ideasIdea
Pay a prize for rare cancer drugs instead of hoping for a market
No company can profit from a drug for a cancer that affects a few hundred people. A guaranteed payment for success would change that calculation.
Rare and paediatric cancers lack markets, and existing incentives — orphan designation, priority review vouchers, the proposed transferable exclusivity vouchers — are criticised for poor targeting and high cost to payers. A directly funded prize or advance market commitment, paid on achieving a pre-specified clinical benefit in a named rare indication, targets the payment to the outcome and avoids distorting prices elsewhere.
Hypothesis
A pooled prize fund of a few hundred million dollars, with clearly specified indication targets and evidence thresholds, attracts at least five serious development programmes into rare cancers within five years, at lower total public cost than voucher schemes.
Rationale
Advance market commitments worked for pneumococcal vaccines, and prize mechanisms have produced results in other fields. Vouchers transfer cost opaquely to payers of unrelated drugs, whereas a prize is explicit and can be targeted at the exact unmet need.
What would test it
Model the cost of existing voucher schemes against an equivalent prize fund, then have one government or philanthropic consortium commit a single named prize for one rare indication and observe how many programmes enter.
Maturity
speculative
Who has to act
policy
Cost to try
Large (over $50M)
Years to first evidence
8
Bottlenecks it attacks
- Rare and paediatric cancers without markets · Taken together rare cancers are a fifth of all cancers, but each one alone is too small for a company to invest in.
- Incentives reward me-too drugs and marginal gains · The system pays the same for a drug that adds two months as for a cure, so companies race to copy rather than to cure.
- Funding follows fashion, not burden · Money goes to the cancers and questions that are easy or popular, not the ones that kill most or where a dollar would do most.