Read our 15 August 2013 update to this sign-on letter
Dear Mr Hain,
We wish to bring to your attention our concerns about the preferential price established for the new version of the Genotype® MTBDRplus (version 2). The preferential price, which has more than doubled compared to the old test, represents an unacceptably steep increase, which will have serious consequences on the budgets of TB projects. We believe common sense changes to the pricing scheme could reduce prices while ensuring Hain earns a fair return for its investment.
Worldwide, MDR-TB is being increasingly recognised as a public health emergency. Access to rapid DST represents a critical tool for the implementation of successful TB control programs. The drastic increase in price for Genotype MTBDRplus will introduce a barrier to diagnosis and treatment of TB.
In prior conversations, the company has justified the price increase for three reasons. These justifications are not satisfactory.
Firstly, your company has indicated that a price increase is justified due to significant technological improvements in the follow-on version of the test. We acknowledge these improvements on the new version of the test, including improved performance of the test on smear negative specimens, inclusion of DNA polymerase enzyme in the amplification mix and improvements on reagent stability. The most relevant added value of these improvements could be the better performance of the test on smear negative specimens. National TB programmes and most NGOs, however, can not exploit this improvement since WHO policy still recommends use of Line Probe Assays for smear positive specimens only, and to our knowledge there are no plans to revise these recommendations in the near future.
Secondly, your company has justified a higher price by bundling the cost of the test with installation and training. We disagree with this pricing arrangement. As stated on the FIND website, the prices for the assay include training and installation costs (in addition to a separate maintenance and service contract for the instrumentation). The pricing should be transparent.
This pricing is also unnecessarily expensive – installation only happens once and training needs and services costs will differ significantly from site to site. We agree that that there must be mechanisms that guarantee rapid and efficient access to training and technical support services, but adding services costs to each order is not necessary. If a need for further training and frequent technical support is identified, customers should be given the option to agree on additional services separately and costs should be included in service contracts rather than into the price of reagents.
Thirdly, your company has indicated that insufficient volume requires higher prices to recuperate costs. We agree that the 3.50 euro per test price for the first version needed to be revised and recalculated based on a more realistic volume. Improving demand forecasting and take-up is a worthwhile goal and should be used to mitigate your risk. However, integrating unnecessary training and services into the cost of the diagnostic to safeguard against low volume is not appropriate. We are ready to work with Hain to identify ways to improve demand forecasting and volume, but only if the price of the diagnostic can ensure uptake.
In the light of the facts stated above we urge Hain to reconsider its pricing strategy and
1. make the pricing of Genotype® MTBDRplus (version 2) more transparent
2. separate the costs for service from the cost of the reagents
3. lower the price for Genotype® MTBDRplus (version 2) to a level that ensures access to this technology in poor countries
We commend Hain for developing a new version of the test. However, unless the technology is affordable, it cannot make a difference in the lives of people suffering from MDR-TB. The budgets of non-governmental organisations and national TB programs simply cannot afford this price. We hope that Hain reconsiders its approach to pricing.
Best regards, Manica Balasegaram, Executive Director, MSF Access Campaign
The Global Tuberculosis Community Advisory Board (TB CAB)
Polly Clayden, United Kingdom
Alberto Colorado, United States
Colleen Daniels, United States
Mike Frick, United States
Sergey Golovin, Russian Federation
Mark Harrington, United States
Giselle Israel, Brazil
Bactrin Killingo, Kenya (ITPC - East Africa)
Blessina Kumar, India (also on behalf of the India CAB)
Erica Lessem, United States
Lindsay McKenna, United States
Natalia Sidorenko, Russia
Khairunisa Suleiman, South Africa
Ezio Tavora dos Santos Filho, Brazil
Wim Vandevelde, South Africa
UNITAID Board Members
Nelson Otwoma, UNITAID board member representing Communities living with the diseases, National Empowerment Network for People Living with HIV/AIDS in Kenya (NEPHAK)
Prof. Brook Baker, Alternate NGO Board Member UNITAID, Health GAP, Northeastern University School of Law
Dr Tido von Schoen-Angerer, NGO Board Member UNITAID, Health Action International\
Organisational Endorsements
Adele Reproductive Health Foundation, Cameroon
Advocates for Health International, US
Afrihealth Information Projects/Afrihealth Optonet Association, Nigeria
Afro Global Alliance, Ghana
AIDS Policy Project, US
AIDS Law Project, Kenya
Aktionsbündnis gegen Aid/Action Against AIDS, Germany
Asia Pacific Network of People Living with HIV (APN+)
Association African Solidarité (A.A.S), Burkina Faso
BUKO Pharma Kampagne, Germany
Cameroon TB Group
Center for the AIDS Programme of Research (CAPRISA), South Africa
The Centre for Health, Human Rights and Development (CEHURD), Uganda
Coalition PLUS, France
CONERELA+, Democratic Republic of Congo
East, Central & Southern Africa Health Community (ECSA HC), Tanzania
East African Health Platform (EAHP)
Eastern Africa Network of National AIDS Services Organisations (EANNASO)
Ethiopian Drug Information Network
The Good Neighbour, Nigeria
Forum Francophone de lutte contre la tuberculose (FFTB), Burkina Faso
Foundation for Integrative AIDS Research (FIAR), US
German Leprosy and Tuberculosis Relief Association (DAHWA), Germany
Health Action International, Netherlands
Health GAP, US
HIV i-base, UK
Hope Care Foundation, Ghana
International Civil Society Support (ICSS), Netherlands
Interagency Coalition on AIDS and Development (ICAD), Ottawa
International Treatment Preparedness Coalition (ITPC)
International Treatment Preparedness Coalition (ITPC) East Africa
INTERSECT Worldwide - US, India, South Africa
Initiative for Social and Economic Rights (ISER), Uganda
Kenya Hospices and Palliative Care Association
Mission Clarite. Cameroon
National Empowerment Network of people living with HIV/AIDS in Kenya (NEPHAK)
National TB Reference Laboratory, Ministry of Health and Child Welfare, Zimbabwe
ORISADE (Organisation Internationale Santé et Débeloppement), Cameroon
Partners in Health, US
People Welfare Services, Cameroon
PROCLADE, Cameroon
Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, US
Results Australia
Results UK
Section 27, South Africa
South Africa Medical Research Council, Clinical and Biomedical TB Research Unit
Stop AIDS Campaign, UK
South African HIV Clinicians Society
Stop TB Forum, Germany
Stop TB UK
Stop TB USA
Treatment Action Group (TAG), US
Wellbody Alliance, Sierra Leone
Wote Youth Development Projects Makueni, Kenya
Zimbabwe National Network of PLHIV