Asia-Pacific diagnostic technologies are key to advancing the health-related SDGs

We are halfway through setting our ambitious Sustainable Development Goal 3 (SDG3) for good health and well-being by 2030. While many agree that we are making progress towards this goal, no one can see that we will face major disruptions from a pandemic.

Measures to slow the spread of COVID-19, along with additional pressures on health systems, have hindered progress towards SDG3. HIV services were disrupted and TB deaths increased for the first time since 2005. Two-thirds of additional malaria deaths in 2020 compared to 2019 were linked to disruptions in the supply of malaria services during the pandemic.

In addition to COVID-19, we also have the new public health emergency of international concern Mpox and the newly identified Langya virus. How do we make a sustainable recovery towards the health-related SDGs, ensuring that we can still make progress in other disease areas, despite another pandemic?

As we move to continue progress on SDG3, we need to incorporate the lessons of the pandemic, especially as we recognize the value of diagnostics for health care management. The concept of value and the method of measurement of diagnostic technologies are different from therapeutic medical devices or pharmaceuticals.

Accurate and timely diagnosis is the first step in the health care journey, as it guides clinicians in subsequent decisions and is critical to successful treatment. Although test results influence up to 70% of clinical decisions, tests account for less than 1% of healthcare spending.

Testing and diagnostic testing are often overlooked, but play a central role in health systems, allowing for greater focus on measuring success through disease treatment outcomes rather than prevention. and disease management.

A recent APACMed article on strengthening health systems through diagnostics shares several case studies of the value brought by diagnostic technologies in the Asia-Pacific. There is a critical need for greater integration of diagnostic tools in health systems, as well as an underlying shared recognition of the value of medical diagnostic technologies, in addressing population health needs. To do this, you must:

Maximize resources for diagnostic solutions

The proportion of the population with undiagnosed conditions represents a diagnosis gap of up to 62%, the largest gap along the care pathway. Only 19% of people in low- and middle-income countries (LMICs) have access to screening.

Not diagnosing patients is a missed opportunity to take preventive measures or treat diseases before they progress to a later stage. Not only can accurate diagnostics dramatically improve patient outcomes, they can also reduce health care system costs of aggressive late-stage treatments. About 1.1 million premature deaths in LMICs could be prevented each year by reducing the diagnostic gap for high-burden diseases such as diabetes, HIV and tuberculosis.

In addition, misdiagnosis, due to the poor quality of diagnostic products and services in the region, resulted in 38% of maternal deaths during pregnancy, all of which could have been prevented. Malaria, the disease most often over-diagnosed in LITIs, has a standard error rate of over 84%. The benefit-cost ratio of reducing the diagnostic gap is estimated at 24:1.

We must maximize the impact of resources by integrating diagnosis into health systems to effectively address disease prevention and treatment. One way to do this is for governments to help clinicians prioritize the greatest burden of disease by providing a readily available catalog of tests to treat the most common conditions in the population.

Rethinking protocols to incorporate health care diagnostics

There is also a need to redesign clinical protocols with an emphasis on how diagnostic technologies can improve early detection.

An example is the high level of unmet need in the liver disease continuum. Inflammation of the liver caused by viral hepatitis can turn into full-blown cancer, known as hepatocellular carcinoma (HCC). However, more than half of HCC cases are diagnosed in the late stages of the disease, when the five-year survival rate is less than 10%. Studies show that in Asia-Pacific, almost 80% of HCC cases are diagnosed at this stage.

The example of liver disease demonstrates the need for a three-pronged approach to effectively managing disease progression from the early stages of the disease to achieving the desired health outcome. It relies on the use of diagnostic tools to identify susceptibility and risk factors, early identification of patients with chronic conditions, and ultimately monitoring to identify disease progression that may potentially receive curative treatment.

Transparent investment and hedging regimes

Complex payer coverage schemes can hinder access to affordable diagnostics. An Economist Intelligence Unit report found that developing countries in Asia-Pacific finance health care through a complex mix of government funding at different levels, donor funding from external sources, as well as large direct payments by individuals. This health care funding environment complicates infectious disease screening and testing efforts. A clear emphasis on treatment rather than prevention can also be seen when health insurance schemes cover the costs of treatment more than examination or diagnosis.

Although a national disease surveillance program may cover the primary cost of national screening, it may shift the cost of needed health care human resources to underfunded local clinics. For example, in the Philippines, most TB screening products and systems are still purchased by the central government, but local governments must fund screening X-rays for high-risk groups. Local governments will have different capacities to provide this funding or may have different priorities.

Lack of clarity on who is responsible for costs associated with testing is also a common problem. A tiered model that takes into account the role of government, private sector and donor investments is needed to ensure that diagnostics remain affordable and accessible. Public-private partnerships can bring gains in population health that cannot be achieved with public sector funding alone.

There is no denying that diagnostics are changing the way diseases are prevented, diagnosed and monitored. They play an important role in providing sustainable health care around the world and helping people live longer, healthier lives. While COVID-19 has certainly put diagnostics in the spotlight around the world, the power of diagnostics goes beyond this disease.

As a healthcare community, we now have the opportunity to collectively upgrade our infrastructure and capabilities – to ensure that we are all effectively equipped to care for our patients not only now, but for the future. generation.

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