New evidence on the allocation of NIH funds across diseases.

Context: The responsiveness of NIH (National Institutes of Health) funding to disease burden is a long-standing issue of policy interest. Previous analyses of this issue have been hindered by data constraints, have not specified channels through which the NIH funding process could be responsive to disease considerations, and have not examined differences across NIH institutes and centers.

Methods: We collected data from the NIH's new RCDC (Research, Condition, and Disease Categorization) database on funding for 107 diseases in 2008 and linked these to data on deaths and hospitalizations for these diseases. We used RCDC data and information from another NIH database--RePORTER--to determine institute-specific funding for these diseases and also funding by award type. We used these data to examine the overall responsiveness of NIH funding to disease burden, within-institute responsiveness, and the responsiveness of different types of NIH awards.

Findings: Overall, we found a strong and statistically significant relationship between NIH funding and deaths and hospitalizations associated with a disease. We detected some evidence that more "applied" grant mechanisms--in particular, funding for clinical trials--are more responsive than other types of funding. We also found evidence of differences across institutes in their extent of responsiveness.

Conclusions: Overall, the data suggest that NIH funding is responsive to the two measures of disease burden. More applied grant mechanisms also may serve as "safety valves" in the allocation process, allowing Congress, disease advocacy groups, and others to apply pressure to address particular health priorities in a more fine-grained way than is possible through investigator-initiated "basic" research grants alone.