Xpert MTB/RIF - WHO...Xpert MTB/RIF Potential for engaging private sector in TB control Evan Lee, MD...
Transcript of Xpert MTB/RIF - WHO...Xpert MTB/RIF Potential for engaging private sector in TB control Evan Lee, MD...
Xpert MTB/RIF
Potential for engaging private sector in TB control
Evan Lee, MD
Lille conference
October 2011
Source of Healthcare by Income, India Treatment prior 2 weeks for diarrhea/fever/cough
Source: www.ps4h.org/globalhealthdata.html
Use of anti-TB drugs confirms demand for TB
diagnostics in private sector
Country Coverage by first line, private sector drugs*
India 117%
Indonesia 116%
Philippines 86%
Pakistan 65%
China 23%
Thailand 17%
Russia 13%
Vietnam 7%
Bangladesh 7%
South Africa 3%
Weighted average 66%
10 country total, as % of global incidence
39%
Source: Wells WA, Ge CF, Patel N, Oh T, Gardiner E,
Kimerling ME. Size and Usage Patterns of Private TB
Drug Markets in the High Burden Countries. PLoS
ONE. 2011 May 4;6(5):e18964.
However, private sector susceptible to overuse of
inappropriate diagnostic assays
9% 9% 3%
8%
71%
Proportion of testing Total ~4000/mo.
Microscopy
Culture
IGRA
Molecular
Serology
Assay Price (USD)
Microscopy 4.5 - 7
Culture 16
IGRA 55
Molecular 45-90
Serology 12 Source: private communication, India
Diagnostic services through the private sector
• Diverse set of providers – Medical colleges
– For-profit private hospitals and clinics
– Not-for-profit hospitals and clinics
– Workplaces
– For-profit stand alone private labs ranging from large established, internationally accredited networks to benchtops
• Link to healthcare providers variable (integrated, referral…)
Capacities of private sector
Xpert: advantages and attraction for laboratory
networks in private sector
- Attractive tool – state of the art - Easy to implement, follow market
demand (placement) – choice - Capacity for reporting via
Internet, cellphone - Flexibility for use with other
assays, e.g. MRSA, C. Diff, EBV, HPV, others inc. potential for HIV viral load (random access)
- Rapid TAT strengthens link to referring provider
Uptake of Xpert
0
5
10
15
20
25
30
35
0
20'000
40'000
60'000
80'000
100'000
120'000
140'000
160'000
2010 Q2 2010 Q3 2010 Q4 2011 Q1 2011 Q2 2011 Q3
# Tests # Countries
0
500
1000
1500
2000
2500
3000
3500
Specimen packing & transport Cost to perform test
Collection/Referral Profit
Reagent
Potential options for Xpert in private sector have
to link to existing cost structures
Cost of Cartridge
Cost
of t
est (
Rs)
• Different models possible Fully subsidized instrument
and reagents Access to negotiated
prices for instrument and reagents
No subsidy at all Private lab refers all
specimens to public lab
• Role of subsidy to “crowd out” TB serology
Laboratory Survey Central Kampala
Private lab survey, Kampala
Diffusion model
Medical colleges
NGOs Private-for-profit
Other
Top Quintile
4th Quintile
3rd Quintile
2nd Quintile
Bottom Quintile
Further areas for investigation
• Improving quality of diagnostics services – Improve reliability of diagnosis (quality/reliability, ability to
implement in stand-alone labs
– Need to displace use of poor quality tests
– Facilitate measuring impact on national case detection rates
• Need to understand diagnostic services in private
sector – Market share of different TB diagnostic tests
– Mapping of laboratory services available outside of the public
sector
• Understand cost structure, to develop different
models
• Roles of partners (NTP, professional associations,
accreditation)
• Link to treatment – what to do with MTB/RIF + result
Thank you!