NTADBM_Group8_LiPAM

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NTADBM PROJECT WORK - 2012

Lipid Profiling App for Mobiles

PROJECT REPORT

Submitted toProf. Rakesh Basant

Prof. Deval Karthik

Prof. Bhavin Kothari

Prof. Jignesh Khakhar

By

Group 8Devdatta BhattacharyyaMawshanlang Swer

Shruti Chowdhury

Vinay Hansija

Aug 13th, 2012

INDIAN INSTITUTE OF MANAGEMENT, AHMEDABAD

&

NATIONAL INSTITUTE OF DESIGN, AHMEDABAD

This document summarizes the design, technology and the business model to be used for the proposed Lipid profiling mobile

application.


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CONTENTS

Introduction: ....................................................................................................................................................................................... 2

Cholesterol in India ......................................................................................................................................................................... 3

Lipid Profiling .................................................................................................................................................................................. 4

How is the sample collected for testing? .................................................................................................................................... 4

How is a lipid profile used? ......................................................................................................................................................... 4

When is it ordered? .................................................................................................................................................................... 4

Target Patients for Lipid Profile Test ............................................................................................................................................... 5

Lipid Profile Analyser .......................................................................................................................................................................... 6

Technology .................................................................................................................................................................................. 6

Usage of LPAs .............................................................................................................................................................................. 6

Accuracy Issues of LPAs............................................................................................................................................................... 7

Indian market for LPAs ................................................................................................................................................................ 7

LipAM - Design & TECHNOLOGY ......................................................................................................................................................... 7

Device Design Guidelines ............................................................................................................................................................ 7

Device Design Philosophy: .......................................................................................................................................................... 8

The Lipam Device Components: ................................................................................................................................................. 8

Working of the Device ................................................................................................................................................................ 9

How to use the device? ............................................................................................................................................................. 12

TECHNOLOGY EXtension ........................................................................................................................................................... 12

Ecosystem of LiPAM .................................................................................................................................................................. 12

Business Model ................................................................................................................................................................................. 13

Market Overview .......................................................................................................................................................................... 13

Healthcare in India from a CVD perspective ............................................................................................................................. 13

Indian Medical Devices and Equipments Industry .................................................................................................................... 14

Target Segments ....................................................................................................................................................................... 15

Market Estimation (Conservative, Topline) .............................................................................................................................. 15

Appropriation ................................................................................................................................................................................ 16

Distribution and Promotion .......................................................................................................................................................... 17

Auxiliary Features and Partnerships ............................................................................................................................................. 18

Bibliography ...................................................................................................................................................................................... 19


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INTRODUCTION:

Cardiovascular diseases which are on the rise comprise a major portion of non-communicable diseases. In 2010, 23

million deaths worldwide were because of cardiovascular diseases. According to Global Burden of Disease, 2004

Report by WHO, CVDs would be the largest cause of death in the world accounting for one-third of all deaths by

2030.

The global cost of CVDs made between 2010 and 2030 is expected to exceed USD 20 Trillion. Overall, CVDs

accounted for around one-fourth of all deaths in India in 2008. CVDs are expected to be the fastest growing chronic

illnesses between 2005 and 2015, growing at 9.2% annually, and accounting for the second largest number of NCDpatients after mental illnesses. A more worrying fact is that the incidences of CVDs have gone up significantly for

people between the ages 25 and 69 to 24.8%, which means we are losing more productive people to these diseases.

Between 2005 and 2015, India is projected to cumulatively lose USD 236.6 billion because of heart disease, stroke,

and diabetes, shaving 1% off the GDP.


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CHOLESTEROL IN INDIA

A study in 2004, partially funded by the Department of Science and Technology, Ministry of Science and Technology,

Government of India, showed a very high prevalence of dyslipidemia. The studied showed an overall prevalence of

dyslipidemia lies between 10-73%. The prevalence of hypercholesterolemia was 28% in urban subjects as compared

to 22% in rural subjects. In urban New Delhi, the prevalence of hypertriglyceridemia was 73% for obese subjectsversus 61% for non-obese subjects. Even subjects belonging to the low socio-economic class showed substantial

prevalence of hypercholesterolemia at 27% and hypertriglyceridemia at 12 17%. (Misra, Lutra, & Vikram, 2004).

Another study of the young Indian population shows a high prevalence of dyslipidemia. (Sawant, Shetty,

Mankeshwar, & Ashavaid, 2008). The figure(s) below shows the high prevalence of dysplipidemia in the form of

hypercholesterolemia, hypertriglyceridemia, high LDL and low LDL.


