ReaMetrix's regeant technology developed in the India

1. Towards Indigenously Developed,
Locally Relevant, Affordable Diagnos<cs
The Search for a Sustainable Model
13th September 2008
© 2006 ReaMetrix, Inc. All rights reserved.

2. Disclosure
 ReaMetrix is a cross‐disciplinary group made up of Biologists,
Chemists, Physicists and Engineers, based out of Bangalore working
towards the vision of affordable diagnosHcs of relevance to the
developing world.
 We would like to honestly admit that all pre‐conceived ideas with
which we started execuHng on our vision in India, turned out to be
totally wrong.
 This has forced us to look at completely new paradigms that can help
build a sustainable economic model to solve the twin issues of
accessibility and affordability
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3. Framing the Big Picture
 DiagnosHcs is an important
component in disease management.
 DiagnosHcs is all about “informaHon”
generaHon: InformaHon is generated
to help the physician (and in some
cases the paHents) make beSer
clinical decisions.
 DiagnosHcs is never about replacing
the doctor or a replacement of the
experience garnered in a local context
by a doctor
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4. How is the cost of diagnos<cs influenced in different contexts?
 In most developing countries, the
diagnosHc soluHons used are parachuted
from resource‐rich countries.
 During development, the cost economics of
these soluHons were highly influenced by
the local macroeconomic environment
prevailing in those countries.
 Design criteria opHmized for one
environment may not be the right soluHon
for another.
CANNOT HAVE A ONE‐SIZE
FITS ALL APPROACH
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5. Different priori<es in different environments
 In the developed countries:
• Labor costs dominate the COGS.
• The emphasis is on reducHon of labor
both in manufacturing and in process.
• Less emphasis on material conservaHon.
 In the resource‐poor countries:
• Material costs dominate the COGS.
• The emphasis has to be on material
recovery – more of the raw material has
to end up in finished goods.
• Labor component has a small contribuHon
to COGS.
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6. An Opportunity to Change the Paradigm?
 Re‐Pose the problem in the local context
 QuanHfy the cost of generaHng clinical informaHon in the local context
 Define “the affordability index” in the context of local macroeconomic
environment – how much will the stakeholder be willing to pay?
 Affordability index drives the appropriate technology that can deliver
the good and services within the affordability index.
PRICE DETERMINES TECHNOLOGY, TECHNOLOGY DOESN’T SET THE PRICE
Pu#ng this Paradigm to Test …..
A Case Study :
An Affordable CD3/CD4 Diagnos@c Test in Managing HIV Pa@ents
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7. Case Study: Affordable CD3/CD4 Diagnos<cs
 Test is used for the measurement of immune system T‐Cells – to enable a
doctor to manage HIV/AIDS paHents
 Disease management is about trends – not decisions based on a single point
CD4 Count
CD4 Count
Rs.500 – Rs.1200 per test
? Cost per test
Time
Time
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8. Anatomy of Clinical Informa<on Genera<on in the Indian Context – esp. in out reach centers
Sample journey and cost accumulaHon
Provide
Acquire
Transport
Process
Run
Results
Collection Centralized
centre
Path Lab
Path Lab
Doctor
Hospital
Layers of
margin
at every
step
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9. Issues with the Current Tes<ng Methodology
Technical
 Aged blood samples
 Accuracy and reliability of Issues with CD3/CD4 Diagnos@cs
results
 Time lag for treatment
decisions
 Traceability of sample
Lack of a Non‐local Non‐Local
mechanism to Manufacture of Manufacture of
Commercial generate clinical Instrumenta?on Reagents :
informa?on o@en with Reliance on
 Encourages too many layers of closer to where features with Imported
margin affecHng affordability its needed minimal Reagents
relevance in the
 Capital costs for imported Indian context
equipments act as big barrier to
entry as well as in adopHon of
closer to customer models
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10. A Systems Approach: Reagents + Instrumenta<on + Delivery
Reagents
 Strategy : Take advantage of low labor cost in India to develop reagents locally
 Focus on process improvements has increased material yield by an average of 400% ‐
higher yield results in lower cost of a test: Rs 100 per test (nearly 5 fold lower)
 Lower cost reagents BUT with the same quality as the more expensive reagents
imported from outside India
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11. A Systems Approach: Reagents + Instrumenta<on + Delivery
Reagents : Designing Features that are Locally Relevant
Concept of Uni<zed Dried Down Reagents
‐ Reagents require no cold‐chain – for transport as well as for storage
‐ Up to 8 day stability of stained‐fixed samples eliminaHng blood stability issues
associated with long periods of transportaHon from collecHon center to central tesHng
facility
‐ Reagents can withstand extreme heat upto 45 C
Dried Reagents are not a significant
need in the western context … but are
a significant boon in the developing
na?on context !
Adv. of defining the problem locally!
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12. A Systems Approach: Reagents + Instrumenta<on + Delivery
• Ability to be run using a car baSery
• UniHzes waste disposal – minimizes chance of
improper waste handling
• Open system – ability to port mulHple tests
onto the system – It is NOT an instrument for
measuring only CD3/CD4 counts
• Designed to withstand harsh environments
• Portable
• Reduced Capital Cost
• Minimal skill level needed to operate
• Requires no field calibraHon
Uni@zed Test Cartridges
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13. A Systems Approach: Reagents + Instrumenta<on + Delivery
How does this enable a new paradigm ?
• The instrument as well as the dried down reagents enable generaHon of
clinical informaHon closer to the doctor‐paHent interacHon context, that is
currently not possible:
‐ GP’s Office
‐ Outreach Centres
‐ ICU’s in Hospitals
‐ Mobile screening vans
‐ Ambulances
* Though the reagents are affordable – there is sHll enough margin to pay for
the cost of the instrument as well, over a 1‐year period
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14. A Systems Approach: Reagents + Instrumenta<on + Delivery
Enabling Local Economic Ac<vity and Empowerment of
Health‐workers by Novel Methods of Delivering Clinical
Informa<on
Case Study : SAANTWANAM
(Work being carried out by HAP (hNp://www.hapindia.org/))
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15. Saantwanam
A health screening project in Kerala
 FighHng life style diseases – A novel project by HAP,
Kutumbashree & State Bank of India.
 ObjecHves ‐ Screening for Diabetes mellitus, obesity,
hypertension and growth retardaHon.
 Referral to physician & health educaHon.
 Strategy – rely on locally recruited and trained young women
with high school educaHon but from poor families and deploy
them to accomplish the objecHve of wellness management
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16. The first batch
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17. © 2006 ReaMetrix, Inc. All rights reserved.
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18. Ques<ons that arise from these case studies ….
 What more can be done using this
model of healthcare delivery?
 How do we combine innovaHons in
reagent design, instrumentaHon
design and delivery to impact public
health especially in the context of
the underserved ?
 How can we extend these
innovaHons to bring about “wellness
management” rather than just
stopping at “illness“ diagnosis ?
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19. In summary…
 One has to look at “diagnosHc informaHon
generaHon” holisHcally, not just as a set of
assay reagents and hardware planorms.
 Addressing “the economics” problem
innovaHvely, will lead to sustainable
soluHons.
 “Import the science” but not the
implementaHon of the science – great to
think globally but sustainable innovaHon is
all local.
 Using this model, one can not only
address the unmet needs in resource‐poor
seongs but change the way diagnosHc
informaHon is delivered globally.
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20. Thank You
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