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Financial research concept

Contract Research Book-to-Bill Ratio

compares new clinical-research bookings with current revenue, indicating whether newly won work is replenishing the revenue being recognized.

By Lee BaileyPublished Sep 28, 2026
Research context

See what supports this page, how current it is, and where comparable or historical context is available.

Research date
Sep 28, 2026Use the dated article and cited sources for the definition, examples, and stated limitations.
Operating-model context
10 connected conceptsPart of the reviewed Contract Research Organization Economics; issuer definitions remain distinct where disclosed.
Company examples
3 reviewed companiesRelationships reflect supported examples, not a normalized cross-company KPI ranking.
  1. Above 1x means bookings exceeded current revenue, not that backlog must rise by the same amount
  2. Pass-through activity can distort the comparison
  3. Part of the Contract Research Organization Economics
  4. See It in Company Research
  5. Continue Research

A contract research book-to-bill ratio compares new business booked during a period with revenue recognized during that period.

Medpace explicitly calculates net book-to-bill as net new business awards divided by revenue. In the second quarter of 2026, Medpace reported 1.13x, IQVIA reported 1.22x, and ICON reported 1.51x.

Above 1x means bookings exceeded current revenue, not that backlog must rise by the same amount

A ratio above 1x is generally consistent with demand replenishing the revenue base, but business cancellations, foreign exchange, scope changes, and backlog conversion all affect the closing backlog balance.

The timing basis also matters. IQVIA publishes quarterly and trailing-twelve-month book-to-bill. A single quarter can be noisy because a handful of large awards or cancellations may move the numerator sharply.

Pass-through activity can distort the comparison

ICON's second-quarter 2026 net book-to-bill was 1.51x, but management also highlighted a 1.2x direct-fee book-to-bill because net bookings and revenue benefited from higher pass-through activity.

That is a useful warning against assuming every reported ratio measures the same economic demand. Read the numerator beside reimbursed expenses and revenue excluding reimbursed expenses when pass-through intensity changes.

Primary sources: Medpace second-quarter 2026 results, IQVIA second-quarter 2026 results, and ICON second-quarter 2026 results.

Part of the Contract Research Organization Economics

Connect clinical-research awards, cancellations, book-to-bill, backlog policy and conversion, near-term revenue visibility, and reimbursed pass-through activity across contract research organizations.

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Where this concept fits
  • Awards, cancellations, and demand coverageCurrent relationship
    Net new awards or bookings incorporate cancellations, while book-to-bill compares that net commercial inflow with current revenue. Together they show whether newly won work is replenishing the revenue base without treating gross wins as guaranteed future revenue.
    CRO Book-to-BillCurrent conceptCRO CancellationsCRO Net New Awards
  • Backlog quality, timing, and conversion
    Backlog captures expected contracted work, inclusion policy defines which work qualifies, RPO preserves a separate accounting boundary, next-twelve-month backlog shows near-term timing, and backlog conversion indicates how quickly the booked work becomes revenue.
    CRO BacklogCRO Backlog ConversionCRO Backlog PolicyCRO Backlog vs. RPOCRO NTM Backlog
  • Pass-through costs and underlying service growth
    Reimbursed expenses can materially change reported clinical-research revenue and costs without adding equivalent service economics, so revenue excluding reimbursed expenses helps isolate the underlying service-growth read.
    CRO Reimbursed ExpensesCRO Revenue ex Reimbursements

See It in Company Research

These companies are examples of how the concept is reported or discussed in public filings. Definitions can differ by issuer; these links open company research rather than a normalized metric comparison.

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Compare CRO demand coverage

Compare bookings relative to revenue while preserving net-versus-direct-fee definitions, pass-through intensity, and quarterly versus trailing periods.

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