Price, Quality, and Market Dynamics of Malaria Rapid Diagnostic Tests: Analysis of Global Fund 2009–2018 Data
Abstract Background: Rapid diagnostic tests (RDTs) for malaria are a vital part of global malaria control. Over the past decade, RDT prices have declined, and quality has increased. However, the relationship between price and product quality and their larger implications on the market have yet to be characterized. We sought to use purchase data from the Global Fund together with product quality data from the World Health Organization and Foundation for Innovative New Diagnostics (WHO-FIND) Malaria RDT Product Testing Programme to understand three unanswered questions: 1) Has the market share by quality of RDTs in the Global Fund’s procurement orders changed over time? 2) What is the relationship between unit price and RDT quality? 3) Has the Global Fund procurement market become more concentrated over time?Methods: We merged data from 10,075 procurement transactions in the Global Fund’s database, which includes year, product, volume, and price, with product quality data from all eight rounds of the WHO-FIND program, which evaluated 227 unique RDT products. To describe trends in market share by quality level of RDT, we used descriptive statistics to analyze trends in market share from 2009–2018. We then applied a generalized linear regression model to characterize the relationship between price and panel detection score (PDS), adjusting for order volume, year purchased, product type, and manufacturer. Third, we calculated a Herfindahl-Hirschman Index (HHI) score to characterize the degree of market concentration.Results: Lower-quality RDTs have lost market share between 2009-2018, as have higher-quality RDTs. We find no statistically significant relationship between price per test and PDS when adjusting for order volume, product type, and year of purchase. The HHI was 3,570, indicating a highly concentrated market.Conclusions: Advancements in RDT affordability, quality, and access over the past decade risk stagnation if health of the RDT market as a whole is neglected. Our results suggest that this market is highly concentrated and that quality is not a distinguishing feature between RDTs. This information adds to previous reports noting concerns about the long-term sustainability of this market. Further research is needed to understand the causes and implications of these trends.