Segmenting the composition of the potential addressable market for TB highlights opportunities and challenges for specific subsets of the market. For the TB market, two of the most important segmentation factors are access to TB diagnosis and whether TB care is sought through the private or public sector.
Access to TB Diagnosis
While the total potential addressable market consists of all persons actively infected with TB, only those who seek care and are diagnosed with TB are serviceable using DAT. Globally, around 2 out of 3 people with active TB were diagnosed in 2019. In countries and regions with highly developed health systems, this case detection rate is often significantly higher. On average, nearly 90% of the potential addressable TB market in European countries is serviceable. Conversely, in African countries, only ~60% is serviceable on average.
Globally, nearly 1 out of every 3 people with active TB remain undiagnosed. This is a substantial segment of the global potential addressable market and highlight a major challenge for the DAT for TB market. In the long term, market growth and sustainability, particularly in Africa and South-East Asia may require investments in developing stronger diagnostic capabilities. In the near term, low case detection rates in Africa which results in nearly 1 million undiagnosed TB cases each year may inhibit the growth of DAT uptake and local manufacturing unless demand across the continent can be consolidated. This is particularly true if foreign DAT products successfully enter the Africa regional market.
Explore how the rate of TB case detection varies across regions, and countries within regions, in the interactive diagram below.
Public / Private Sector Care-Seeking
At present, the vast majority of DAT deployments have been done through the public sector. However, the aggregate TB burden treated through the private sector is substantial and future expansion into this market segment, and likely challenges, is a necessary consideration.
Generally, TB treatment in the private sector is less structured than in the public sector. Independent providers or networks of providers have freedom to approach TB treatment differently, prescribing different types of drugs and with varying degrees of effort in ensuring treatment adherence. While some providers may choose to integrate DAT into routine TB care, others may lack the incentive or capacity to do so. As such, adoption of DAT in the private sector is likely be fragmented.
The challenge presented by this fragmentation is nothing new and TB control programs in LMICs have long struggled to engage the private sector effectively. A useful example for the effort required to surmount this challenge can be found in India’s efforts to combat under-reporting of TB cases from private providers. In 2012, TB was mandated a notifiable disease, thus legally compelling all health providers to notify local health authorities of TB cases. However, this policy change alone was insufficient and requires routine efforts to engage private providers through education, financial incentives, and creation of user-friendly mechanisms for notification (ex: Nikshay web-based application).
Widespread adoption of DAT into routine care management in the private market will require similarly sustained and dedicated effort from governments. At minimum, national control programs must
- Create systems allowing private care providers to easily register patients into a national adherence platform where data can be securely stored and tracked.
- Develop a viable business model for private providers which incentivizes effective follow-up for non-adherent patients. Depending on how financial incentives are structured, adoption of DAT could happen without improving treatment adherence; such as if private providers can maximize profit by selling DAT without providing support for users.
In countries where private sector care-seeking is high, a large segment of the potential addressable market may be difficult to service using DAT at present. Use the interactive dashboard below to explore the countries and regions where the public sector market segment is largest.
The impact of private sector care-seeking on the DAT for TB market is greatest in the South-East Asia regional market. Over 40% of persons with TB in India, Indonesia, and the Philippines are diagnosed and treated by private providers annually. In these countries, especially India, significant progress in deepening public-private sector collaboration may be necessary for the long-term development of the DAT for TB market.
There are early positive signs of interest from the private sector in all three of these South-East Asian countries. As of 2019, DAT have been adopted to varying degrees for use in TB treatment adherence by private providers. While likely limited in scope, these pioneering programs will help elucidate the path forward towards more widespread use.