Eyes on the Prize

One popular idea among the global health policy wonks is that offering big cash prizes will “incentivize” companies to develop products for global health diseases, and back in March, the Gates Foundation-funded think tank, the Center for Global Health R and D Policy Assessment (CGHRDPA), part of the Results for Development Institute consulting company (R4D), issued the final version of its assessment of this concept (Prizes Report).  As did others, I submitted my input to the draft version (my posting of 12/9/10) and think that while prizes may work to stimulate solutions when the problem is well-defined and the sponsors don’t specify how the solution will be implemented (which they can’t but do anyway), there are better ways, for example, through broadly dispersed early-stage investment and creating an assessable potential for future revenue.  I mention this report because the authors use the development of a diagnostic for tuberculosis (TB) as a case study (a not-for-profit group had proposed offering a $100 million OPM [other people’s money] prize) and because, being a technology geek, I noted a recent announcement of a new TB diagnostic test in development.

At the end of last month, Epistem Ltd., a publicly-traded company based in Manchester, UK, announced that it and Xcelris Genomics, of Ahmedabad, India, had initiated a collaboration in which the companies will evaluate Epistem’s GeneDrive system for diagnosing TB under India’s Revised National Tuberculosis Control Programme (Epistem Press Release).  Interesting in a number of ways.  First, Epistem is not really a diagnostics company; its three main business lines are:  contract research for drug discovery, early-stage therapeutic discovery and development (250 leads in its bank), and biomarkers primarily for cancer using gene expression in epithelial cells taken from a single hair sample (Epistem).  It evidently developed the GeneDrive system to support its biomarker business (there’s not much about it on the company website).  As described in an April, 2011, article in PCR Insider, an online magazine (PCR Insider article), GeneDrive is a fully integrated, PCR-based platform weighing just over 1 lb. with a small size, “a little smaller than an iPad,” a 25-minute read time, an integrated sample and reagent consumable cartridge, battery-capability (12V DC), low price ($400 for the box and $0.50 for the cartridge), and simple controls, all features that make it a suitable for low-resource settings.  Evidently, Epistem sees a business opportunity in low-cost, point-of-care (POC) diagnostics for global diseases and put five years into developing this technology.  As noted in the press release, “Positioned as a handheld ‘consumable’ device, GeneDrive brings a new ‘Point of Need’ approach to diagnostic testing across a broad spectrum of infectious diseases such as TB, Dengue and Sexually Transmitted Diseases (STD’s).”  Astute readers will recognize the contrast in the cost to use the GeneDrive system and the recently “launched” XpertÒMTB/RIF test for confirming TB and identifying drug-resistant strains.  The latter was co-developed by the Foundation for Innovative New Diagnostics, Cepheid, NIH, and the Gates Foundation, at a cost of many millions, and uses a machine priced at $17,000 and $17 per cartridges (my posts of 1/6/11 and 1/13/11).

So who is Xcelris Genomics and what is their interest?  Xcelris did not issue a press release, but, according to its website (Xcelris), its main business is serving India’s growing pharma, biotech, and academic research sectors, primarily by providing gene sequencing services and custom oligonucleotide synthesis (Xcelris Services).  It is privately held and is part of Abellon Business Group which runs four businesses including Xcelris and two social initiatives (Abellon).  And, interestingly and laudably, seems to be a socially-repsonsible, multiple bottom line company:  “Through its presence in sectors such as clean energy, agriculture and genomics research, Abellon aims to create businesses that provide financial inclusion to the ‘bottom of the pyramid’, preserve the environment, even while generating a good economic return on capital” (Red Bricks Education).

The other player in this unfolding drama is the Revised National Tuberculosis Control Programme (RNTCP), “revised” about 10 years ago because the first version wasn’t working, but now is a model for a government-run TB control program that now covers all of its 1.2 billion citizens.  Although I could not find details, I am assuming that the RNTCP is providing sites and support for field tests of the Epistem/Xcelris system and is interested in a better, cheaper way than microscopy to diagnose TB.  Based on the RNCTP’s most recent report (2010 4Q Report), it examines about 1.8 million samples a quarter, and so my guessimate is that an contract with the RNTCP would be worth about $3.5 million annually in consumables to Epistem, not bad for a entry market.

With a bit of hard work and luck, Epistem and Xcelris may succeed in commercializing a low-cost, easy-to-use, POC diagnostic for TB in two years, with the prize being sales of its product in India (and, maybe sales in the “developed world” where we can use all the cost-saving diagnostics technology we can get).  No elaborate prize program needed, just a market and years of clever engineering.

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