Homely Diagnostics

Out of a population of one billion, I don't think there will be more than 50,000 people in India using home diagnostic kits," suggests S P Chandrashekar, general manager and country head, Lifescan (a Johnson & Johnson subsidiary). "Consider this in the context of the 3-crore diabetics in India," he adds. Chandrashekar, whose company has been trying to convince consumers to buy blood-glucose monitoring machines since late 1998, is not alone in his grievance. R H Chandwani, a pharma stockist, was the biggest distributor of diagnostic kits till 1995, before he gave it up altogether. "Institutional sales contribute to volumes but government hospitals in the country are themselves not quality conscious and use cheap substitutes," he complains.

 

Blood-pressure, diabetes and pregnancy make up the three chief categories that have been addressed by marketers for consumer kits (HIV is another one, but is currently not represented in India). The factors that determine whether a home diagnostic kit for something holds potential are:

* it should be amenable to home testing. Minimal mixing, storing or use of reagents should take place. The kit should be easy-, and ready-to-use.

* the kit should be for an ailment that calls for continuous monitoring. No patient will invest in a kit that which addresses testing every two to three months or so.

* the price should not be high.

In this context, both pregnancy and diabetes kits score high, more or less. "Diabetes and pregnancy are two areas with great scope for home diagnostic tests," agrees a pharma executive. Look at the sheer numbers on pregnancy now. A 1995 NCAER survey pegged incidence of pregnancy at 29.3 per 1,000 women. "Roughly 30 per cent of India's population will be in the child-bearing age (16-45 years)," says this executive from a leading pharma company. Not a surprise then that new entrant Unipath, a Unilever subsidiary, has pegged the market potential at 210 million people. Current sales, however, hover at close to 2 million kits (branded OTC kits; and this includes a high level of repeat purchase).

"The population explosion is taking place at the lower end of the market," remarks the pharma executive. "But the kits cannot be brought by the people who need it most." It is not just price though. It is a mixture of consumer attitudes and doctor interest too. Doctors are reluctant to let go of the lucrative 'testing' business from their hands. Patients are routinely referred to pathological labs for the simplest of checks. Consumers, putting almost their entire faith in doctors, shun self-tests. Pregnancy, in fact, carries much more of a cultural roadblock. But price has the habit of spoiling the best-laid of plans because of the import component. Most kits are imported, thereby incurring a duty of 50 per cent or more.

Ranbaxy was one of the prominent victims of high customs duty. The company had launched Earlie Icon, a pregnancy-testing kit, in 1987. Sourced from the US under an import duty of 64 per cent or so, its sale price to pharmacies was in the region of Rs 100. "It was pretty much priced out of the market," recalls an executive. It struggled amongst cheaper, locally-assembled competitors before withdrawing from the market.

So what makes Lifescan and Flora Finin, the Delhi-based distributor for Unipath, so optimistic?

Hello doctor

Lifescan, for starters, finished its first year with sales of Rs 10 crore in a market which was all worth Rs 16 crore when it entered. "The spurt in growth will happen," promises Chandrashekar. "But it will take about two to three years."

For Lifescan, price is a big factor. One Touch Basic, the machine that it markets, sells at Rs 3,850 (almost Rs 1,000 less than its launch price). "It is still expensive," he believes. And this week, J&J is launching One Touch Basic Plus. Like its predecessor, this sugar-count measuring kit reads a blood sample in about 45 seconds, but can also store records of 75 blood tests. Its contents can be downloaded on to a PC, so the doctor needn't search for a patient's logbook. The price: Rs 4,500.

If the price makes customers think twice before buying it, the fact that Lifescan is reluctant to advertise it makes it even difficult for consumers to consider it in the first place. This is a trend that's affecting the entire OTC market. As soon as a product, like Crocin paracetamol tablet, is advertised, there is a fear of doctors not prescribing it. Ditto for home diagnostics kits. "Doctors fear that their territory is being treaded upon, and so they start prescribing competitive brands," explains an analyst.

There is another interesting fall-out. "In some areas close to big cities and even in some remote areas of big cities, many One Touch kits have been bought by doctors," believes Chandrasekar. Doctors thus make easy money on tests. Out of One Touch's total sales, nearly 60 per cent are accounted for by doctors. But the company dare not bypass the doctor. "The role of a doctor is critical for us," affirms Chandrashekar. "But unfortunately, doctors are not willing to let go of the diabetes-testing business out of their hands." As a result, he says that only about 400 diabetologists would recommend a One Touch test to patients. This has been helped by the many CMEs (continuous medical education programmes) that the company has been conducting for doctors.

My own doctor

Which is why doctors form an integral part of the adopted by Flora Finin which has secured the distribution rights for two products from the UK-based Unipath. The company has recently launched two products in India - a pregnancy-testing kit called Clear View and an ovulation-testing kit called Clear Plan.

The Indian market for pregnancy kits can be cleaved into two parts - prescribed and OTC. Brands like Velocit (from Dr Reddy's) and Pregcolour (from Infar) sell over the counter in the Rs 40-60 price band. At Rs 150, Clear View is certainly costlier than the competition. This, says Anil Sharma, director, Flora Finin, is due to the 68 per cent duty that imported ready-to-sell medical diagnostic kits attract. What makes Sharma confident even then is the product's claimed technological superiority. Like it can detect pregnancy on the very first day of a missed period, it is 99.7 per cent accurate, tests can be conducted at any time, and so on. Besides the OTC brands, Clear View surely competes with the Elisa test that most neighbourhood clinics thrive on. "This costs between Rs 60-110, but takes longer to confirm," says a company spokesperson. "But think of the anxiety levels as you wait for the tests, the travel to and fro versus the convenience of conducting the test at home."

While internationally, home kits rise in popularity over in-clinic testing, awareness in India is still low, and has barely touched the tip of the whole market potential. Flora Finin, like Lifescan, won't be promoting the brand to consumers. In Stage One, the company plans to garner doctor endorsements by showcasing the products. The OTC route, with attendant promotions, will be employed only once doctors are strongly behind the brand, and are recommending it. So a 15-people sales team is meeting chemists and doctors across the four metros. "We are trying to create awareness slowly and subtly," says Sharma.

So it is sponsoring seminars for gynaecologists, in addition to MR visits. Once the doctors are won over, it will switch to advertising. The brand is already present in Delhi and Mumbai. Over the next six months, it will enter other metros and should be selling nationally by year-end. By the end of 2001, Sharma wants the product to be available across the five SAARC countries. By its fifth year, the company aims to sell 20 lakh kits a year.

Much will depend on how much awareness both companies can bring to these nascent markets. It will also be governed by how soon how many doctors can let go of testing from their hands, may be even due to external factors like the entry of insurance firms. But more than anything, the market will see a spurt the day consumers begin to place some of their faith in the doctor on to an impersonal meter.