In the UK, a significant amount of medical research funding – an estimated £2.9 billion in 2012/13 – comes from the public purse through taxes and charitable donations, or from the Wellcome Trust, so it is important to see whether the resultant health benefits justify this spending. However, conclusively proving that funding medical research benefits society financially is incredibly difficult.
In 2008, the Health Economics Research Group, Office of Health Economics and RAND Europe published the results of a study investigating the financial benefits of investing in cardiovascular disease research, and in mental health research in the UK. This study found that the rate of return was 9% for cardiovascular disease and 7% for mental health, meaning that for each £1 spent on cardiovascular or mental health research, benefits to health costs – for example cheaper treatment, or more effective disease prevention so services were ultimately used less – were 9p and 7p every year in perpetuity respectively. These were both at least double the UK government’s minimum recommended threshold of 3.5%, indicating that the government should view investment in these areas positively.
Building on the methodologies developed for the 2008 study, Glover et al. (2014) investigated the economic value of investing in cancer research. This study was funded by the Wellcome Trust, Cancer Research UK, the National Institute for Health Research, and the Academy of Medical Sciences.
Using data from the National Cancer Research Institute (NCRI) Cancer Research Database, they found that 10 funders, including the Medical Research Council and the Wellcome Trust, accounted for over 95% of the research conducted at the NCRI between 2002 and 2011. Funding data covering the 30 year period between 1970 and 2009 were compiled for these 10 funders, and showed that in this time together they had spent roughly £15 billion (adjusted to 2011/2012 prices) on all cancer-related research activity.
Next the authors determined which cancer interventions had yielded the greatest difference to health outcomes in the last 20 years. They found the seven major interventions were smoking cessation/ prevention programmes; breast, cervical and bowel cancer screening programmes; and improved breast, prostate and colorectal cancer treatments. In particular, anti-smoking schemes provided 65% of the net monetary benefit seen in this time, making it the most effective cancer intervention analysed.
In order to determine what contribution UK research had to these interventions, the authors analysed the citations used in 31 clinical guidelines commonly used in the UK, and assessed which citations resulted from UK funding. The proportion of financial health gains due to UK-funded research was found to average 17%. However, this analysis does not take into government schemes, such as awareness campaigns or anti-smoking messages on cigarette packages.
The net monetary benefit (NMB) of the seven interventions was sensitive to the quality-adjusted life year (QALY) value. When the QALY was set at £25,000, all seven interventions were found to show a NMB. However, when the QALY were reduced to £20,000, prostate and colorectal cancer treatments, and breast cancer screening did not yield financial gains on investment. This indicates that the financial gains of these interventions are more marginal, and also illustrates the sensitivity of the analysis.
The overall rate of return for UK government and charitable investment in cancer research was estimated to be 10.1%. However, the average time elapsed between investment and patient benefit was 15 years, meaning that investment in cancer research is a long term one.
This study focusses on common cancers and lifestyle factors, such as breast cancer and smoking. However, research on rare diseases can yield benefits for both rare and common diseases. Rare diseases are often more extreme forms of common disorders, and usually have a more straightforward aetiology, making them easier to investigate than their common counterparts. Research on the rare disease hypercholesterolemia led to the development of statins, which are now commonly prescribed in the UK for high cholesterol, and provide sales revenues worth billions of dollars; and the rare disease alkaptonuria is a good model for osteoarthritis (Taylor et al., 2011), which affects 1 in 3 people over the age of 45. Additionally, rare diseases are often chronic and disabling, meaning that medical and social care can be costly, both to the patient and to the NHS.
Investment in cardiovascular, mental health and cancer research have all proven to have a positive rate of return on investment. Additionally, increased public investment in research often yields sufficient intellectual property or innovation to attract private investment, further increasing the health benefits gained from public investment (Haskel et al., 2014, a report for the Campaign for Science and Engineering).
Thus, increased spending on rare disease research may prove to be a wise investment for the UK government and charity sector, as developing treatments for rare diseases will not only benefit rare diseases patients themselves, but also has the potential to benefit the wider population with more common forms of those diseases.
- Glover M, Buxton M, Guthrie S, Hanney S, Pollitt A, & Grant J (2014). Estimating the returns to UK publicly funded cancer-related research in terms of the net value of improved health outcomes. BMC medicine, 12 PMID: 24930803
- Taylor AM, Boyde A, Wilson PJ, Jarvis JC, Davidson JS, Hunt JA, Ranganath LR, & Gallagher JA (2011). The role of calcified cartilage and subchondral bone in the initiation and progression of ochronotic arthropathy in alkaptonuria. Arthritis and rheumatism, 63 (12), 3887-96 PMID: 22127706