1
|
Dabas H, Deo S, Sabharwal M, Pal A, Salim S, Nair L, Chauhan K, Maheshwari P, Parulkar A, Singh R, Chitalia M, Kadam R, Kaur M, Oghor C, Ponnudurai N, Kumta S, Small P, Dewan P, Pai M. Initiative for Promoting Affordable and Quality Tuberculosis Tests (IPAQT): a market-shaping intervention in India. BMJ Glob Health 2019; 4:e001539. [PMID: 31908854 PMCID: PMC6936393 DOI: 10.1136/bmjgh-2019-001539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/19/2019] [Accepted: 10/25/2019] [Indexed: 11/04/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Sarang Deo
- Operations Management, Indian School of Business, Hyderabad, India
| | | | - Arnab Pal
- Clinton Health Access Initiative, New Delhi, India
| | - Sachin Salim
- Clinton Health Access Initiative, New Delhi, India
| | - Lakshmi Nair
- Clinton Health Access Initiative, New Delhi, India
| | | | | | | | - Ritu Singh
- Clinton Health Access Initiative, New Delhi, India
| | | | | | - Manjot Kaur
- Clinton Health Access Initiative, New Delhi, India
| | - Collins Oghor
- Epidemiology and Biostats, McGill University, Montreal, Quebec, Canada
| | - Nirros Ponnudurai
- Epidemiology and Biostats, McGill University, Montreal, Quebec, Canada
| | - Sameer Kumta
- Bill and Melinda Gates Foundation, New Delhi, India
| | - Peter Small
- Bill and Melinda Gates Foundation, New Delhi, India
| | - Puneet Dewan
- Bill and Melinda Gates Foundation, New Delhi, India
| | - Madhukar Pai
- Epidemiology and Biostats, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
2
|
Cazabon D, Suresh A, Oghor C, Qin ZZ, Kik SV, Denkinger CM, Pai M. Implementation of Xpert MTB/RIF in 22 high tuberculosis burden countries: are we making progress? Eur Respir J 2017; 50:50/2/1700918. [PMID: 28860268 DOI: 10.1183/13993003.00918-2017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/31/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Danielle Cazabon
- McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Anita Suresh
- McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Collins Oghor
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Sandra V Kik
- KNCV Tuberculosis Foundation, The Hague, Netherlands
| | | | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, QC, Canada .,Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| |
Collapse
|
3
|
Cazabon D, Castro A, Cinà M, Helmer-Smith M, Vlček C, Oghor C. A case study of Gavi'S human papillomavirus vaccine support programme. ACTA ACUST UNITED AC 2017. [DOI: 10.4103/2468-6360.198797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
4
|
Puri L, Oghor C, Denkinger CM, Pai M. Xpert MTB/RIF for tuberculosis testing: access and price in highly privatised health markets. Lancet Glob Health 2016; 4:e94-5. [PMID: 26823226 DOI: 10.1016/s2214-109x(15)00269-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 11/03/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Lekha Puri
- McGill International Tuberculosis Center, McGill University, Montreal, Canada
| | - Collins Oghor
- McGill International Tuberculosis Center, McGill University, Montreal, Canada
| | | | - Madhukar Pai
- McGill International Tuberculosis Center, McGill University, Montreal, Canada; Department of Epidemiology and Biostatistics, 1020 Pine Avenue West, Montreal QC H3A 1A2, Canada.
| |
Collapse
|