{"entity":{"id":"idea-reg-repurposing-social-impact-bond","kind":"idea","name":"A social impact bond: investors fund a repurposing trial, payers repay from savings","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (No incentive to repurpose cheap drugs): Pantziarka et al., The Repurposing Drugs in Oncology (ReDO) Project (ecancer 2014)","url":"https://doi.org/10.3332/ecancer.2014.442"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-generic-repurposing","b-funding-allocation"],"keyPapers":["paper-pantziarka-ecancermedicalscience"],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"medium","horizonYears":5},"route":"/ideas/idea-reg-repurposing-social-impact-bond/","neighbours":{"bottleneck":[{"id":"b-funding-allocation","kind":"bottleneck","name":"Funding follows fashion, not burden","route":"/bottlenecks/b-funding-allocation/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"}],"paper":[{"id":"paper-pantziarka-ecancermedicalscience","kind":"paper","name":"The Repurposing Drugs in Oncology (ReDO) Project","route":"/key-papers/paper-pantziarka-ecancermedicalscience/"}]}}