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Concept: Rate of return


Is existing provision of health services in Europe affordable during the recession or could cuts damage economic growth? This debate centres on whether government spending has positive or negative effects on economic growth. In this study, we evaluate the economic effects of alternative types of government spending by estimating “fiscal multipliers” (the return on investment for each $1 dollar of government spending).

Concepts: Medicine, Economics, Investment, Gross domestic product, Macroeconomics, Late-2000s recession, Rate of return, Government spending


Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions.

Concepts: Public health, Investment, Net present value, Rate of return, Internal rate of return, Future value


Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we - a group of scholars and practitioners from Africa, America, Asia and Europe - argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action.

Concepts: Scientific method, Gender, Science, Research, Investment, Bias, Rate of return


An analysis of return on investment can help policy makers support, optimize, and advocate for the expansion of immunization programs in the world’s poorest countries. We assessed the return on investment associated with achieving projected coverage levels for vaccinations to prevent diseases related to ten antigens in ninety-four low- and middle-income countries during 2011-20, the Decade of Vaccines. We derived these estimates by using costs of vaccines, supply chains, and service delivery and their associated economic benefits. Based on the costs of illnesses averted, we estimated that projected immunizations will yield a net return about 16 times greater than costs over the decade (uncertainty range: 10-25). Using a full-income approach, which quantifies the value that people place on living longer and healthier lives, we found that net returns amounted to 44 times the costs (uncertainty range: 27-67). Across all antigens, net returns were greater than costs. But to realize the substantial positive return on investment from immunization programs, it is essential that governments and donors provide the requisite investments.

Concepts: Immune system, Vaccine, Vaccination, Adaptive immune system, The Return, Investment, Rate of return, Return


The choice of financing mechanisms - payments versus penalties - determines how much a health care goal will be advanced. So why do we focus so heavily on return on investment when the topic is chronic illness but rarely mention it when the topic is cancer?

Concepts: Health care, Medicine, Health, Epidemiology, Medical terms, Illness, Investment, Rate of return


Health care providers remain uncertain about how they will fare financially if they adopt electronic health record (EHR) systems. We used survey data from forty-nine community practices in a large EHR pilot, the Massachusetts eHealth Collaborative, to project five-year returns on investment. We found that the average physician would lose $43,743 over five years; just 27 percent of practices would have achieved a positive return on investment; and only an additional 14 percent of practices would have come out ahead had they received the $44,000 federal meaningful-use incentive. The largest difference between practices with a positive return on investment and those with a negative return was the extent to which they used their EHRs to increase revenue, primarily by seeing more patients per day or by improved billing that resulted in fewer rejected claims and more accurate coding. Almost half of the practices did not realize savings in paper medical records because they continued to keep records on paper. We conclude that current meaningful use incentives alone may not ensure that most practices, particularly smaller ones, achieve a positive return on investment from EHR adoption. Policies that provide additional support, such as expanding the regional extension center program, could help ensure that practices make the changes required to realize a positive return on investment from EHRs.

Concepts: Investment, Electronic health record, Electronic medical record, Medical record, Health informatics, Medical informatics, Rate of return, Internal rate of return


To estimate the average return on investment for the overall activities of county departments of public health in California.

Concepts: Investment, Net present value, Rate of return, Internal rate of return, Future value


To evaluate the cost savings attributable to the implementation of a continuous monitoring system in a medical-surgical unit and to determine the return on investment associated with its implementation.

Concepts: Investment, Net present value, Rate of return


The portfolio of the National Center for Advancing Translational Sciences (NCATS) rare-diseases therapeutic development program comprises 28 research projects initiated at the preclinical stage. Historical data reveal substantially lower costs and higher success rates but longer preclinical timelines for the NCATS projects relative to the industry averages for early-stage translational medical research and development (R&D) typically cited in literature. Here, we evaluate the potential risks and rewards of investing in a portfolio of rare-disease therapeutics. Using a “megafund” financing structure, NCATS data, and valuation estimates from a panel of industry experts, we simulate a hypothetical megafund in which senior and junior debt yielded 5 and 8%, respectively. The simulated expected return to equity was 14.7%, corresponding to a modified internal rate of return of 21.6%. These returns and the likelihood of private-sector funding can be enhanced through third-party funding guarantees from philanthropies, patient advocacy groups, and government agencies.

Concepts: Medicine, Investment, Finance, Research and development, Net present value, Industry, Rate of return, Internal rate of return


In response to the Bayh-Dole Act, synergies between the academic and business sectors have been contemplated for the development of biotechnology companies for the past 30 years. However, the failure rate for biotech startups has been notably high, albeit variable depending on the source and more importantly, the definition of failure that is applied. Shikhar Ghosh from the Harvard Business School stated “If failure means liquidating all assets,… then the failure rate for start-ups is 30-40%. If failure refers to failing to see the projected return on investment (ROI,) then the failure rate is 70-80%. If failure is defined as declaring a projection and then falling short of meeting it, then the failure rate is a whopping 90-95% (1).” The risk of failure as well as the decrease in available funding from both public and private sectors has led to more forethought given to the development of translational technologies, i.e. technologies developed with the goal of moving from bench to bedside. The Tissue Engineering and Regenerative Medicine International Society - Americas (TERMIS-AM) Industry Committee seeks to guide academic-entrepreneurs on approaches to successfully assess their technologies and to make strategically-focused business and development decisions. Early evaluation of a technology’s potential allows for optimization of a product in a pre-market setting and more importantly, mitigation of risk. Academics most often consider the “science risk,” or risk associated with the intital R&D phase, but a more long-range consideration of commercialization, regulatory and investment risks, as well as potential exit strategies would most likely result in a greater likelhood of success. The TERMIS-AM IC established a vision to identify barriers to commercialization and to work toward offering insights and understanding of these barriers, as well as approaches to potential business solutions (2-4). A workshop focused on key risks has been developed with experts who will share their insights on the successful navigation of these risks and advancement of their products toward commercial reality. One approach that may be helpful is to illustrate this process with respect to the risks that are within an academic’s control versus those that are outside.

Concepts: Risk, Management, Investment, Failure, Finance, Business school, Rate of return, Harvard Business School