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LIPID PROFILING

The lipid profile is a group of tests that are often ordered together to determine risk of coronary heart disease. They

are tests that have been shown to be good indicators of whether someone is likely to have a heart attack or stroke

caused by blockage of blood vessels or hardening of the arteries (atherosclerosis). The lipid profile typically includes:

Total cholesterol High density lipoprotein cholesterol (HDL-C) often called good cholesterol Low density lipoprotein cholesterol (LDL-C) often called bad cholesterol Triglycerides

An extended profile may also include:

Very low density lipoprotein cholesterol (VLDL-C) Non-HDL-C

Sometimes the report will include additional calculated values such as the Cholesterol/HDL ratio or a risk score basedon lipid profile results, age, sex, and other risk factors. Talk to your doctor about what these other reported values

may mean for you.

HOW IS THE SAMPLE COLLECTED FOR TESTING?

A blood sample is obtained by inserting a needle into a vein in the arm. Sometimes a drop of blood is collected by

puncturing the skin on a fingertip. This finger stick sample is typically used when a lipid profile is being measured on

a portable testing device, for example, at a health fair. You need to fast for 9-12 hours before having your blood

drawn; only water is permitted.

HOW IS A LIPID PROFILE USED?

The lipid profile is used to help determine your risk of heart disease and to help guide you and your health care

provider in deciding what treatment may be best for you if you have borderline or high risk. The results of the lipid

profile are considered along with other known risk factors of heart disease to develop a plan of treatment and

follow-up. Depending on your results and other risk factors, treatment options may involve life-style changes such as

diet and exercise or lipid-lowering medications such as statins.

WHEN IS IT ORDERED?

It is recommended that healthy adults with no other risk factors for heart disease be tested with a fasting lipid

profile once every five years. You may be screened using only a cholesterol test and not a full lipid profile. However,

if the cholesterol test result is high, you may have follow-up testing with a lipid profile. If you have other risk factors

or have had a high cholesterol level in the past, you should be tested more regularly and you should have a full lipid

profile.

For children and adolescents at low risk, lipid testing is usually not ordered routinely. However, screening with a lipid

profile is recommended for children and youths who are at an increased risk of developing heart disease as adults.

Some of the risk factors are similar to those in adults and include a family history of heart disease or health problemssuch as diabetes, high blood pressure (hypertension), or being overweight. High-risk children should have their first

lipid profile between 2 and 10 years old, according to the American Academy of Pediatrics. Children younger than 2

years old are too young to be tested.


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A lipid profile may also be ordered at regular intervals to evaluate the success of lipid-lowering lifestyle changes such

as diet and exercise or to determine the effectiveness of drug therapy such as statins.

TARGET PATIENTS FOR LIPID PROFILE TEST

The following people are required to undergo lipid profile testing

Adults Healthy adults (male 45 years and female 55 years), with no added risk factors, are required to go for a

lipid profile test once every 5 years.

Children Children at low risks are not done routinely. However children at high risks such as hypertension,

diabetes, family history of cardiovascular disease and overweight are recommended for a lipid profile test.

High-risks/past history of high cholesterol In such a case lipid profile testing should be done more regularly

Source: (American Association for Clinical Chemistry, 2012)


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LIPID PROFILE ANALYSER

TECHNOLOGY

One of the latest portable lipid profile analyser (LPA) is CardioChek manufactured by Polymer Technology Systems,

Inc., a US-based medical devices manufacturer that specializes in the manufacture of testing devices for chronicdiseases. Its products are sold in over 100 countries.

Technology benefits:

The CardioChek has the following benefits

Reliability that meets the NCEP guidelines Fast results in approximately 2 minutes Portable hand-held (battery operated) and tests can be done anywhere Simple very easy to use Connectivity can be connected to a printer and computer Versatility can be used for multiple tests

Source: (http://www.cardiochek.com)

Disadvantages:

Cost Very costly. Retails in the US markets for around $260 (approximately Rs. 13,000) Connectivity can connect to a printer or computer, but lacked the connectivity capabilities of a smart

phone

UI the device uses a LCD seven-segment display, hence the degree of interaction is limited

USAGE OF LPAS

The LPAs are used for the following tests

Total cholesterol HDL cholesterol Triglycerides Glucose Ketone Creatinine

Gaps Identified

Cost Connectivity User-Interface


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ACCURACY ISSUES OF LPAS

LPAs have been known to be inaccurate in their test results. A study of the Mennonite population in the United

