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市场调查报告书
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1477385

临床试验支援服务市场 - 全球产业规模、份额、趋势、机会和预测,按服务、赞助商、地区和竞争细分,2019-2029F

Clinical Trials Support Services Market - Global Industry Size, Share, Trends, Opportunity, and Forecast, Segmented By Service, By Sponsor, By Region and Competition, 2019-2029F

出版日期: | 出版商: TechSci Research | 英文 187 Pages | 商品交期: 2-3个工作天内

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简介目录

2023 年全球临床试验支援服务市场估值为 205.2 亿美元,预计到 2029 年预测期内将稳定成长,复合年增长率为 5.25%。 。然而,有效率且有效地进行这些试验需要大量的支援服务。全球临床试验支援服务市场透过提供一系列对试验成功至关重要的服务,在促进这些试验的顺利执行方面发挥关键作用。从患者招募到资料管理,这些服务对于确保临床研究的完整性和有效性至关重要。

市场概况
预测期 2025-2029
2023 年市场规模 205.2亿美元
2029 年市场规模 279.6亿美元
2024-2029 年复合年增长率 5.25%
成长最快的细分市场 临床试验现场管理
最大的市场 北美洲

慢性病的日益普及和对创新治疗的需求导致全球临床研究活动激增,推动了对支援服务的需求。电子资料采集 (EDC)、基于云端的解决方案和人工智慧 (AI) 等技术进步正在彻底改变临床试验操作、简化流程并提高效率。随着个人化医疗和标靶治疗的出现,临床试验变得更加复杂,需要专门的支援服务来完成生物标记分析、基因检测和方案设计等任务。监管机构提出的严格监管要求需要在整个临床试验过程中提供细緻的文件记录、品质保证和合规性,从而刺激了对监管支援服务的需求。

主要市场驱动因素

创新疗法的需求不断增加

临床试验的全球化

主要市场挑战

患者招募和保留

物流复杂性

主要市场趋势

技术进步

细分市场洞察

服务洞察

区域洞察

目录

第 1 章:产品概述

第 2 章:研究方法

第 3 章:执行摘要

第 4 章:客户之声

第 5 章:全球临床试验支援服务市场展望

  • 市场规模及预测
    • 按价值
  • 市占率及预测
    • 按服务(临床试验中心管理、病患招募管理(病患招募与登记服务、病患保留、其他)、资料管理、行政人员、IRB、其他)
    • 按赞助商(製药与生物製药、医疗器材、其他)
    • 按公司划分 (2023)
    • 按地区
  • 市场地图

第 6 章:北美临床试验支援服务市场展望

  • 市场规模及预测
    • 按价值
  • 市占率及预测
    • 按服务
    • 透过赞助商
    • 按国家/地区
  • 北美:国家分析
    • 美国
    • 墨西哥
    • 加拿大

第 7 章:欧洲临床试验支援服务市场展望

  • 市场规模及预测
    • 按价值
  • 市占率及预测
    • 按服务
    • 透过赞助商
    • 按国家/地区
  • 欧洲:国家分析
    • 法国
    • 德国
    • 英国
    • 义大利
    • 西班牙

第 8 章:亚太地区临床试验支援服务市场展望

  • 市场规模及预测
    • 按价值
  • 市占率及预测
    • 按服务
    • 透过赞助商
    • 按国家/地区
  • 亚太地区:国家分析
    • 中国
    • 印度
    • 韩国
    • 日本
    • 澳洲

第 9 章:南美洲临床试验支援服务市场展望

  • 市场规模及预测
    • 按价值
  • 市占率及预测
    • 按服务
    • 透过赞助商
    • 按国家/地区
  • 南美洲:国家分析
    • 巴西
    • 阿根廷
    • 哥伦比亚

第 10 章:中东和非洲临床试验支援服务市场展望

  • 市场规模及预测
    • 按价值
  • 市占率及预测
    • 按服务
    • 透过赞助商
    • 按国家/地区
  • MEA:国家分析
    • 南非
    • 沙乌地阿拉伯
    • 阿联酋

