Costs of pharmaceutical innovation in non-commercial research and development: analysis of investments by the Drugs for Neglected Diseases initiative, 2003-2023

Understanding the true cost of pharmaceutical innovation is essential for shaping policies that promote innovation and drive equitable access to treatment. This study analyses 21 therapeutic innovations developed by the Drugs for Neglected Diseases initiative (DNDi), a non-profit R&D organization focused on neglected diseases and accelerating therapeutic innovation for neglected tropical diseases. Historical costs ranged from 2 to 110 million USD (or up to 114 million USD including in-kind support). When modelling standard attrition, the estimated median investment rose to 184 million USD for novel drugs, with a high-end projection of 365 million USD, and 9 million USD for repurposed drugs, with a higher estimate of 41 million USD . These figures include the cost of failures but exclude capitalization and inflation adjustments, reflecting DNDi’s non-profit model. The analysis identifies 13 cost drivers and 9 cost-efficiency factors unique to neglected disease R&D, offering insights into the variability of costs and the benefits of the collaborative, open science approach. Compared with industry benchmarks, DNDi’s costs align more closely with orphan drugs and reflect the lower attrition in anti-infective indications, while remaining significantly lower than industry headlines. The study, contributing valuable evidence to the broader field of pharmaceutical costing, including non-commercial ventures, underscores the need to distinguish between scientific failure and business-driven attrition when evaluating innovation costs, and to further explore policies to support collaborative innovation for global health.