States regarding the accuracy of two PLAs, Accu-Chek Instant Plus designated as PLA1 and Cardiochek PA designated

as PLA2. It was found that PLA1 systematically underestimated the TC and PLA2 systematically overestimated the TC

as compared to a reference laboratory values. Also the PLA2 system systematically overestimated the LDL values as

compared to a reference laboratory values. The following table below shows the results of the study. (Main, Jones, &

Abell, 2010)

However it was noted in the study that venous samples avoided the false positives and false negatives that come

when using the LPAs. Because of the inaccuracy of the LPAs, their results should not be used for developing

treatment plans and management of patients. The scope that is open for the LPAs is screening of patients.

INDIAN MARKET FOR LPAS

Current portable lipid profile analysers available in India are

CardioChek marketed by medical services companies like Medikraft Services and BHR Diagnotics. LipidPro marketed by Kannu Impex

The Indian market for LPAs is very nascent with very little information regarding the market size available publicly.

LIPAM - DESIGN & TECHNOLOGY

DEVICE DESIGN GUIDELINES

Lessons learned from the inaccuracy of the current LPAs are

Venous sampling works best with LPAs Screening LPAs are not reliable as a base for planning treatment plans and patient management

Gaps identified in the technology of the current LPAs are

Learnings

Venous Sampling Screening


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Costcurrent devices are prohibitively very expensive Connectivitytrue mobility and access to information as seen in a smartphone is missing User Interface the LCD seven-segment display does not provide much room for a rich user experience

DEVICE DESIGN PHILOSOPHY:

The main philosophy behind the device design is hi-tech at low cost. The current devices in the market like

CardioChek retails at around Rs. 13,000 (retails in the US at around $260).

Cost reduction:

The cost of the device can be brought down by removing the following components out of the device

Display MEMo Chip that does the setting and calibration. Each MEMo chip is unique for each set of strips Battery that powers the device Reflectance photometry processor that processes the change in colour of the test strips and interprets it

Hi-Technology:

The hi-technology part of the technology of the device comes in the integration with a smartphone or a

laptop/desktop for seamless storage of test results (can also include uploading to a web-server)

THE LIPAM DEVICE COMPONENTS:

As mentioned in the section above, the device will shed the display, MEMo chip and the battery. These

functions/features will be substituted by a smart phone so that

The smartphone will act as the display The smartphone will be processing the input data The smartphone will act as the power source

The main components that the LPA device will have will

Photo sensor to read the test strips USB connect to connect with the smartphone

The design of the device is shown in the diagram below. As seen from the diagram the device is without display and

MeMo chip; and also without batteries (not shown).


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The device connected to the smartphone is shown in the figure below

Shown below is the USB connector of the LPA device

WORKING OF THE DEVICE


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The LPA device will work if the following resources/applications are available

LPA device A smartphone An application (that will be like the OS of the LPA device) that must be installed in the smartphone. The

application, for short we can call app, has the following functions

Testing Functions Enables the LPA device to interface with the smartphone. The app will use the power of the smartphones processing capability to perform the tests

and readings of the blood samples.

Provides a UI that a user can use to interact with the LPA device and to look at the testresults

The app will test the expiration date of the test strip The app will have the ability to detect the type of test to be done based on the colour coding

of the test. This way no error can be made from the users side.

Added Functions Maintain a patients profile and the test results history of that patient The data can either be downloaded physically by connecting into a desktop system, or can

be uploaded and saved instantaneously onto a web server.

The app is compatible across different current mobile platforms such as Android, Windows Phone, Symbian and iOS.

A mock screen of the app interface


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Users can add/update/retrieve a patients info

Users can look at the history of a patient

Users can upload results and also retrieve patient information from the Internet


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HOW TO USE THE DEVICE?

The following steps will describe how the LPA device can be used

Taking blood sample from the subjects Venous blood sample should be taken from the subjects

Reading the blood sample using the device

Step 1: Install the app into the smartphone

Step 2: Connect the device to the smartphone

Step 3: Start the app. The app will now detect the device.

Step 4: User will select a new test to be done

Step 5: The test strip with the blood sample from a test subject is inserted into the slot for the sensor to read

the changes in the test strip.

Step 6: The test results will come up in approximate 2 minutes and the results will by default be saved in the

smartphones memory. The user can also choose to upload the result onto a webserver immediately.

