India is home to nearly 3 in every 10 (27%) TB patients in the world. TB disease kills an estimated 1,200 people every day in India, according to the World TB report 2019. As per the 2019 India TB report, 2.15 million TB cases were notified to India’s public sector Revised National Tuberculosis Program (RNTCP) in 2018. This is a 16% increase as compared to 2017 with 25% (0.54 million) of these notifications coming from the private sector; a 40% increase from last year. This data is encouraging and indicates that the various private sector interventions for TB control are bearing fruit.
Historically, getting an accurate estimate of exactly how many patients seek care in the private sector has been fraught with many challenges. The old management adage of “What can’t be measured, cannot be improved” is also true for India’s Tuberculosis epidemic. It is in this view, that many stakeholders in the public health community have stressed on the importance of having accurate and verifiable estimates of true disease burden in the private sector.
IQVIA’s role in Disease Management: Methodology to estimate the true burden in the private sector
In order to get an accurate estimate of TB burden in the private sector, IQVIA created a robust methodology to find an evidence-based estimate of number of TB patients. The methodology was developed by integrating inputs of experts from Imperial College London, Central TB Division (Government of India), World Health Organization (WHO), and Bill & Melinda Gates Foundation (BMGF). In the latest report from 2019, IQVIA presents a comprehensive approach for the ‘Estimation of TB Patient Months through anti-TB drug sales in private sector in India’. The team collected drug sales data and prepared a nationally representative dataset for private sector anti-TB drug sales across the country. They calculated the patient-months (Unit defined to estimate the volume of treatment based on total sales of the pack (in terms of tablets) and monthly average intake to estimate the total consumption in terms of months for an average patient) of treatment.
This exercise was conducted for the first time in 2014 and the results were astounding. It was estimated that 2.2 Mn cases of TB were being treated in India’s private sector, almost twice as many estimated to seek care through the RNTCP. These estimates along with emerging data from other private sector interventions eventually led policymakers, government stakeholders, and donors to rethink strategies to tackle the TB crisis.
Resultantly, disease burden estimation using drug sales data was identified as a baseline indicator by India’s ‘National Strategic Plan (NSP) for TB elimination for 2017-2025’. Our 2018 drug sales data reveals there are ~11.7 Mn patient-months in the private sector, a decrease of approximately 7.5% as compared to 2017. It further demonstrated that private sector case load in 5 states, namely Uttar Pradesh, Bihar, Maharashtra, Rajasthan and Delhi contributes to ~64% of the total national burden in 2018. Encouragingly, comparing 2018 data with 2014 shows that while public sector notifications have increased by 14% overall, the notifications from the private sector have increased by over 400%.
Table 1. TB Cases notified / estimated
Significance of the methodology
This methodology played an important role in revising the country’s overall burden estimates for TB. Furthermore, the report was also acknowledged as a tool for tracking progress of NSP (2017-25), which eventually became part of the overall M&E framework to assess effective implementation of Public Private Engagement (PPE).
With all these efforts from multiple partners, India’s ambition has progressed from being a control program to an elimination program. Government of India has stated India would eliminate tuberculosis (TB) by 2025, a good 5 years ahead of the global 2030 target. It is clear that granular information on patient numbers is required at national, state, and city level to run effective interventions for TB.
Leveraging the power of data for better healthcare outcomes
It is evident that drug sales data is a useful tool in monitoring healthcare ecosystems that are large, fragmented, and opaque as India’s private sector. Such disease burden estimates serve as useful tools to monitor and evaluate the relative progress achieved by providing an accurate denominator with which to measure an interventions progress. IQVIA’s disease burden estimation model is versatile enough to replicate for other diseases and geographies. In fact, a similar approach for estimating the TB burden in other South Asian countries is already being utilized to inform their future strategy. Chronic diseases such as HIV/AIDS, diabetes, hypertension – treatment which have a defined regimen typically spread over a long period of time, are ideal use-cases for application of IQVIA’s model. Such projects undertaken by IQVIA for chronic diseases improve functioning of disease programs and ultimately improve health outcomes.
1 India TB report 2015 & 2019
2 IQVIA TB report 2019
If you would like any more information, please get in touch with Kaartik Chauhan: firstname.lastname@example.org.