Patients in the highest tuberculosis-burden countries who primarily rely on the private sector for their healthcare needs do not have access to the GeneXpert MTB/RIF diagnostic test for drug-resistant tuberculosis, according to a new study published in The Lancet. And if they do have access, the people who most need the test can’t afford it.
Researchers found that within twelve of the 22 highest TB-burden countries where the private sector is the primary source of health care — which includes India, Pakistan, the Philippines, and Uganda, among others — six countries have no commercial availability of GeneXpert at all while the average price for a test is $68.73 in the remaining six countries that do have availability of the rapid diagnostic test in the private sector. The price ranges from $155.44 per test in the Philippines to $37.26 in Pakistan. The average cost — six times higher than the $9.98 per cartridge paid by the public sector thanks to subsidized pricing — paid by patients in the private sector includes the costs of reagents and instruments shipping, import duties, distributor margins, and laboratory profit margins, among others.
The private sector isn’t eligible for subsidized pricing that keeps the price of GeneXpert low for the public sector, the study says. Manufacturers also set higher prices for reagents and instruments for private laboratories than public ones.
The Indian private sector, however, has come up with an innovative pricing scheme the study’s authors suggest should be replicated in other countries. The Initiative for Promoting Affordable and Quality TB Test — IPAQT — initiative offers World Health Organization-diagnostics at concessional prices. Laboratories in the IPAQT network offer GeneXpert at a fixed price of $30.26, and receive concessional pricing for the cartridge as well as for line probe assays and liquid cultures. In exchange, laboratories must agree to pass on price price reductions to patients and also notify TB cases to the public sector, as well as participate in quality assurance programs. More than 200,000 TB tests have been conducted by IPAQT labs since the introduction of the program in 2013.
The study’s authors underscore the need for a private sector access strategy to ensure quality diagnostics reach all who need them. A strategy should include the replication of IPAQT-like models in other countries, as well as public-private mix projects and subsidies and vouchers for private providers.