India sets an example in subsidised TB diagnosis

genexpert

There is a bright spot in an otherwise gloomy TB scenario in India. Of the 12 high-burden countries where the private sector is a major player in providing health care, the Indian private sector offers the cheapest price for the WHO-approved Xpert MTB/RIF, a molecular test for diagnosing TB. India also has the highest number of private labs offering the test, with 113 labs offering it at a subsidised rate.

While it costs only Rs.2,000 in the 113 labs (with 5,200 collection centres) which are part of a novel initiative — Improving Access to Affordable & Quality TB Tests (IPAQT) — that was launched in India in March 2013, the charges are anywhere between Rs.3,500 and Rs.5,000 in labs that are not part of the IPAQT initiative. (The ipaqt.org site provides the details of other labs in the country that offer the WHO-approved subsidised tests.)

The mean price of the highly accurate TB test in Bangladesh is nearly $75, while it is $50 in the case of Afghanistan. It is as high as $155.5 in Philippines. Xpert is not commercially available in the private sector in six other high-burden countries.

These are some of the results of a study published today (January 26) in the journal Lancet Global Health.

The cost of the test will see a further drop if the Indian government waives off customs duty of 31 per cent levied on Xpert machine and reagents. “Nothing is preventing the government from waiving off the duty. There is a provision to waive import duties for life saving drugs and products, and HIV kits, for example, are duty-waived. Something similar is necessary for the WHO-endorsed TB tests,” Dr. Madhukar Pai, Professor at McGill University, Canada and one of the Governing Council Members of IPAQT and a coauthor of the paper said in an email to The Hindu.

As a result of the subsidised pricing agreement with the manufacturer, there has been an increase in the number of people in India accessing the highly accurate diagnostic test since 2013. From 15,190 people who availed the test between March and December 2013, it has gone up to 131,440 tests in 2015. The total number of tests done since March 2013 stands at 208,550.

“With a lot of effort, we have managed to keep the price manageable via IPAQT in India, and have shown that volumes can greatly increase. In other privatized countries, patients pay a lot, and have limited access to good tests,” said Dr. Pai.

Pai
Dr. Madhukar Pai. – Photo: R. Prasad

Access to accurate tests at subsidised price is very important in India as nearly 80 per cent of the population in the country first seek the private sector.  If one out of every four TB patients in the world is an Indian, one in eight TB patients in the world is a privately treated Indian patient.

Though the price is internationally set at $9.98 per cartridge, and the agreement allows for a 10 per cent variation in the exchange rate, the cost of the test has not been increased since January 2014 despite the rupee depreciating against the dollar in recent times. But the price may be revised if the rupee continues to depreciate, warns Dr. Pai.

Besides increasing the access to the highly reliable and sensitive test, all labs that become a member of the Initiative abide to ban the unreliable serological test. India banned serological test for TB in June 2012. Also, TB notification by the member labs has improved dramatically as IPAQT helps them with the process of notifying all TB cases.

While the sensitivity of smear microscopy is about 50 per cent, Xpert has 90 per cent sensitivity (in smear positive cases) and 98 per cent specificity. It can also indicate resistance to rifampicin — a first-line TB drug.

Published in The Hindu on January 26, 2016

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