第 11 章:市场动态

  • 司机
  • 挑战

第 12 章:市场趋势与发展

  • 併购(如有)
  • 产品发布(如有)
  • 最近的发展

第 13 章:波特五力分析

  • 产业竞争
  • 新进入者的潜力
  • 供应商的力量
  • 客户的力量
  • 替代产品的威胁

第14章:竞争格局

  • Charles River Laboratories International, Inc.
  • Wuxi Apptec
  • IQVIA Inc.
  • Syneos Health
  • Eurofins Scientific
  • Ppd, Inc. (Thermo Fisher Scientific Inc.)
  • Icon Plc
  • Laboratory Corporation Of America Holdings
  • Parexel International (MA) Corporation

第 15 章:策略建议

第16章调查会社について・免责事项

简介目录
Product Code: 23961

Global Clinical Trials Support Services Market was valued at USD 20.52 Billion in 2023 and is anticipated to project steady growth in the forecast period with a CAGR of 5.25% through 2029. Clinical trials are at the heart of medical research, driving innovation and advancements in healthcare. However, conducting these trials efficiently and effectively requires a multitude of support services. The global clinical trials support services market plays a pivotal role in facilitating the smooth execution of these trials by providing a range of services essential for their success. From patient recruitment to data management, these services are critical in ensuring the integrity and validity of clinical research.

Market Overview
Forecast Period2025-2029
Market Size 2023USD 20.52 Billion
Market Size 2029USD 27.96 Billion
CAGR 2024-20295.25%
Fastest Growing SegmentClinical Trial Site Management
Largest MarketNorth America

The growing prevalence of chronic diseases and the need for innovative treatments have led to a surge in clinical research activities worldwide, driving the demand for support services. Technological advancements, such as electronic data capture (EDC), cloud-based solutions, and artificial intelligence (AI), are revolutionizing clinical trial operations, streamlining processes, and enhancing efficiency. With the emergence of personalized medicine and targeted therapies, clinical trials have become more complex, requiring specialized support services for tasks such as biomarker analysis, genetic testing, and protocol design. Stringent regulatory requirements imposed by regulatory authorities necessitate meticulous documentation, quality assurance, and compliance throughout the clinical trial process, fuelling the demand for regulatory support services.

Key Market Drivers

Increasing Demand for Innovative Therapies

In the fast-paced realm of healthcare, the demand for innovative therapies continues to surge as populations age, chronic diseases proliferate, and expectations for personalized treatments rise. This escalating demand is propelling the global clinical trials support services market to new heights. Clinical trials are the cornerstone of medical research, enabling the evaluation of new drugs, therapies, and medical devices. However, the complexity and regulatory requirements associated with conducting clinical trials necessitate specialized support services. As the quest for groundbreaking treatments intensifies, the importance of efficient and reliable clinical trial support services becomes paramount. Breakthroughs in genomics, molecular biology, and other fields are unveiling novel therapeutic targets and treatment modalities. This has led to a surge in the development of innovative therapies, including gene therapies, immunotherapies, and precision medicines, which require rigorous clinical testing.

The global burden of chronic diseases such as cancer, cardiovascular disorders, and neurological conditions is on the rise, creating an urgent need for effective treatments. Clinical trials play a crucial role in evaluating the safety and efficacy of new interventions to address these health challenges. Regulatory bodies worldwide are imposing stringent requirements for the approval of new drugs and medical devices to ensure patient safety and efficacy. Navigating the regulatory landscape necessitates expertise in compliance, documentation, and quality assurance, driving the demand for specialized support services. There is a growing emphasis on patient-centric healthcare, with stakeholders increasingly prioritizing patient engagement and feedback throughout the drug development process. This shift underscores the importance of patient recruitment, retention, and compliance in clinical trials, driving the need for tailored support services.

Pharmaceutical companies and contract research organizations (CROs) are increasingly conducting clinical trials in diverse geographic regions to access diverse patient populations, accelerate recruitment, and navigate regulatory challenges. This globalization trend necessitates comprehensive support services to ensure seamless trial execution across different jurisdictions.

Globalization of Clinical Trials

The global clinical trials support services market encompasses a wide range of services aimed at facilitating the planning, execution, and management of clinical trials. These services include clinical trial design, site selection, patient recruitment, regulatory compliance, data management, and quality assurance, among others. As the complexity and scale of clinical trials have increased, so too has the demand for specialized support services to ensure their successful implementation.

