Case Example
Developing a White Paper for PPP in blood and cervical cancer screening using nucleic acid testing and HPV testing respectively in select states of India
Client Challenge
Client is a Swiss International healthcare company specialized in developing innovative medicines and diagnostic tests across the globe. The client initiated the first state PPP (Public-private partnership) in Odisha to implement Nucleic Acid Testing- a FDA approved method to screen three viral targets (HCV, HBV and HIV) simultaneously in the donated blood. The client wanted to capture the on-ground social and economic impact of the pilot PPP model of NAT implementation as well as estimate the benefits of pan state NAT implementation. Additionally, the client wanted to pitch to the Punjab government for a similar state-wide implementation considering their success in Odisha sate. Similarly, in case of HPV testing used to screen cervical cancer, they wanted to develop a whitepaper for its PPP adoption in states of Tamil Nadu and Maharashtra
Our Approach
To develop a whitepaper highlighting the benefits/impact of the blood and cervical screening technology offered by the client, UC adopted the following approach:
● NAT testing -Using secondary research
● Summarized the macroeconomic indicators of the state such as socio-economic parameters, state disease burden, specific burden of HCV, HIV and HBV infections, government health programs for both Odisha and Punjab state
● Analysed the current blood screening landscape and regulations in India
● Identified countries across the globe where NAT is a mandatary blood screening practice or have recently adopted to understand the benefits of a nationwide implementation
● Using primary research inputs with internal stakeholders and the on-ground stakeholders, we designed a cost-effective analysis model
● Cost effectiveness of NAT was modelled for a specific cohort (dependent on the recorded annual blood donations), the infected cases were calculated based on the residual risks associated with NAT vs other interventions used in blood screening, disease progression post infection was assumed based on Markov model, the associated costs were obtained through primary research
● Success of current Odisha PPP model of NAT implementation were evaluated based on Treatment Cost Saved and DALYs averted
● Benefits of the pan-state NAT implementation in Odisha and Punjab state, were evaluated in terms of Incremental Cost-Effective Ratio (ICER)
● HPV testing for cervical cancer screening:
● Using secondary research
● Summarized the cervical cancer burden in India and compared the global vs India trends/ methods for cervical cancer screening
● Documented state specific macroeconomic indicators of the state such as per capita health spends by government and identified the adopted cancer screening programs in the state of Tamil Nadu and Maharashtra
● Based on global case studies, we arrived at the key steps for successful implementation of HPV screening program
● Using primary research inputs with internal stakeholders and the on-ground stakeholders, we designed a cost-effective analysis model
● Cost effectiveness of HPV testing was modelled for a specific cohort, the diagnosed pre-cancer cases based on screening intervention were calculated based on sensitivity and specificity of the tests, disease progression was assumed based on Markov model and the costs were assigned based on primary research
● Benefits of the pan-state implementation of one-time HPV screening in comparison to no screening or VIA screening (most adopted screening method in the states of Tamil Nadu and Maharashtra) were evaluated in terms of Incremental Cost-Effective Ratio (ICER)
Our Impact
UC developed the following structure for the whitepaper document using background information and the results of Cost effective model analysis:
Using the CEA model analysis for the CEA model, we found:
● The Odisha PPP implementation of NAT testing incurred a net saving by the lives saved due to NAT, given current NAT yield
● Based on our cost-effective model analysis a pan state implementation in Punjab it would be cost saving due to high burden of HCV in the state
● For HPV/Cervical Cancer Screening, the low price of VIA may be a major inhibitor for cost effectiveness. However, we calculated the incremental lives and DALYs that can be saved by HPV