# A social impact bond: investors fund a repurposing trial, payers repay from savings

Source: https://onco.cc/ideas/idea-reg-repurposing-social-impact-bond/  
OnCo record `idea-reg-repurposing-social-impact-bond` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

If a cheap old drug could replace or reduce an expensive cancer treatment, health systems save money. Investors could fund the trial and be repaid from those savings if it works.

## Summary

Some repurposing questions have direct payer savings attached: a generic that reduces relapse (fewer expensive second-line treatments), replaces a costly supportive drug, or allows de-escalation. The proposal is a development impact bond in which investors fund the trial, an independent evaluator verifies the result and the projected savings, and one or more payers repay investors with a return only if the trial is positive and the intervention is adopted. Outcome-based bonds have funded health interventions in India and the UK; none has funded a cancer trial.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: At least one repurposing trial is financed through a bond within three years, and the structure delivers a positive return to investors in the event of a positive result while costing payers less than 10% of the verified savings.
- Rationale: The bond converts a payer's future savings into present trial funding without the payer bearing the risk of a negative result, matching the incentive of the party that benefits with the cost of generating the evidence.
- Proposed test: Identify three candidate trials with quantifiable payer savings, structure one bond with a national payer and impact investors, and run the trial with pre-registered adjudication.
- Maturity: speculative
- Actor: payer

## Sources

- Bottleneck evidence (No incentive to repurpose cheap drugs): Pantziarka et al., The Repurposing Drugs in Oncology (ReDO) Project (ecancer 2014): https://doi.org/10.3332/ecancer.2014.442

## Connected records

- bottlenecks: [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/), [No incentive to repurpose cheap drugs](https://onco.cc/bottlenecks/b-generic-repurposing/)
- key papers: [The Repurposing Drugs in Oncology (ReDO) Project](https://onco.cc/key-papers/paper-pantziarka-ecancermedicalscience/)

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