The primary driver of growth in the clinical trials support services market is the increasing globalization of clinical research. Pharmaceutical and biotechnology companies are expanding their reach beyond traditional markets to leverage diverse patient populations, access novel therapies, and navigate complex regulatory environments. This has led to a surge in demand for support services tailored to international trials, including language translation, cultural adaptation, and regulatory consulting. The adoption of advanced technologies such as electronic data capture (EDC), remote monitoring, and wearable devices has transformed the conduct of clinical trials. These technologies offer opportunities to streamline trial processes, enhance data quality, and improve patient engagement. As a result, there is a growing need for support services that can harness the potential of these technologies while ensuring compliance with regulatory standards and data security requirements. Modern clinical trials are becoming increasingly complex, involving multiple study sites, diverse patient populations, and intricate study protocols. Managing such complexity requires specialized expertise in areas such as project management, protocol design, and regulatory affairs. Clinical trials support services providers offer valuable insights and resources to help sponsors navigate these complexities and optimize trial outcomes. There is a growing emphasis on patient-centricity in clinical research, with stakeholders seeking to improve patient recruitment, retention, and engagement. Clinical trials support services play a crucial role in developing patient-centric strategies, including targeted recruitment campaigns, patient education materials, and remote monitoring solutions. By placing the needs and experiences of patients at the forefront, these services contribute to the success and sustainability of clinical trials.

Key Market Challenges

Patient Recruitment and Retention

Recruiting and retaining participants for clinical trials is a perennial challenge, particularly in the context of global trials. Cultural differences, language barriers, and socio-economic factors can influence patient participation rates, making it challenging to achieve the desired sample size within stipulated timelines. Additionally, ensuring diversity and representation among trial participants is crucial for producing generalizable results. Leveraging innovative recruitment strategies, such as digital outreach campaigns and community engagement initiatives, can help overcome these challenges and enhance patient recruitment and retention rates.

Logistical Complexities

Conducting global clinical trials involves intricate logistical arrangements, including sourcing investigational drugs, managing supply chains, and coordinating site operations across multiple geographies. Delays in logistics can disrupt trial timelines and escalate costs, underscoring the importance of robust supply chain management strategies. Furthermore, geopolitical tensions, natural disasters, and public health emergencies can pose unforeseen challenges, necessitating agile contingency planning to mitigate risks and ensure the continuity of clinical trial operations.

Key Market Trends

Technological Advancements

In recent years, the global healthcare landscape has been significantly influenced by technological advancements, leading to the transformation of various sectors within the industry. One such area experiencing a remarkable evolution is the realm of clinical trials support services. As innovation continues to surge, the demand for efficient and streamlined processes in clinical research has intensified, propelling the growth of the global market for clinical trials support services. The digitization of healthcare data has revolutionized the way clinical trials are conducted and managed. Advanced electronic data capture (EDC) systems, cloud-based platforms, and wearable devices have enabled real-time collection, analysis, and sharing of clinical data, enhancing efficiency and accuracy in trial processes. Moreover, technologies such as blockchain are being leveraged to ensure data integrity, transparency, and security throughout the trial lifecycle.

AI and ML technologies are revolutionizing various aspects of clinical trials, from patient recruitment and eligibility screening to predictive analytics and adverse event monitoring. These advanced analytics tools can sift through vast amounts of data to identify patterns, predict outcomes, and optimize trial protocols, ultimately expediting the drug development process and reducing costs.

The adoption of telemedicine platforms and remote monitoring devices has facilitated decentralized clinical trials (DCTs), allowing patients to participate in studies from the comfort of their homes. This approach not only improves patient recruitment and retention but also enhances the diversity and inclusivity of trial populations. Furthermore, remote monitoring tools enable real-time data collection and analysis, leading to more efficient and patient-centric trial management.

VR and AR technologies are increasingly being utilized to enhance patient engagement and compliance in clinical trials. By creating immersive and interactive experiences, these technologies can educate patients about trial procedures, simulate medical interventions, and alleviate anxiety during procedures or treatment. Additionally, VR and AR applications are being employed in training healthcare professionals and researchers, improving their skills and knowledge in clinical trial conduct.

