Federal investment in the National Institutes of Neurological Disorders and Stroke's research program earned a 4,600% return over the last 10 years, in terms of improved quality of life for patients who benefited from the studied interventions.
Only 8 of 28 phase III trials included in the analysis contained information about their economic impact on society. However, those eight alone produced a net benefit to society of more than $15 billion, far exceeding the $335 million it cost the agency to fund all 28 of the trials, said Dr. S. Claiborne Johnston, the study's primary investigator (Lancet 2006;367:1319–27).
Because the analysis included only 8 studies, the actual benefit of the 28 trials is probably far greater. “Our approach was very conservative,” Dr. Johnston, director of stroke services at the University of California, San Francisco, said in an interview. “But even with underestimating the impact, the return on the investment was enormous.”
The study by Dr. Johnston and his colleagues is one of the first to systematically analyze the impact of publicly funded research on medical care, public health, and health care costs. They examined the costs and benefits of all phase III studies supported by the National Institute of Neurological Diseases and Stroke (NINDS).
They also assessed the studied interventions' effects on total costs and savings or quality of life; only eight of the trials contained this information. Six of these had demonstrable benefits to health. Projected gains in quality-adjusted life years (QALYs) ranged from 4,038 to 146,847 years in the first 10 years after the funding was completed.
Four of the trials actually ended up increasing medical costs, since they involved implementing a specific intervention, and four resulted in decreased costs.
But when the researchers figured each trial's impact on QALYs, the trials became much more economically beneficial, Dr. Claiborne said. Each QALY—a year of perfect health—was assigned a value of $40,310, which was the average economic productivity of a U.S. resident in 2004. Years of suboptimal health received lower values.
After this calculation, six of the trials were economically beneficial, with the net benefit ranging from $0.3 billion to $6.5 billion. Only two studies—carotid endarterectomy for asymptomatic carotid stenosis and recombinant interferon-β for multiple sclerosis—exceeded the cost-benefit ratio. The cost-effective interventions included diazepam for repeated seizures, endarterectomy for symptomatic carotid stenosis, arterial anastomosis to increase cerebral blood flow in ischemic stroke, tissue plasminogen activator for ischemic stroke, aspirin or warfarin to reduce the risk for ischemic stroke or systemic embolism in atrial fibrillation, and indomethacin for the prevention of brain hemorrhage in premature infants.
The overall cost to fund all 28 studies was $335 million. The overall net benefit over 10 years for the eight studies with economic outcomes data was $15.5 billion—a 4,600% investment return, or 460% per year.
When the researchers projected out the economic benefit over the entire 27-year period, the impact was even more striking. “The expected return over this period would be more than $50 billion,” Dr. Claiborne said. “The total budget of NINDS during the 27-year period covered by this study was $29.5 billion. Thus, benefits from the clinical trials alone have been large enough to justify the entire program of research, basic and clinical.”
He hopes these conclusions will have a positive impact on federal funding for medical research.
“Part of the reason the Lancet decided to fast-track the study's publication was to illustrate the economic impact of medical research in anticipation of upcoming congressional funding decisions for the National Institutes of Health,” Dr. Johnston said. “Obviously, we do believe this paper justifies the federal expenditures on research.”
But it's important to remember that only top-quality research will yield such impressive results, Dr. Colin Blakemore wrote in an accompanying editorial (Lancet 2006;367:1293–5). “Badly designed trials or epidemiological research will produce unreliable results,” wrote Dr. Blakemore, chief executive officer of the Medical Research Council, London. “Their conclusions underline the benefits to society of high-quality medical research. The value is never certain in advance, but the pay-off can be very high.”
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