OnCo
ideasIdea

A Health Impact Fund pilot that pays for measured health gain instead of price

Companies could choose to sell a new cancer drug at cost worldwide and instead be paid from a pooled fund according to how much health it actually delivers.

The Health Impact Fund proposal: an optional, government-financed pool that pays registered products annually for ten years in proportion to their measured health impact (quality-adjusted life years gained across all countries), on condition that the product is sold at the cost of manufacture everywhere. For oncology this rewards drugs that deliver large gains to many patients, including in low-income countries, rather than drugs that extract high prices from few. An oncology-only pilot with a few billion dollars and two or three products would test measurement feasibility and industry appetite.

Hypothesis
In a pilot, at least two oncology products register, health impact can be measured with acceptable uncertainty using registry and sales data, and registered products reach patients in low- and middle-income countries at volumes an order of magnitude above comparable priced products.
Rationale
The proposal has been developed in detail by economists and philosophers over fifteen years and is endorsed by several Nobel laureates; the pieces (impact measurement, cost-of-goods auditing, tiered access) exist separately. Oncology has strong outcome data and stark access inequalities, making it a fair test.
What would test it
A government-philanthropy consortium funds a five-year pilot with a small number of products and pre-registered impact measurement methodology; success is completed measurement, access volumes and industry willingness to register further products.
Maturity
speculative
Who has to act
policy
Cost to try
Large (over $50M)
Years to first evidence
6
Bottlenecks it attacks

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