Segmental Insights

Service Insights

Based on the category of service, Clinical Trial Site Management emerged as the dominant player in the global market for Clinical Trials Support Services in 2023 One of the primary drivers of the dominance of clinical trial site management is the need for efficient resource utilization. Sponsors and contract research organizations (CROs) are increasingly looking to streamline operations, reduce costs, and accelerate trial timelines. By outsourcing site management functions to specialized service providers, they can leverage expertise, infrastructure, and technology to optimize trial performance. Moreover, the expansion of clinical research globally has necessitated a more decentralized approach to trial management. With trials being conducted across diverse geographic regions and healthcare settings, effective site management becomes paramount for ensuring consistency, quality, and regulatory compliance across sites.

Regional Insights

North America emerged as the dominant region in the global Clinical Trials Support Services market in 2023, holding the largest market share in terms of value. North America boasts a sophisticated healthcare infrastructure comprising state-of-the-art research facilities, academic institutions, and specialized hospitals. This infrastructure provides the necessary framework for conducting clinical trials across various therapeutic areas. The region is at the forefront of technological innovation, with significant investments in healthcare IT, data analytics, and artificial intelligence. These technological advancements have revolutionized the conduct of clinical trials, enabling efficient data collection, analysis, and management.

Key Market Players

Charles River Laboratories International, Inc.

Wuxi Apptec

IQVIA Inc

Syneos Health

Eurofins Scientific

Ppd, Inc (Thermo Fisher Scientific Inc.)

ICON plc

Laboratory Corporation Of America Holdings

Parexel International (MA) Corporation

Report Scope:

In this report, the Global Clinical Trials Support Services Market has been segmented into the following categories, in addition to the industry trends which have also been detailed below:

Clinical Trials Support Services Market, By Service:

    Clinical Trial Site Management Patient Recruitment Management Data Management Administrative staff IRB Others

Clinical Trials Support Services Market, By Sponsor:

    Pharmaceutical & Biopharmaceutical Medical Devices Others

Clinical Trials Support Services Market, By Region:

    North America

United States

Canada

Mexico

    Europe

France

United Kingdom

Italy

Germany

Spain

    Asia-Pacific

China

India

Japan

Australia

South Korea

    South America

Brazil

Argentina

Colombia

    Middle East & Africa

South Africa

Saudi Arabia

UAE

Competitive Landscape

Company Profiles: Detailed analysis of the major companies presents in the Clinical Trials Support Services Market.

Available Customizations:

Global Clinical Trials Support Services market report with the given market data, Tech Sci Research offers customizations according to a company's specific needs. The following customization options are available for the report:

Company Information

Detailed analysis and profiling of additional market players (up to five).

Table of Contents

1. Product Overview

  • 1.1. Market Definition
  • 1.2. Scope of the Market
    • 1.2.1. Markets Covered
    • 1.2.2. Years Considered for Study
    • 1.2.3. Key Market Segmentations

2. Research Methodology

  • 2.1. Objective of the Study
  • 2.2. Baseline Methodology
  • 2.3. Key Industry Partners
  • 2.4. Major Association and Secondary Sources
  • 2.5. Forecasting Methodology
  • 2.6. Data Triangulation & Validation
  • 2.7. Assumptions and Limitations

3. Executive Summary

  • 3.1. Overview of the Market
  • 3.2. Overview of Key Market Segmentations
  • 3.3. Overview of Key Market Players
  • 3.4. Overview of Key Regions/Countries
  • 3.5. Overview of Market Drivers, Challenges, and Trends

4. Voice of Customer

5. Global Clinical Trials Support Services Market Outlook

  • 5.1. Market Size & Forecast
    • 5.1.1. By Value
  • 5.2. Market Share & Forecast
    • 5.2.1. By Service (Clinical Trial Site Management, Patient Recruitment Management( Patient recruitment & registry services, Patient retention, Others), Data Management, Administrative staff, IRB, Others)
    • 5.2.2. By Sponsor (Pharmaceutical & Biopharmaceutical, Medical Devices, Others)
    • 5.2.3. By Company (2023)
    • 5.2.4. By Region
  • 5.3. Market Map

