New TB Tools Need to be Affordable in the Private Sector: The Case Study of Xpert MTB/RIF

Ponnudurai, Nirros; Denkinger, Claudia M.; Gemert, Wayne van; Pai, Madhukar

doi:10.1016/j.jegh.2018.04.005

Cited by 7 publications

(5 citation statements)

References 12 publications

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“…This suggests that the lower pricing offered by IPAQT laboratories, which are dominant players in the market, may have created a downward pressure on these commercial prices. These prices were also lowest among seven countries with a comparably sized private healthcare sector 7. Furthermore, the average price in those countries increased from $68.73 in 2015 to $84.53 in 2017 compared with the downward trend observed in India.…”

Section: Trends In Test Pricesmentioning

confidence: 84%

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Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT): a market-shaping intervention in India

Dabas¹,

Deo

Sabharwal³

et al. 2019

BMJ Glob Health

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A majority of patients with tuberculosis (TB) in India are diagnosed and treated in the private sector. Yet, most private providers do not use most recent WHO-endorsed microbiological tests such as liquid cultures, line probe assays and Xpert MTB/RIF due to a combination of factors such as lack of awareness, misaligned incentives and high prices that are unaffordable for patients. We designed a market-based approach to transform a high-price, low-volume market equilibrium into a low-price, high-volume equilibrium to improve the uptake of these tests. Toward this end, a non-profit consortium of private laboratories, called Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT) was formed in India in March 2013. It negotiated lower pricing on equipment and reagents with manufacturers, closer to that offered to the public sector. In return, IPAQT assured that this discount was passed on to patients, who typically paid for these tests out of their pockets, through an informally agreed on retail ceiling price. IPAQT also invested in demand generation activities that complemented the supply-side effort. IPAQT membership grew from 56 laboratories in 2013 to 211 in 2018. During this period, the initiative resulted in a 10-fold increase in the uptake of Xpert and a 30%–50% reduction in price. This initiative is planned to be expanded to other South Asian countries with similar TB epidemic and private market structure and dynamics. However, long-term sustainability of the initiative would require developing more cost-effective marketing activities and integration with broader private sector engagement agenda of the national TB programme.

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Section: Trends In Test Pricesmentioning

confidence: 84%

“…In these countries, patient pathways (including those for low-income segments) comprise visits to multiple providers leading to delayed diagnosis and suboptimal quality of care 2–4. Thus, large-scale engagement of private providers, including rapid scale-up of novel TB diagnostic tools, is critical for TB elimination by 20301 5–7…”

Section: Introductionmentioning

confidence: 99%

Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT): a market-shaping intervention in India

Dabas¹,

Deo

Sabharwal³

et al. 2019

BMJ Glob Health

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“…In recent years the Xpert MTB/RIF R (GeneXpert, Cepheid, Sunnyvale, CA, USA) 2 , molecular test (Xpert) has become increasingly popular, with a high sensitivity and specificity 2 , and endorsement from the World Health Organization (WHO) since 2010. However, with the majority of TB cases occurring in resource-constrained settings, the cost of the Xpert test remains comparatively high (from $13 in countries where concessional pricing is available [3][4][5] , and $46-175 in private healthcare settings 6 ). Obtaining sputum samples from large populations is additionally both time-consuming and logistically difficult while daily throughput is limited by the processing time of 2 hours for the Xpert test.…”

Section: Introductionmentioning

confidence: 99%

Computer aided detection of tuberculosis on chest radiographs: An evaluation of the CAD4TB v6 system

