title: Choosing the right incentive strategy for research and development in neglected diseases.
abstract: For the first time in history, worldwide neglected disease budgets may be large enough to deliver a new drug every few years. That said, sponsors will only succeed if they extract maximum value from every dollar spent. This paper reviews possible cost-containment strategies and provides an evidence-based framework for choosing between them. Current proposals can be categorized as "end-to-end" proposals which require the sponsor to set a single reward for companies that complete the entire drug discovery process or "pay-as-you-go" schemes in which sponsors offer repeated rewards as drug candidates progress through the pipeline. A generic weakness of end-to-end proposals is that rewards are likely to be 20-30% higher than they would be in an equivalent pay-as-you-go programme. However, the benefits of pay-as-you-go programmes may be lost if commercial pharmaceutical companies are substantially better at choosing successful programmes than are their non-profit counterparts. The efficiency of pay-as-you-go methods depends on sponsors' willingness to withdraw funding from failed drug discovery programmes.
authors.affiliation: Goldman School of Public Health, University of California, Berkeley, CA 94720-7320, USA. smaurer@berkeley.edu
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Maurer
mesh_terms: D014943:Global Health; D006292:Health Priorities; D006801:Humans; D009042:Motivation; D009965:Orphan Drug Production; D012106:Research