6. North America Clinical Trials Support Services Market Outlook

  • 6.1. Market Size & Forecast
    • 6.1.1. By Value
  • 6.2. Market Share & Forecast
    • 6.2.1. By Service
    • 6.2.2. By Sponsor
    • 6.2.3. By Country
  • 6.3. North America: Country Analysis
    • 6.3.1. United States Clinical Trials Support Services Market Outlook
      • 6.3.1.1. Market Size & Forecast
        • 6.3.1.1.1. By Value
      • 6.3.1.2. Market Share & Forecast
        • 6.3.1.2.1. By Service
        • 6.3.1.2.2. By Sponsor
    • 6.3.2. Mexico Clinical Trials Support Services Market Outlook
      • 6.3.2.1. Market Size & Forecast
        • 6.3.2.1.1. By Value
      • 6.3.2.2. Market Share & Forecast
        • 6.3.2.2.1. By Service
        • 6.3.2.2.2. By Sponsor
    • 6.3.3. Canada Clinical Trials Support Services Market Outlook
      • 6.3.3.1. Market Size & Forecast
        • 6.3.3.1.1. By Value
      • 6.3.3.2. Market Share & Forecast
        • 6.3.3.2.1. By Service
        • 6.3.3.2.2. By Sponsor

7. Europe Clinical Trials Support Services Market Outlook

  • 7.1. Market Size & Forecast
    • 7.1.1. By Value
  • 7.2. Market Share & Forecast
    • 7.2.1. By Service
    • 7.2.2. By Sponsor
    • 7.2.3. By Country
  • 7.3. Europe: Country Analysis
    • 7.3.1. France Clinical Trials Support Services Market Outlook
      • 7.3.1.1. Market Size & Forecast
        • 7.3.1.1.1. By Value
      • 7.3.1.2. Market Share & Forecast
        • 7.3.1.2.1. By Service
        • 7.3.1.2.2. By Sponsor
    • 7.3.2. Germany Clinical Trials Support Services Market Outlook
      • 7.3.2.1. Market Size & Forecast
        • 7.3.2.1.1. By Value
      • 7.3.2.2. Market Share & Forecast
        • 7.3.2.2.1. By Service
        • 7.3.2.2.2. By Sponsor
    • 7.3.3. United Kingdom Clinical Trials Support Services Market Outlook
      • 7.3.3.1. Market Size & Forecast
        • 7.3.3.1.1. By Value
      • 7.3.3.2. Market Share & Forecast
        • 7.3.3.2.1. By Service
        • 7.3.3.2.2. By Sponsor
    • 7.3.4. Italy Clinical Trials Support Services Market Outlook
      • 7.3.4.1. Market Size & Forecast
        • 7.3.4.1.1. By Value
      • 7.3.4.2. Market Share & Forecast
        • 7.3.4.2.1. By Service
        • 7.3.4.2.2. By Sponsor
    • 7.3.5. Spain Clinical Trials Support Services Market Outlook
      • 7.3.5.1. Market Size & Forecast
        • 7.3.5.1.1. By Value
      • 7.3.5.2. Market Share & Forecast
        • 7.3.5.2.1. By Service
        • 7.3.5.2.2. By Sponsor

8. Asia-Pacific Clinical Trials Support Services Market Outlook

  • 8.1. Market Size & Forecast
    • 8.1.1. By Value
  • 8.2. Market Share & Forecast
    • 8.2.1. By Service
    • 8.2.2. By Sponsor
    • 8.2.3. By Country
  • 8.3. Asia-Pacific: Country Analysis
    • 8.3.1. China Clinical Trials Support Services Market Outlook
      • 8.3.1.1. Market Size & Forecast
        • 8.3.1.1.1. By Value
      • 8.3.1.2. Market Share & Forecast
        • 8.3.1.2.1. By Service
        • 8.3.1.2.2. By Sponsor
    • 8.3.2. India Clinical Trials Support Services Market Outlook
      • 8.3.2.1. Market Size & Forecast
        • 8.3.2.1.1. By Value
      • 8.3.2.2. Market Share & Forecast
        • 8.3.2.2.1. By Service
        • 8.3.2.2.2. By Sponsor
    • 8.3.3. South Korea Clinical Trials Support Services Market Outlook
      • 8.3.3.1. Market Size & Forecast
        • 8.3.3.1.1. By Value
      • 8.3.3.2. Market Share & Forecast
        • 8.3.3.2.1. By Service
        • 8.3.3.2.2. By Sponsor
    • 8.3.4. Japan Clinical Trials Support Services Market Outlook
      • 8.3.4.1. Market Size & Forecast
        • 8.3.4.1.1. By Value
      • 8.3.4.2. Market Share & Forecast
        • 8.3.4.2.1. By Service
        • 8.3.4.2.2. By Sponsor
    • 8.3.5. Australia Clinical Trials Support Services Market Outlook
      • 8.3.5.1. Market Size & Forecast
        • 8.3.5.1.1. By Value
      • 8.3.5.2. Market Share & Forecast
        • 8.3.5.2.1. By Service
        • 8.3.5.2.2. By Sponsor

