Table 1 The impacts in each payback category from the 29 cases, with illustrative examples

Knowledge production: peer-reviewed publications. All 29 projects

A Canadian project on the determinants of increased growth of vascular smooth muscle in spontaneously hypertensive rats produced 16 articles - cited 849 times.

Research targeting and capacity building: Post Graduate research training; career development of PI and team; transfer of skills; informing future studies. All 29 projects

An Australian project on high density lipoprotein (HDL) led to: many collaborations for the PI; advanced the career of the post-doc; new research techniques; further research funding for the group; and better targeting of other groups’ research through increased understanding of HDL. A UK project on the role of coagulation and fibrinolysis in the pathogenesis of recurrent stroke supported the training of 2 PhDs, an MD and development of a patient cohort and control group that formed the basis of a stream of work. It helped the PI establish his research group.

Informing policy and product development: informing a wide range of policies, including clinical guidelines; informing the development of therapeutic products, diagnostic tests, etc. 23 of the 29 projects

An Australian project that created animal models for myocardial dysfunction had contributed to the decision to create a transgenic facility at the research institute, which later informed the development of a commercial facility. Guidelines recommend a treatment pathway for antiphospholipid antibodies based on a Canadian project on warfarin and thrombosis; work on the follow-on studies informed guidelines for warfarin therapy. A UK project on the incidence, severity and recovery of language disorders following right-hemisphere stroke informed: national guidelines, curriculum development of a speech therapy school, and a patient leaflet.

Health and health sector benefits: health gains from improved treatments and public health; more effective use of healthcare resources; increased health equity. 19 of the 29 projects

An Australian project studying the effects of angiotensin converting enzyme (ACE) inhibitors provided part of the international literature used to justify their adoption in the treatment of LV hypertrophy, hypertension, cardiac disease, etc; there have been major health gains from the introduction of ACE inhibitors. A Canadian project on nimodipine binding in cerebral ischemia was part of a stream of work underpinning some of the Canadian Best Practice Recommendations for Stroke. This study, along with many others, led to health gains and cost savings through the administration of tissue plasminogen activator. A UK project analyzing the results of the Heartstart Scotland initiative to introduce automated defibrillators into all Scotland’s ambulances informed not only guidelines but also the policy of ambulance services in Scotland and England. As a result it has made an important contribution to health gains through the increased survival rate following out-of-hospital cardiac arrest.

Broader economic benefits: benefits to the economy such as greater employment, exports, etc., as a result of commercial development informed by the research; contribution to a healthier workforce through a reduction in production lost by mortality and morbidity. 10 of the 29 projects

The commercial transgenic facility developed in Australia as a result of the animal models for myocardial dysfunction described above is now a multi-million dollar business that exports 80% of its services. A Canadian project on coronary lesions and vasoactivity in salmon led on to a body of work that contributed to the literature showing farmed salmon are a safe source of human dietary omega-3 input, thus contributing to sustainable aquaculture. A UK project on fibrillin deficiency in Marfan Syndrome (a condition affecting perhaps 18,000 people in the UK alone) contributed to international research that improved diagnostic tests and informs preventive management that pushed the average age of death higher and most of this health gain is among people of working age; therefore a number of people have been able to remain active in the workforce.