so much in the last year or so, but certainly in the last, we are seeing more and more components of our clinical trials being more decentralized. An opportunity for us, again, to be more efficient for our customers. We have a platform that integrates a number of our services, be it our home care, be it our site network, be it our monitoring, the way we do risk-based monitoring, our imaging, all of those sorts of areas. Our FIRECREST facility, which is a site portal that we have sites get trained on and get information through. There are a number of things that our decentralized platform brings to a clinical trial that allow us to be more effective and certainly more efficient.
I think the other thing that's perhaps not there as a competitive strength, but is an output of those competitive strengths, is those partnerships in the large pharma space. We have, as I say, 17 of the top 20 in preferred partnerships. We're increasingly moving that now to some of the mid-sized companies, companies who commit us a spend or commit a spend to two or three. Sometimes it's one. That tends to be more rare. It's certainly two, three, occasionally four providers. As one of the top-tier providers, we're always in the conversation when those sorts of partnerships come up.
In terms of our innovation and some of the applications and systems that we've been bringing to the market or bringing to our customers, really over the last few years, and some of these you'll already be aware of, those of you who follow ICON, our One Search facility helps us to identify the right sites. We generally recruit patients through sites. It's rare that we go directly to patients. Getting the right site and the right investigator into the trial is critically important. You do not want to have sites that do not recruit patients. It's a resource-intensive thing, bringing a site to a point where they can recruit patients into a trial. There is a lot of documents to collect. There is a lot of approvals to get. You do not want to waste that money. You do not want to waste that time.
Typically, in the industry, 30%-40% of sites do not recruit a patient. Or sometimes it is even worse if they recruit one patient because you have got to go out there and monitor that one patient and spend money doing that. It tends to be very inefficient. Where we can find the right sites and we can get sites that recruit multiple patients into those clinical trials, we become a much more efficient deliverer of that clinical trial for our customers. Our One Search tool, through data, through vast amounts of data, through our CTMS, our clinical trial management system, through our lab, through Citeline, through a number of external sources, allows us to identify the right sites and the sites that will contribute well to the clinical trial that we are contemplating doing.
Our Cassandra system, which helps us to predict post-marketing commitments based on FDA, EMA, Japanese authorities, what trials that our customers will need to do as they move to marketing, again, helping our real-world business. Tokenization is an area where we're able to follow a patient, tokenize a patient, and follow a patient through accessing real-world data. That's particularly important as we go back to some of these larger scale trials, these obesity trials where we're recruiting thousands of patients for vaccine trials, where we're recruiting thousands of patients and you need a flawless safety profile. The only way to do that is to follow those patients on a long-term basis over a number of years, even after the trial's finished. We can do that again in a very cost-effective manner, albeit fairly high-level basic data, but that's all you need once you get regulatory approval.
The regulatory authorities are looking for this sort of data going forward, particularly with these large-scale obesity-type compounds and vaccines where large amounts of patients and large proportions of the population are taking them. ICONex helps us to identify key opinion leaders. Again, an important part of commercialization of the drugs as they get to market. Our digital platform, I have mentioned, that's how we do decentralized clinical trials. More recently, SmartDraft has helped us to contract more effectively with sites and bring sites up to a point where they can recruit patients more speedily, more efficiently. Typically, it can take 6-12 months to go from identifying a site to a point where they can actually recruit patients with all the documentation and approvals that need to be collected. SmartDraft, one of the rate-limiting steps, is contracting with those sites.
The contracts that you put in place, which include the budgets, are rate-limiting. We use AI now to help us look at what we've done before with that particular site. Of course, we work with these sites for multiple customers in multiple trials, and we know what they will accept. We know what we'll work with them. We are able to bring that to our customers much more speedily as we take those discussions forward. We can say to a customer, "Listen, you can discuss and negotiate for six months, or you can go straight to what we know this site has already accepted, and it can be done in a month." There is a potential, of course, up to the customers to what they want to accept.
We have the potential to significantly reduce the amount of time to get that site to a point where they can recruit patients. I submit around our trial master file. As you run clinical trials, you collect vast amounts of documentation. That all needs to be put into files, typically digitally these days in electronic files. We have a trial master file. The submission of those or putting those documents, whether they be CVs, whether they be approvals, whether they be data into a trial file, allows us to be able to do that on an easy basis. Again, we've been able to save a significant amount of time and resource using our iSubmit tool. We're typically doing up to, we're planning for up to 5 million hours in robotic-type work. It's not all AI, but it is robotic-type work.
