Pay for one-time curative therapies as an annuity that stops at relapse

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.