Murphy

Habib

Zaidi

et al. 2020

Sci Rep

103

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There is a growing interest in the automated analysis of chest X-Ray (CXR) as a sensitive and inexpensive means of screening susceptible populations for pulmonary tuberculosis. In this work we evaluate the latest version of CAD4TB, a software platform designed for this purpose. Version 6 of CAD4TB was released in 2018 and is here tested on an independent dataset of 5565 CXR images with GeneXpert (Xpert) sputum test results available (854 Xpert positive subjects). A subset of 500 subjects (50% Xpert positive) was reviewed and annotated by 5 expert observers independently to obtain a radiological reference standard. The latest version of CAD4TB is found to outperform all previous versions in terms of area under receiver operating curve (ROC) with respect to both Xpert and radiological reference standards. Improvements with respect to Xpert are most apparent at high sensitivity levels with a specificity of 76% obtained at 90% sensitivity. When compared with the radiological reference standard, CAD4TB v6 also outperformed previous versions by a considerable margin and achieved 98% specificity at 90% sensitivity. No substantial difference was found between the performance of CAD4TB v6 and any of the various expert observers against the Xpert reference standard. A cost and efficiency analysis on this dataset demonstrates that in a standard clinical situation, operating at 90% sensitivity, users of CAD4TB v6 can process 132 subjects per day at an average cost per screen of $5.95 per subject, while users of version 3 process only 85 subjects per day at a cost of $8.41 per subject. At all tested operating points version 6 is shown to be more efficient and cost effective than any other version.

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“…First, data from the private sector and data from commercial procurement of Xpert MTB/RIF by public sector entities in certain countries (due to failure to meet concessional pricing conditions) were not included, thus the smear volumes and Xpert procurement are not representative of country totals. However, data shows that Xpert MTB/RIF prices are high in the private sector, and volumes are likely to be low, except for India 13 . Second, cartridge procurement data may not reflect the actual utilisation of Xpert MTB/RIF.…”

Section: Discussionmentioning

confidence: 99%

Market penetration of Xpert MTB/RIF in high tuberculosis burden countries: A trend analysis from 2014 - 2016

et al. 2018

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Background: Xpert® MTB/RIF, a rapid tuberculosis (TB) molecular test, was endorsed by the World Health Organization in 2010. Since then, 34.4 million cartridges have been procured under concessional pricing. Although the roll out of this diagnostic is promising, previous studies showed low market penetration. Methods: To assess 3-year trends of market penetration of Xpert MTB/RIF in the public sector, smear and Xpert MTB/RIF volumes for the year 2016 were assessed and policies from 2014-2016 within 22 high-burden countries (HBCs) were studied. A structured questionnaire was sent to representatives of 22 HBCs. The questionnaires assessed the total smear and Xpert MTB/RIF volumes, number of modules and days of operation of GeneXpert machines in National TB Programs (NTPs). Data regarding the use of NTP GeneXpert machines for other diseases and GeneXpert procurement by other disease control programs were collected. Market penetration was estimated by the ratio of total sputum smear volume for initial diagnosis divided by the number of Xpert MTB/RIF tests procured in the public sector. Results: The survey response rate was 21/22 (95%). Smear/Xpert ratios decreased in 17/21 countries and increased in four countries, since 2014. The median ratio decreased from 32.6 (Q1:14.3, Q3: 58.9) in 2014 to 6.0 (Q1: 1.6, Q3: 17.0) in 2016. Nineteen countries (19/19; 100%) were not using GeneXpert machines to their full capacity, however seven countries (7/19; 37%) were running tests for other diseases on their NTP-procured GeneXpert systems in 2017, such as HIV, hepatitis-C virus (HCV), Chlamydia trachomatis, and Neisseria gonorrhoeae. Five (5/15; 33%) countries reported GeneXpert procurement by HIV or HCV programs in 2016 and/or 2017. Conclusions: Our results show a positive trend for Xpert MTB/RIF market penetration in 21 HBC public sectors. However, GeneXpert machines were under-utilized for TB, and inadequately exploited as a multi disease technology.

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New TB Tools Need to be Affordable in the Private Sector: The Case Study of Xpert MTB/RIF

Cited by 7 publications

References 12 publications

Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT): a market-shaping intervention in India

Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT): a market-shaping intervention in India

Computer aided detection of tuberculosis on chest radiographs: An evaluation of the CAD4TB v6 system

Market penetration of Xpert MTB/RIF in high tuberculosis burden countries: A trend analysis from 2014 - 2016

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