In a move that may further push India's battle against tuberculosis in a big way, public health researchers have demonstrated how the prices of superior TB diagnostics can be brought down significantly even in the private sector, if the laboratories form a consortium to offer such tests to a larger population at an affordable price.
Between 2013 and 2018, one such a consortium in India led to a ten-fold increase in the use of a sophisticated WHO-approved molecular test by slashing its price by half, making them accessible to people suspected to have the disease.
In India, more than half of the estimated 2.8 million TB patients (more than 25% of the global TB burden) are treated in the private sector, with poor diagnostic and treatment practices.
Most private doctors diagnose TB based on a combination of chest X-ray and non-specific laboratory examination, rather than the WHO recommended microbiological tests, which can not only spot the bug but also find out if it is drug-resistant.
But cost was the inhibiting factor in the widespread use of such tests in private clinics, even though they are being used extensively in government programmes.
Looking for a solution, a team of public health specialists in 2013 encouraged private diagnostic laboratories to form a consortium named 'Initiative for Promoting Affordable and Quality Tuberculosis Tests', which negotiated lower pricing on equipment and reagents with manufacturers, closer to that offered to the public sector.
“Since concessional pricing is often not available to the private health sector, several partners worked together to shape the market, and reduce the price of the tests,” said Madhukar Pai, a professor at McGill University in Canada and one of the scientists associated with the project.
In the next five years, the consortium laboratories offered the most popular of such tests at 50% of its original price, illustrating how it was a win-win situation for the diagnostic laboratories (because of large volume) and the patients (get to know their disease status accurately). The prices of two other molecular tests were also brought down.
While the consortium began with 56 laboratories in 2013, it grew to 211 members in 2018, thanks to the success and expanded further to 274 in 2019.
“Despite the price reduction, under-testing of suspected TB patients is still an issue in India, as there are only 275,000 tests for 22 million presumptive patients who need to be tested once a year,” Sarang Deo, one of the IPAQT researchers from the Indian School of Business, Hyderabad told DH.
The experiment's success was reported in a study published in BMJ Global Health last week.
“The initiative has now expanded to also including HIV and HCV tests, and is being adapted in Pakistan and Philippines,” added Pai.
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