OnCo
ideasIdea

A survivorship research endowment funded by a levy on curative therapy prices

Tens of millions of people live after cancer with heart damage, infertility and second cancers. A tiny levy on the price of curative treatments would build a permanent fund to study and treat late effects.

Health systems and payers negotiate a 0.5% levy on reimbursed prices of curative-intent oncology drugs and radiotherapy into an independent endowment for late-effects research and survivorship services: long-term cohort follow-up, cardio-oncology and fertility-preservation trials, second-cancer surveillance and return-to-work interventions. The logic is that the cost of cure includes the cost of living with its consequences, and that no manufacturer has an incentive to fund it.

Hypothesis
An endowment of this kind funds long-term cohort follow-up for more than 80% of paediatric and young-adult survivors in its jurisdiction within five years and produces at least three practice-changing late-effects interventions within ten.
Rationale
Earmarked levies have built sustainable research funds elsewhere: France's tobacco tax allocation, the US vaccine injury compensation excise tax, and blood-product and pharmaceutical sector levies in several European countries. Survivorship research currently competes poorly in general peer review because it lacks novelty appeal.
What would test it
Model the levy yield against reimbursed spend in one country, then negotiate a three-year pilot with one national payer and one manufacturer group, tracking funded cohort coverage and cost.
Maturity
speculative
Who has to act
payer
Cost to try
Large (over $50M)
Years to first evidence
5
Bottlenecks it attacks

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