Step 7: Take out the test strip and dispose it carefully

Step 8: If the user wishes to perform another test, then repeat step 4 through step 7

TECHNOLOGY EXTENSION

Since the device is a mobile device in itself, it can be connected to any other device that is able to run the app. This

can the device can be connected to a laptop or desktop.

ECOSYSTEM OF LIPAM

The device will have the following entities in its technology eco-system:

App

The software that will run the device and interface with the smartphone. Also has the capability to

store and access data online/offline

Smartphone Maintain a symbiotic relationship with the device. The device extends the limits of whatsmartphones are capable of.

LiPAM

Smartphones

Laptop

Desktops


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Test Strips Will be the component of the eco-system that will generate the largest amount of revenue byemploying the classic razor and blademodel.

Blood Sampling This will be a component in the system only when the target user is an individual. Needlesand lancets form the sub-components of the blood sampling component.

BUSINESS MODEL

MARKET OVERVIEW

For estimating the market we first need to look at two related sectors, the Indian healthcare industry from the

perspective of Cardio Vascular Diseases and the Indian Medical Devices and Equipment Industry.

HEALTHCARE IN INDIA FROM A CVD PERSPECTIVE

There is limited availability of affordable preventive and curative cardiac care across the country. India faces a

challenge of shortage of trained healthcare personnel at all levels, and especially in the rural areas. There is only

about one doctor for every 1700 people in India and it faces a more than 60% shortfall of specialists at the CHC level.

India produces less than 30,000 doctors every year and there is a shortfall of about 600,000 doctors and 1,000,000

nurses to reach the WHO recommended standard of 1 doctor every 1000 people. The situation is even grimmer

when it comes to cardiology; India trains only about 150 cardiologists every year, and the number is not enough

given the disease burden. There is a shortage of adequately trained specialists, nurses and technicians for cardiology

to cater to the masses for preventive health check-ups, interventions and disease management. Inequitable access

to healthcare delivery has been a key issue with the Indian healthcare system. Public healthcare infrastructure for

cardiology is inefficient and inadequate too. Around 60% of the hospitals in India are located in the urban areas and

cater to only 30% of the population. Only 13% of the rural population has access to a primary healthcare facility

LiPAM

App

Test

Strips

Smartphone

BloodSampling


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and less than 10% to a hospital. The Indian primary and secondary healthcare system is under prepared to handle

cardiac diseases and has focused predominantly on infectious diseases, child and maternal health and small injuries.

This leads to increased patient flow and patient load on tertiary care hospitals. Affordability of quality care is a key

concern for most of the population, both for preventive check-ups and treatment. Big hospitals in Tier I cities are

typically driven by use of advanced medical technology, thus raising the cost of treatment. The issue of

affordability is further magnified by the low penetration of health insurance in India. Even in case of the smallpercentage of people under insurance cover, the coverage is limited to the treatment of CVDs once the disease is in

the intervention stage. There is no coverage for preventive or diagnostic or in fact any outpatient care. This is a huge

barrier towards lowering the burden of CVDs through preventive measures. Our device is an effective preventive

measure against CVDs which are related to high cholesterol indices.

INDIAN MEDICAL DEVICES AND EQUIPMENTS INDUSTRY

The Medical Devices and Equipment industry, valued at US$ 2.5 billion contributes only 6% of Indias US$ 40 billion

healthcare sector. It is growing at a faster annual rate of 15% than 10-12% growth seen in the Healthcare sector in

its entirety. A rise in the number of hospitals and the increased requirement for healthcare facilities creates a needfor sophisticated devices and equipment, which can provide accurate treatment to individuals. The Medical

Electronics segment of this industry incorporates control, conversion, sensing, processing, storage, display, and

transfer of information on anatomy and physiology by making use of the Electronics and Communication

Technologies. The Medical Equipment industry is quite wide with > 14,000 different products types, as per the

Global Medical Device Nomenclature (GMDN). The products range from wound closure pads to stents and IVD

machines of medical devices. Further, it can be reasonably said that Medical Electronics is an area, where Electronics

and Information Communication Technology play a decisive role. Moreover, significant efforts have been made in

the medical technology ecosystem to stimulate innovation in this space so that the opportunities provided in the

Indian market can be capitalized by the companies working in this domain and the Indian consumer of healthcare

services stands to benefit. In the past, the sector has significantly brought down the incidence of disease among

patients, families, society as well as improved the countrys health system, significantly. However, in India the

penetration of medical devices is low and inadequate due to the barriers that prevent their usage.