We're very practical in the way we apply those applications and those systems. We've been able to save, I believe it's getting towards $80 million-$100 million in our SD&A costs through our robotics and through our RPI. We believe there's further opportunity in that as we go forward. It's just another way we're able to continue to look at our costs. The challenges that we're looking at really are around key industry challenges. That, as I said, relates to recruitment of patients, recruitment in a way that's effective and efficient, and looking at sites that fail to recruit patients. I talked about our One Search tool and the way that's been implemented now over a number of years and in terms of ability to meet our planned enrollment challenges. Typically, in the industry, about 40% of trials don't meet their enrollment timelines.
We have been able to bring that down significantly, as you can see there, through the use of One Search, through the use of our Accellacare site network. We do believe our execution and delivery is on track and is a competitive advantage for us. It is something that we emphasize significantly around our company. We have been able to get sites up at about 10% faster. We have 33% fewer non-recruiting sites. We are in the teens on non-recruiting sites, whereas the industry is well north of that in the high 20s or even 30%, depending upon therapeutic area, etc., etc. In terms of trials completed on time, we believe we are also ahead of the industry average. The technology and the innovation that we have put in place has been able to practically and tangibly improve our execution and delivery.
That is particularly important for us, I think, for customers who are always looking for value, particularly in these somewhat challenging and tough times. What are we focused on through what we have called a transition year, 2025? Of course, as you are all aware, the market has a number of challenges. The LOEs, with respect to large pharma, particularly $200 billion-$300 billion in loss of exclusivity over the next five years or so. They are looking very hard at what they are doing in that space now. Biotech funding, as I have mentioned, although it was up last year, has had a fairly lukewarm start to this year. Even the results I have seen for May, again, not as strong as we would like. There are still some challenges. Some challenges remain in terms of funding. There are 700-ish public biotech companies.
There are some challenges, I think, there with the funding and with the public markets almost non-existent at the moment for them. They do have some challenges. That is showing up with our business in terms of the speed of decision-making and the amount of money that they have and they are able to allocate to their trials. The market dynamics are challenging. We have seen elevated cancellations. That will likely continue, certainly for the second quarter and into the year. I think as we get into next year, we will start to see that settle down. I think there is still a period of time where we are working through some of those elevated cancellations and cautious customer behavior, which we have seen certainly over the last 6- 12 months or so. We have a good track record of executing on cost management.
We've been able to maintain our margins pretty well, certainly over the last couple of quarters, given the shortfall in the revenue. We actively look at our costs on a very regular basis. We have a good track record of that over not just the last year or so, but over the last 15 or 20 years. It's something that we do. It's part of our DNA. We manage that very effectively. I think we're able to maintain our margins. We've shown an ability to do that. We do think we're capturing opportunity. There's progress across our customer groups. Our large pharma win rate has been very strong. The opportunities in our biotech space have been increasing, albeit they're not always opportunities that move then forward to awards and then revenue. There's an element of budget requests, I think, in some of those biotech ones.
The quality of those RFPs is not quite where we'd like it to be. We do believe that'll come back over the more medium term. We do believe we're capturing market share. It's a little bit hard to tell in sort of this challenging, somewhat volatile time. As an organization that's delivering and executing, as I showed you with those slides, we're getting good feedback from customers in terms of our engagement scores and our ability to deliver for them in an effective manner. Of course, we have a very strong balance sheet. We've paid down our debt from our acquisition of PRA Health Sciences four years ago. We're at about 1.7 adjusted EBITDA to debt. That gives us a strong balance sheet and ability to deploy that. We're focusing that in the relatively short term or medium term, I suppose, on share buybacks.
We did $250 million in the first quarter. We're aiming to do a similar number in this quarter. We are an Irish company. That means we have some restrictions as to how much we can spend in the share buyback area. It really comes down to free cash flow. Our free cash flow is strong. We are looking to continue to spend at about a similar level to what we did in the first quarter as we continue to go ahead. We believe our share price and our value is unprecedented at the moment. Certainly, we're continuing on that front. We also are looking in the M&A market because we do believe with our balance sheet so strongly, we believe there are opportunities out there, particularly in this somewhat challenged environment.
There are a number of areas that we're looking at in terms of patient recruitment, in terms of site networks. Our lab, I would like to be larger and to be a larger part of the landscape. Even in the real-world evidence, I think we're seeing some evidence that the regulatory authorities, particularly FDA, are shifting towards post-approval commitments. I think the real-world evidence market is also set to, on a long-term basis, grow as well. There are opportunities there. We look at that. Right at the moment, share buybacks do take precedence. With that, I'll finish. I think we'll have the question and answer in the Adler room, Max. Thank you very much.
All right. Thanks, everyone, for joining again. We're doing the breakout in the Adler on the second floor. So we'll see everybody up there in about 10-15 minutes. Thank you.