Allocation of NIH funding demonstrates ‘great stability’ over time

Researchers observed a “remarkably similar” allocation of NIH funding for 46 diseases in multiple body systems, including neurological and cardiovascular diseases, in 2019 compared with 2008 despite changing patterns in burden of disease.

Funding for Alzheimer’s disease and dementia increased the most, according to the study findings that were published in JAMA Network Open, receiving an estimated $1.8 billion more in 2019 compared with 2008. Funding for these diseases went from $530 million in 2008 to more than $2.3 billion in 2019, representing a 352% increase.

“Congress and the NIH allocate the budget for biomedical research to specific institutes and then often to specific centers and diseases, suggesting that the NIH is using burden of disease as a factor in making allocation decisions to diseases that are most likely to improve health for people living in the United States,” Jeromie M. Ballreich, PhD, an assistant scientist in the department of health policy and management at Johns Hopkins Bloomberg School of Public Health, and colleagues wrote. “Other possible funding considerations include recent changes in the burden of disease, the potential for a scientific breakthrough, advocacy by disease-focused organizations or simply an increase in funding based on the allocation for that disease in prior years.”

Research published over the last 20 years demonstrated a link between the amount of NIH funding and the burden of disease, according to Ballreich and colleagues. In particular, a study published in 1999 showed a statistically significant link between the amount of NIH funding and the burden of disease, as measured by disability-adjusted life years (DALYs), for 29 specific diseases.

“The analysis [from 1999] also reported that certain diseases, most notably AIDS, diabetes, dementia and breast cancer, received more NIH funding than would have been expected according to an allocation based solely on disability-adjusted life-years, whereas chronic obstructive pulmonary disease, perinatal conditions, and peptic ulcer received less than would be expected solely according to DALYs,” the researchers wrote.

However, the tools used to evaluate disease burden in the United States have improved in the past 20 years, Ballreich and colleagues noted. There have also been changes in the burden of disease in the country as well as advances in basic science.

“Therefore, an important question is whether recent changes in the burden of disease are reflected in the NIH disease-specific allocation process,” the researchers wrote. “In this article, we examine factors associated with 2019 NIH funding levels for specific diseases, including current and historical disease burden, cost of providing medical care, and prior levels of NIH funding.”

Funding in 2008 vs. 2019

Ballreich and colleagues compared NIH funding in 2008 and 2019 in cross-sectional as well as longitudinal analyses for 46 diseases to determine which of the following factors correlated the most with NIH funding in 2019: 2008 and 2019 burden of disease, 2016 health spending and 2008 NIH funding levels for that disease. They used DALYs to calculate the total for each category.

The diseases affected all parts of the body, including the cardiovascular system, the neurologic system and the respiratory system. The researchers included multiple cancer types and mental health disorders, as well as other diseases like perinatal disorders, psoriasis and sudden infant death syndrome, among others.

The 46 diseases accounted for 62,392,713 of 94,399,784 DALYs (66.1%) in 2008 and 75,706,718 of 111,074,472 DALYs (68.2%) in 2019, representing more than 66% of all DALYs in both years.

By dollar volume, Alzheimer’s disease and dementia spending rose the most, with an estimated $1.8 billion more funding in 2019 than in 2008. Spending in this area went from $530 million in 2008 to about $2.4 billion in 2019, representing a 352% increase. Spending on interpersonal violence experienced the greatest decrease from $236 million in 2008 to $141 million in 2019, for a 40% decrease and $95 million fewer dollars in funding.

The results demonstrated that the level of NIH funding in 2008 was the variable with the greatest link to NIH funding in 2019 for the 46 diseases analyzed, with a simple correlation of 0.88. Ballreich and colleagues found no significant relationship between burden of disease and shifts in burden of disease and NIH funding levels after the previous funding level was included in the model.

“The models suggested that a 1% higher level of NIH funding in 2008 was associated with a 0.91% higher level of NIH funding in 2019,” the researchers wrote.

‘Great stability’ in funding over time

One factor associated with NIH funding allocation is scientific opportunity, according to Ballreich and colleagues.

“We agree that centers and institutes are typically looking for the best and most innovative research; however, an important question is whether research on the same diseases remains on the forefront of discovery for many years,” the researchers wrote. “It is difficult to accept, given the constancy of funding across diseases, that the relative likelihood of scientific breakthroughs varies in the same way across diseases now as it did 11 or 21 years earlier.”

Another factor that has “an important role” in funding is disease-specific advocacy.

“Although advocates’ success in garnering congressional support for research can lead to higher overall NIH budgets, most advocacy groups focus on specific diseases,” Ballreich and colleagues wrote. “Some of the extra funding that certain diseases obtain could be the result of these efforts.”

Overall, however, the researchers observed “great stability” in the funding for diseases in the last 11 and 21 years, they noted.

“There are many reasons for Congress and the NIH to continue spending at levels similar to those of past years,” Ballreich and colleagues wrote. “Possibly the most important is that there is an infrastructure of people at the NIH and researchers in academic medical centers who have invested substantial human capital in certain diseases and may advocate maintaining funding.”