9. South America Clinical Trials Support Services Market Outlook

  • 9.1. Market Size & Forecast
    • 9.1.1. By Value
  • 9.2. Market Share & Forecast
    • 9.2.1. By Service
    • 9.2.2. By Sponsor
    • 9.2.3. By Country
  • 9.3. South America: Country Analysis
    • 9.3.1. Brazil Clinical Trials Support Services Market Outlook
      • 9.3.1.1. Market Size & Forecast
        • 9.3.1.1.1. By Value
      • 9.3.1.2. Market Share & Forecast
        • 9.3.1.2.1. By Service
        • 9.3.1.2.2. By Sponsor
    • 9.3.2. Argentina Clinical Trials Support Services Market Outlook
      • 9.3.2.1. Market Size & Forecast
        • 9.3.2.1.1. By Value
      • 9.3.2.2. Market Share & Forecast
        • 9.3.2.2.1. By Service
        • 9.3.2.2.2. By Sponsor
    • 9.3.3. Colombia Clinical Trials Support Services Market Outlook
      • 9.3.3.1. Market Size & Forecast
        • 9.3.3.1.1. By Value
      • 9.3.3.2. Market Share & Forecast
        • 9.3.3.2.1. By Service
        • 9.3.3.2.2. By Sponsor

10. Middle East and Africa Clinical Trials Support Services Market Outlook

  • 10.1. Market Size & Forecast
    • 10.1.1. By Value
  • 10.2. Market Share & Forecast
    • 10.2.1. By Service
    • 10.2.2. By Sponsor
    • 10.2.3. By Country
  • 10.3. MEA: Country Analysis
    • 10.3.1. South Africa Clinical Trials Support Services Market Outlook
      • 10.3.1.1. Market Size & Forecast
        • 10.3.1.1.1. By Value
      • 10.3.1.2. Market Share & Forecast
        • 10.3.1.2.1. By Service
        • 10.3.1.2.2. By Sponsor
    • 10.3.2. Saudi Arabia Clinical Trials Support Services Market Outlook
      • 10.3.2.1. Market Size & Forecast
        • 10.3.2.1.1. By Value
      • 10.3.2.2. Market Share & Forecast
        • 10.3.2.2.1. By Service
        • 10.3.2.2.2. By Sponsor
    • 10.3.3. UAE Clinical Trials Support Services Market Outlook
      • 10.3.3.1. Market Size & Forecast
        • 10.3.3.1.1. By Value
      • 10.3.3.2. Market Share & Forecast
        • 10.3.3.2.1. By Service
        • 10.3.3.2.2. By Sponsor

11. Market Dynamics

  • 11.1. Drivers
  • 11.2. Challenges

12. Market Trends & Developments

  • 12.1. Merger & Acquisition (If Any)
  • 12.2. Product Launches (If Any)
  • 12.3. Recent Developments

13. Porters Five Forces Analysis

  • 13.1. Competition in the Industry
  • 13.2. Potential of New Entrants
  • 13.3. Power of Suppliers
  • 13.4. Power of Customers
  • 13.5. Threat of Substitute Products

14. Competitive Landscape

  • 14.1. Charles River Laboratories International, Inc.
    • 14.1.1. Business Overview
    • 14.1.2. Company Snapshot
    • 14.1.3. Products & Services
    • 14.1.4. Financials (As Reported)
    • 14.1.5. Recent Developments
    • 14.1.6. Key Personnel Details
    • 14.1.7. SWOT Analysis
  • 14.2. Wuxi Apptec
  • 14.3. IQVIA Inc.
  • 14.4. Syneos Health
  • 14.5. Eurofins Scientific
  • 14.6. Ppd, Inc. (Thermo Fisher Scientific Inc.)
  • 14.7. Icon Plc
  • 14.8. Laboratory Corporation Of America Holdings
  • 14.9. Parexel International (MA) Corporation

15. Strategic Recommendations

16. About Us & Disclaimer