DAT products are increasingly used around the world in a variety of income settings to assist patients diagnosed with TB in adhering to medication regimens. This emerging market is an exciting development within the Global Health field and of interest to a wide range of stakeholders but currently not well understood and quantified. Through the process of market sizing, the ASCENT project aims to analyze and communicate key trends and opportunities in the global DATs for TB market.
Note: This work only explores potential use of DAT for one health condition – infection with TB. Other use cases for DAT are well-established and would increase the overall DAT market size but remain outside the scope of this analysis.
How big is the total DAT for TB market? Where is it concentrated?
There are many ways to define the global DAT for TB market and estimate its size. Theoretically, every person infected with TB has unmet need for treatment adherence support through use of DAT. Hence, the most logical starting point is by defining the market as the annual global incidence of TB, which is the total number of people who experience a case of active TB in a year. In 2019, this was estimated to be ~9 million people.
A significant portion of global TB burden is in Asia, a geography which encompasses the WHO regions of South-East Asia and Western Pacific. Here, 4 of the top 5 countries by annual incidence in the world are found (India, China, Indonesia, and the Philippines). As decision-makers in high-burden countries push to meet targets set in the United Nations Sustainable Development Goals (SDGs), demand for innovative digital solutions to improve treatment adherence will continue to grow. We anticipate that National Tuberculosis Control Programs (NTPs) in these Asian countries will be major drivers in the long-term development of the DAT for TB market, and their procurement strategies may reshape the landscape of DAT manufacturing for TB and other health conditions (ex: management of non-communicable diseases), which is currently more concentrated in high-income, western countries.
The DAT for TB market in Africa is also substantial in aggregate. Annually, ~2 million cases of TB occur in the region. However, potential demand is more widely dispersed across countries relative to the Asian market. Additionally, infrastructural constraints such as limited cellular network coverage and internet access limit the applicability of many existing DAT products. These constraints will be explored in greater detail in later sections.
Use the interactive diagrams below to explore the distribution of global TB burden across countries and WHO regions. Select WHO region(s) in the bar chart to apply filters on the map. Hover over elements to review data in detail.
How much of the potential DAT for TB market is currently addressable?
In practice, not all persons infected with TB can use DATs (as currently designed) to address their need for treatment adherence support. To use most commercially available DAT, a person with active TB must be:
- Diagnosed with the disease
- Able to obtain appropriate medication to initiate treatment
- Have access to information and communication technologies (ICT) such as a cellular network or internet and/or feature phone or smart phone
Data exists to factor in these constraints, in order to narrow in and enumerate potential DAT users for TB treatment adherence. We illustrate this calculation process, through which we arrive at the addressable market size for cellphone-based DAT (4.6 million) and smartphone-based DAT (2 million), in the Sankey diagram below.
In the tabs below, we explore different factors which constrain the size of the addressable DAT for TB market, and analyze implications.
How does case detection affect addressable market size?
As illustrated in the figure below, the rate of case detection is not uniform from country to country, even within the same region. Generally speaking, health systems in high income countries tend to face much fewer cases of TB but have sufficient resources and capabilities to diagnose the vast majority. Conversely, health systems in lower income countries tend to face high TB burden but lack the resources and capabilities to achieve high case detection. In certain countries, such as Nigeria where TB case detection is below 30%, the TB burden potential addressable by DAT is greatly restricted.
Collectively, health systems around the world diagnosed roughly 2/3 of global incident TB cases. We estimate that ~5.8 million cases are potentially addressable by the global DAT market. Regionally, the drop-off between TB burden and diagnosed cases is most significant in Africa and South-East Asia, the two highest burden regions. Currently, we estimate that 58% and 72% of TB burden in these respective regions are potentially addressable by DAT.
How does access to ICT affect addressable market size?
There is a wealth of different designs within the DAT market, leading to a great variety of form factors and user experience. A key design consideration is the method by which adherence data collected by the device is transferred. Common approaches include using the internet, or via mobile networks using device-integrated SIM cards, feature phones, or smartphones.
For users in high income settings where access to Internet and Communications Technologies (ICT) is generally high, this design choice may seem immaterial. However, the picture is different in many lower income settings where TB burden and the need for effective DAT products are higher. For example, in India, the country with the highest TB burden, cellphone ownership is currently <70% and smartphone ownership is <30%.
Globally, in 2019, we estimate that ~4.6 million patients diagnosed with TB had access to cellphones, of which ~2 million had access to smartphones. More than 1.2 million patients diagnosed with TB currently lack ICT access altogether.
Market size constraints in detail