Prices analysis of essential HIV CD4 and VL technologies · price (incoterm)2 Lowest CHAI...
Transcript of Prices analysis of essential HIV CD4 and VL technologies · price (incoterm)2 Lowest CHAI...
Prices analysis of essential HIVCD4 and VL technologies
Teri Roberts & Cara Kosack
Diagnostics Network
30 September 2014
What do lab-based viral load tests cost?- Reagents and consumables
Manufacturingcost1
Supplier quotedprice (incoterm)2
Lowest CHAInegotiated in-country price3
Price survey across6 countries4
$1.61 - $6.77 $11 (CPT) - $25(Exworks/CPT)
$10.50 (Kenya, CIF) $18.62 - $36.38
1Estimated by Cambridge Consultants (MSF commissioned study); reagents only (consumables adds only a small amount)2Putting HIV Treatment to the Test (http://msfaccess.org/content/putting-hiv-treatment-test); lowest quoted price3ASLM meeting 2013: “Consultation on Viral Load Monitoring for African HIV Treatment Programmes”4All costs for point of use from national programmes (Kenya, Thailand) or MSF sites (Lesotho, Malawi, Swaziland,Zimbabwe)
Account forsome profitanddistributioncosts
Account forsomedistributioncosts
Account forsomedistributionand othercosts e.g.tax
Estimated manufacturing costs ofexemplar lab and POC products (1mil/yr)
Reagent costs Moulding costs Reagentcontainer costs
Final assemblycosts
Total withoutintellectual
property costs
LAB-BASED TESTS (COMMERCIALLY AVAILABLE)
Abbott RealTime HIV-1assay
$2.38 $0.02 $0.07 $0.06 $2.52
Roche CAP/CTM HIV-1assay
$4.37 $0.07 $0.03 $0.04 $4.51
BioMerieux NucliSensEasyQ HIV-1 assay
$1.23 $0.00 $0.35 $0.04 $1.61
Cavidi ExaVir Load assay $2.49 $0.00 $0.22 $0.05 $2.76
POINT-OF-CARE TESTS (NOT YET MARKET LAUNCHED)
Alere Q HIV Test $1.56 $4.01 $0.00 $1.50 $7.07
DRW SAMBA test $1.62 $3.29 $0.00 $1.50 $6.41
Wave80 EOSCAPE-HIVtest
$1.56 $3.50 $0.00 $0.00 $5.06
Lumora “BART” test $1.62 $0.00 $1.27 $0.95 $3.84
Moulding costs for POC POC = x2
Breakdown of average comprehensivecosts from 6 country survey
Comprehensive test cost range: $24.90 - $44.07 of that reagents and consumables range from $18.62 - $36.38
Modelling the effect of throughput onviral load cost per test
Using the instrument at <50% capacity means up to double the cost per testMay mean that larger instruments will have to remain centralized for now
Sample pooling as a cost reductionstrategy
Efficiency expressed as cost savings:
• Example of Thyolo District
– Population: 620,000
– HIV prevalence: 14,5%
– # VL tests needed/year: 23,000
– Price per VL test: $24
• Total cost/year = 23,000 x $24 = $552,000
– Efficiency at 1,000 cps/mL = 28,6% => $157,800 saved
– Efficiency at 5,000 cps/mL = 51,4% => $283,700 saved
Sample 1500 µL
100 µL
Pool 500 µL
Viral loadtesting
100 µL100 µL
100 µL
100 µL
Sample 2500 µL
Sample 3500 µL
Sample 4500 µL
Sample 5500 µL
What to do with pooledresults?1. Pooled VL result < threshold=> no further testing2. Pooled VL result > threshold=> further testing
©G
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Task shifting sample collection as acost reduction strategy
In Malawi, MSF has previously validated the use of fingerprick DBS, prepared by lab techsand lay workers, on the bioMerieux NucliSENS EasyQ HIV-1 platform (RNA-specific) Now finishing a study to show whether it is possible to task-shift to lay workers
© Giulio Donini / UNITAID
Task shifting point-of-care testing as acost reduction strategy
In Malawi, MSF is investigating whether point-of-care testing can be task-shifted to layworkers (PIMA, SAMBA)
In Swaziland, MSF has set up “mini-labs” at clinics, where phlebotomists have beentrained to perform point-of-care testing (RDTs, PIMA, HemoCue, Reflotron)
© Giulio Donini / UNITAID © Giulio Donini / UNITAID
Future directions to reduce costs• Use negotiating power through mechanisms such as pooled
procurement to bring down prices large volume procurers suchas the Global Fund, PEPFAR, and countries like South Africa, can dothis right now
• Higher demand for testing will promote competition and bringdown extraneous costs such as in-country maintenance (typicallyabout 20% in RLS compared with 10% in rich countries)
• Use instruments at maximal capacity• Other cost reducing strategies may include:
– Replacing CD4 testing for treatment monitoring with viral load testingin stable patients
– Sample pooling– Task shifting sample acquisition and point-of-care testing to lay
workers
Want to know more?www.msfaccess.org/undetectable
Thank you
Acknowledgements:Professor Bruce Larson and Bryan Patenaude from Boston University for creating the costing models and undertakingthe data analysisUNITAID as co-fundersMSF colleagues, PLWHA, Ministries of Health and Laboratories with which we work