A social impact bond: investors fund a repurposing trial, payers repay from savings
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.
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.
- No incentive to repurpose cheap drugs · Old, cheap drugs with anti-cancer signals never get the trials they need because no one profits from the result.
- 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.
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