{"entity":{"id":"idea-reg-annuity-payment-durable-therapies","kind":"idea","name":"Pay for one-time curative therapies as an annuity that stops at relapse","aka":[],"tldr":"A single cell therapy can cost more than a house. Paying in yearly instalments, only while the patient stays well, spreads the cost and shares the risk.","summary":"Single-administration therapies with durable but uncertain benefit strain annual budgets and shift all risk of relapse to the payer. Annuity or performance-linked instalment models have been implemented for gene therapies for rare diseases in the US and Europe (for example for spinal muscular atrophy and haemophilia), with payments contingent on continued response. The proposal is to make annuity contracts standard for oncology cell therapies with curative intent: a fixed payment at infusion covering manufacturing, then annual payments for up to five years while the patient remains in remission, adjudicated through the treatment registry.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Prices and value): Prasad, De Jesús & Mailankody, The high price of anticancer drugs: origins, implications, barriers, solutions (Nat Rev Clin Oncol 2017)","url":"https://doi.org/10.1038/nrclinonc.2017.31"}],"tags":[],"related":["idea-reg-cart-outcomes-refund"],"cancers":[],"sections":[],"technologies":["car-t"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-drug-pricing","b-manufacturing-cell-therapy"],"keyPapers":["paper-prasad-nat-rev-clin-oncol"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Annuity contracts increase the number of centres and payers offering CAR-T (especially smaller insurers and middle-income systems) and reduce payer spend on patients who relapse early by more than 50%.","rationale":"Aligning cash flows with realised benefit removes both the budget-impact barrier and the risk barrier that keep durable therapies out of many systems; registries make remission status verifiable at low cost.","test":"Pilot annuity contracts for CAR-T in lymphoma with two payers and one or two manufacturers for three years; compare uptake and spend per durable remission with fixed-price contracts.","maturity":"early-clinical","actor":"payer","cost":"small","horizonYears":3},"route":"/ideas/idea-reg-annuity-payment-durable-therapies/","neighbours":{"idea":[{"id":"idea-reg-cart-outcomes-refund","kind":"idea","name":"Full refund for CAR-T if the patient has not responded at three months","route":"/ideas/idea-reg-cart-outcomes-refund/"}],"technology":[{"id":"car-t","kind":"technology","name":"CAR-T cell therapy","route":"/technologies/car-t/"}],"bottleneck":[{"id":"b-manufacturing-cell-therapy","kind":"bottleneck","name":"Manufacturing cost and time for living and radioactive medicines","route":"/bottlenecks/b-manufacturing-cell-therapy/"},{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"}],"paper":[{"id":"paper-prasad-nat-rev-clin-oncol","kind":"paper","name":"The high price of anticancer drugs: origins, implications, barriers, solutions","route":"/key-papers/paper-prasad-nat-rev-clin-oncol/"}]}}