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TARGET SEGMENTS

For the target market, we have identified two major forms of usage of the device:

1. Public Health Care Centres (Rural) Public usage all Public Health Care Centres. Since rural people mostlygo to PHCs for any medical treatment, so by targeting these outlets we are getting the entire rural market.

Screening would be the main purpose of being in this segment.

2. Personal Use People who have high risks/past history (family or individual) of high cholesterol.3. Small laboratories in Tier-I,II,III cities Since people from the lower social economic strata also show a

prevalence of dyslipidemia, this forms a segment that cannot be neglected. Screening would be the main

purpose of being in this segment

MARKET ESTIMATION (CONSERVATIVE, TOPLINE)

Personal use cannot be estimated since its very difficult to predict uptake of this device by individual users.

Small Laboratory or Public Health Care Centreusage has been modelled on the number of points of usage in a

year as shown below. Total market size comes to Rs. 15.4 crores for strips (annually) and Rs. 2.6 crores for

devices.

Price of Device 999

Per year points of usage in a small laboratory (urban)* 104

Number of public health centres in countrya 23200

Per year points of usage in a public health centre* 52

Number of

Labs per

city #

Number

of cities

#

Number of

Labs in each

Tier #

Total Usage in each

tier per year

Total Number of

devices required

Tier 1 30 10 300 31200 300

Tier 2 20 50 1000 104000 1000

Tier 3 10 100 1000 104000 1000Rest 5 100 500 52000 500

Total URBAN points of usage in country (per year)

291200

Cost of each strip 99

Annual market of strips in Rs. (urban) 28828800

Total Market for the Device in Rs. (urban) 2797200


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Total Market for Device in Rs. (public health care centres) 23176800

Annual market for strips in Rs. (public health care centres) 125465600

Total Market for strips in India (annual) Rs. 15,42,94,400.00

Total Market for device in India Rs. 2,59,74,000.00

Assumptions Explained:

*Based on assumptions that on an average 2 lipid profile cases come in a week. It has been assumed that if a PHC

is equipped with a Lipid profiling device then at least 1 profile will be done in a week. This gives annual points of

usage in each small lab in Urban scenario as 104 (52 weeks *2), and at PHCs as 52.

# Number of labs in each city and number of cities in each tier estimates used here are very conservative figures

based on various Planning Commission Reports.a

Number of PHCs is based on Ministry of Health and Family

Welfare estimate.

Other figures are obtained from simple additions and multiplications of the above explained numbers.

MARGIN ESTIMATES

The margin %age estimates for the device and the strips comes as below:

For Device: For Strips:

Selling Price 999 Selling Price 99

Cost of Sensor 400-700 Cost of Chemicals 25

Assembling Cost 100 Packaging Cost 25

Other hardware cost (wire and micro USB slot etc) 50 Other Material Cost (paper etc.) 10

Margin 449-149 Margin 39

Margin %age 15-45 Margin %age 40

Device: The maximum cost of a high-end single sensor required for the device is Rs.800. So it can be assumed that a

decent sensor will cost within Rs. 400 to 700. The cost for a micro USB slot is less than Rs. 20 in the market and even

less than Rs. 10 for Chinese makes. So the entire cost of other hardwares required in the device has been capped at

Rs. 50. The assembly cost has all firm related expenses like salaries and other miscellaneous.

So that gives us a margin in rupee terms ofRs. 37 lakhs to Rs. 1.12 crores for the device.

Strips: The costs specified here are based on secondary research. The packaging cost actually comes out to be

comparable to the chemicals cost required in the strips because the packaging needs to be done to specifications so

as the preserve the chemicals in the strip. The base material of paper or pulp has negligible cost of production.

For strips, therefore, we arrive at a margin in rupee terms ofRs. 6.16 crores per year.

Overall: Taking a very conservative stance of NO MARKET GROWTH during the lifetime of this technology , we can

say that the annual bottom-line contribution of this technology will be Rs 6.5 to 7 crores.

Assuming a 10 yr product life cycle, the Present Value of this project comes at Rs. 45 to Rs. 50 crores.


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If 50% of this goes for partnering with the Govt. or other bigger players for distribution and marketing then the

overall in-hand cash income over the next 10 years comes to Rs. 25 crores , which is decent considering that we

have assumed no market growth.

