Max Institute of Healthcare Management, Indian School of Business, Mohali, Punjab, India
Operations Management, Indian School of Business, Hyderabad, Telangana, India.
BMJ Glob Health. 2020 Dec;5(12). doi: 10.1136/bmjgh-2020-003600.
Impact of novel high-quality tuberculosis (TB) tests such as Xpert MTB/RIF has been limited due to low uptake among private providers in high-burden countries including India. Our objective was to assess the impact of a demand generation intervention comprising field sales force on the uptake of high-quality TB tests by providers and its financial sustainability for private labs in the long run.
We implemented a demand generation intervention across five Indian cities between October 2014 and June 2016 and compared the change in the quantity of Xpert cartridges ordered by labs in these cities from before (February 2013-September 2014) to after intervention (October 2014-December 2015) to corresponding change in labs in comparable non-intervention cities. We embedded this difference-in-differences estimate within a financial model to calculate the internal rate of return (IRR) if the labs were to invest in an Xpert machine with or without the demand generation intervention.
The intervention resulted in an estimated 60 additional Xpert cartridges ordered per lab-month in the intervention group, which yielded an estimated increase of 11 500 tests over the post-intervention period, at an additional cost of US$13.3-US$17.63 per test. Further, we found that investing in this intervention would increase the IRR from 4.8% to 5.5% for hospital labs but yield a negative IRR for standalone labs.
Field sales force model can generate additional demand for Xpert at private labs, but additional strategies may be needed to ensure its financial sustainability.
新型高质量结核病（TB）检测，如 Xpert MTB/RIF 的应用受到限制，因为在包括印度在内的高负担国家，私营提供者的接受程度较低。我们的目标是评估包括现场销售力量在内的需求产生干预对提供者接受高质量 TB 检测的影响，以及从长远来看对私营实验室的财务可持续性。
我们在 2014 年 10 月至 2016 年 6 月期间在五个印度城市实施了需求产生干预，并比较了这些城市的实验室在干预前（2013 年 2 月至 2014 年 9 月）和干预后（2014 年 10 月至 2015 年 12 月）订购 Xpert 盒的数量变化，以对应比较非干预城市的实验室变化。我们将这种差异的差异估计值嵌入财务模型中，以计算实验室在有或没有需求产生干预的情况下投资 Xpert 机器的内部收益率（IRR）。
干预导致干预组每个实验室每月增加约 60 个额外的 Xpert 盒，预计在干预后期间增加了 11500 次测试，每次测试的额外成本为 13.3-17.63 美元。此外，我们发现，对于医院实验室，投资于这种干预措施将使内部收益率从 4.8%提高到 5.5%，但对于独立实验室则会产生负内部收益率。
现场销售力量模式可以在私营实验室产生对 Xpert 的额外需求，但可能需要额外的策略来确保其财务可持续性。
