Diversified investors - through their allocations to listed shares, corporate bonds, and private equity - are already connected to hundreds of medicines and thousands of clinical trials.
Investors can measure the wealth gains (financial returns) they generate for their end-beneficiaries down to the cent but have little insight into the health gains generated by their portfolio companies.
The mission of RESOURCES FOR INVESTING IN HEALTH (R4IH) is to solve this.
| Organisation Type | Organisation | Target-setting / Reporting | Health Outcome |
|---|---|---|---|
| corporate investor | Bayer (Leaps) | quantitative: total impact | In 2034, our evaluated health portfolio has the potential to achieve the following annual impact in the US: Total WALYs (Wellbeing Adjusted Life Years) saved: 709359 |
| public asset owner | PGGM | quantitative: per-patient impact | gain 0.27 quality-adjusted life years per patient in The Netherlands |
| public investor | InvestNL | quantitative: per-investment impact | expected delivered quality of life in 2030 is approximately 200 QALYs [resulting from 2 out of 6 assessed companies in the portfolio] |
| stock-exchange listed company | Johnson & Johnson | qualitative (for determining executive pay) | delivering more years of life and quality of life for people around the world |
Yet the challenge remains: which target is high and which is low? Financial performance is meticulously tracked against a broad-market benchmark. How to benchmark health outcomes performance? R4IH fills this gap.
Investors typically limit their health outcomes targets to a specific country. This provides a common population base to assess relative contributions of various health technologies and various healthcare sector companies.
For the 2024 Annual Benchmark, R4IH assessed all novel medicines first admitted to the market in the Netherlands in 2024.
The treemap chart displays the additional health gains each medicine is expected to offer compared to existing treatments - measured as incremental Quality-Adjusted Life Years (QALYs).
Example: per-patient incremental QALY gains for capivasertib - a medicine for certain breast cancers - are 0.54 over a lifetime (that is, about half a year of additional healthy life compared to previous treatments). In the Netherlands 629 patients are expected to be suitable for treatment with this medicine. Accordingly, total QALY gains are 0.54 × 629 = 340 for the Netherlands alone.
In scope: 43 European Medicines Agency (EMA)-Procedure approvals for novel medicines (incl. existing active substance expanded to a new indication (1), and existing active substance expanded to a new patient population (1)). Out of scope: medicines approved through a national marketing authorisation procedure (medicines not containing a new active substance); EMA-procedure approvals other than novel medicines: updated authorisations for established meningococcal and influenza vaccines (4), new combination of existing active ingredients (2), generic (1), diagnostic (1), re-introduction of a medicine that used to have a marketing authorisation in the past (1), vaccine for a disease endemic in the area outside of the Netherlands (1).
In the base case estimation 24 out of 41 novel medicines are expected to offer efficacy gains compared to existing treatments (the other 17 are non-inferior - that is, they do not offer efficacy gains compared to existing treatments; they may offer secondary benefits, such as ease of administration). Summing up the efficacy gains for all these medicines results in a total of 6.4 thousand QALYs for a total of 25 thousand patients.
For comparison, the population of the Netherlands stands at 18 million; number of prevalent cases for all causes of disease is 16.4 million; number of people living with a chronic condition is 10.5 million; and the overall disease burden is 5374 thousand QALYs.
While the new medicines are expected to result in health gains of 0.25 QALYs per treated patient, the patient population they address is about 0.2% of the total population in the country. The health gains per every patient with a chronic condition are 0.0006 QALYs ( = 0.2 days). This demonstrates the scale of the "missing medicines" phenomenon: medicines addressing high disease burden that have not been developed (yet).
At the current rate of progress, it would take more than 442 years to achieve a health gain of 0.27 QALYs for every patient with a chronic condition living in the country.
Sources: World Health Organization - Global Health Estimates 2021, National Institute for Public Health and the Environment (RIVM), R4IH calculations.
Majority of global disease burden cannot be eliminated through risk factor mitigation (diet, smoking, exercise) and is therefore in need of technological solutions: medicines, vaccines, medical devices, etc.
Global burden of disease measured in disability-adjusted life-years (DALYs)
Risk factors include: metabolic, behavioural, environmental and occupational. Sources: GBD 2021 Risk Factors Collaborators, 2024, The Lancet.