APPROPRIATION

The Medical devices industry regulated but the regulations lack structure. The government is expected to develop a

regulatory structure leading to quality products being developed by manufacturers. However, the current regulatory

structure lacks active participation from the government but with the increase in competition in the sector, this is

just a matter of time. The main legislation is the Indian Patents Act, 1970 and TRIPS agreement which has

fundamentally changed the nature of competition in the industry. The last few years have seen an increase in

domestic manufacturing of medical equipment. With impetus from Government of India schemes, India is

beginning to look forward to being recognized as a manufacturing destination for sophisticated medical

technology. So optimistically it can be assumed that the innovation, especially the battery less design, will be and

can be protected with support from the Government, so as to create entry barriers to bigger firms like Medtronics,

Abbot Vascular, Becton Dickinson who have high stakes in the Indian medical devices industry and can get veryinterested in this device since it encroaches on their fields of activity in the market.

Source: (Federation of Indian Chambers of Commerce and Industry)

DISTRIBUTION AND PROMOTION

So clearly the distribution channels will have to handle the devices and the strips. The distribution for strips should

be at a much larger scale than the devices.

It is intuitively clear that all the above mentioned distribution channels (except for the app) are dominated by

current players who manufacture and market healthcare devices . These include the likes of India Medtronic,

Johnson and Johnson, Abbott Vascular, Zimmer India, BPL Healthcare, Boston Scientific, GE Healthcare and many

more such globally renowned names. Having accepted this premise it becomes imperative for a start-up company

to either license out their innovation or partner with one of these major players for overall distribution and

promotion.The Government of India will also have to be a partner since one of the major target segments is the

Public Health Care Centres.

The promotion will have to beGovernment backed since the margins are mediocre. So it should be issued in publicinterest because only 10% of rural population who need it have access to proper Cardio Vascular Disease monitoring.

Therefore this low cost device solves affordability and availability issues if significant proportion of penetration is

Device

Direct Salesto Personal

Users(Online,Medical

Shops etc.)

Sales to PHCsand Small

Labs

Strips

Direct Salesto Personal

Users(Online,Medical

Shops etc.)

Sales to PHCsand Small

Labs

All ClinicalSuppliesOutlets

Retail outletswhich

provideclinical

supplies

App

iPhoneAppStore,AndroidMarket,

WindowsApp Store

etc.


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achieved in the market. According to market estimation shown previously, the PHCs will account for 78% of the top

line revenue.

Apart from this, retail chains like Apollo which provide clinical supplies can be partnered with for strip distribution.

Since strips are estimated to form 81% of the top line revenues , so the partnership with this distribution channel

will be very important with regard to overall distribution in the business model.

AUXILIARY FEATURES AND PARTNERSHIPS

The customer base of the app can be used as an asset to collect data and health trends , through opt-in, both at

aggregate level and at individual level. This can help market research agencies who need market trends in health for

their research. It can help the Government with deciding if a geographical area is experiencing some trends in health

deterioration. The data of each individual customer can be analysed by healthcare companies to collate and find any

relationships between health deterioration and improvement with drug usage or other activities, lifestyle etc. This

can form a very important part of the business model once the customer base acquires a critical mass, similar to

what some other apps do for market research etc.


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BIBLIOGRAPHY

American Association for Clinical Chemistry. (2012, 5). http://labtestsonline.org. Retrieved 8 5, 2012, from

http://labtestsonline.org: http://labtestsonline.org/understanding/analytes/lipid/tab/glance

Federation of Indian Chambers of Commerce and Industry. (n.d.). http://www.ficci.com. Retrieved 8 5, 2012, from

http://www.ficci.com:

http://www.ficci.com/sector/76/Project_docs/Medical_Devices_and_Equipment_Sector_profile.pdf

http://www.cardiochek.com. (n.d.). Retrieved 8 5, 2012, from http://www.cardiochek.com:

http://www.cardiochek.com/index.php?option=com_content&view=article&id=89&Itemid=166

Main, M. E., Jones, S., & Abell, C. (2010). THE ACCURACY OF REFERRAL FOR PORTABLE LIPID ANALYZERS IN AN OLD

ORDER MENNONITE POPULATION.

Misra, A., Lutra, K., & Vikram, N. (2004). Dyslipidemia in Asian Indians : Determinants and Significance.

Sawant, A., Shetty, D., Mankeshwar, R., & Ashavaid, T. (2008, 2). http://www.japi.org. Retrieved 8 5, 2012, from

http://www.japi.org: http://www.japi.org/february2008/O-99.htm

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