Why Delhi’s private labs conduct fewer CBNAAT and TrueNAT tests despite ICMR push

ICMR had revised its guidelines in May and pushed for a variety of Covid tests, including TrueNAT and CBNAAT systems, which are easily available across the country.

Representational image | T Narayan | Bloomberg

New Delhi: Months after the Indian Council of Medical Research (ICMR) allowed CBNAAT and TrueNAT tests to detect Covid-19 due to their easy availability, most private labs in the national capital are still opting for the RT-PCR test over the other two in view of pricing and capacity issues.

ThePrint spoke to several of the 45 private facilities in Delhi that are conducting Covid tests — amid a total of 68 labs in the city, according to the ICMR. Of these 45, seven are exclusively conducting TrueNAT tests, six are performing only CBNAAT tests and the remaining are primarily RT-PCR labs, but are equipped for the other two kinds of tests as well.

Asked about their preference for RT-PCR tests, the private labs said CBNAAT and TrueNAT tests are far too expensive, given the Rs 2,400 “price cap” imposed by the Delhi government, even though they yield results much faster than RT-PCR, which is considered as the gold standard for testing.

The labs also said that these two tests run only up to 25 samples at a time while RT-PCR has a capacity for 90 samples. 

This choice comes despite ICMR’s revision of its Covid testing guidelines and push for a variety of tests. The central agency said TrueNAT and CBNAAT systems have been deployed due to the availability of customised cartridges, which form the basis of these tests, and are easily available across the country.

As of Thursday, Delhi has recorded 230,269 Covid cases and 4,839 deaths.

What CBNAAT and TruNAT cost, and what labs are charging

CBNAAT, TrueNAT and RT-PCR are all molecular tests with similar levels of accuracy in detecting SARS-CoV-2, but all three use different machines and kits.

While the first two systems are faster than RT-PCR, with a turnaround time of just 30 minutes to two hours as compared to six hours for the latter, labs ThePrint spoke to said CBNAAT and TruNAT tests cost well over Rs 3,000 while RT-PCR tests are available for less than Rs 2,000.

“According to my calculations, doing the CBNAAT test costs us Rs 3,150 because that is how much the kit costs. But the government has put a price cap of Rs 2,400 on these tests, so it is expensive for us to do it,” said Dr S.C.L. Gupta, medical superintendent, Batra Hospital.

In an order dated 18 June, the Delhi government capped RT-PCR test prices at Rs 2,400. Most labs are charging the same price for CBNAAT and TrueNAT too, even if it is unprofitable to do so, because the “test is the same”.

“TrueNAT is simply another modality of the RT-PCR test so the ceiling applies here as well,” said Dr Vinay Yadav, who works at the Indian Spinal Injuries Centre, which is conducting TrueNAT tests for in-house patients. 

However, two labs — Apollo Indraprastha and Akash Path Labs — are charging more for the CBNAAT tests.

“The technology is imported, and so it costs more to do this test. That’s why we charge more,” said Dr Rajesh Chawla, pulmonologist at Apollo, which is charging Rs 4,500 for these tests.

Even the made-in-India TrueNAT test is more expensive than the RT-PCR, doctors say, because of a two-step confirmatory process that is absent in the other molecular tests for Covid.

“Currently, the Covid-19 detection chip costs Rs 1,340 with taxes, and if it shows a positive result, labs will have to purchase a confirmatory chip that costs another Rs 1,100,” said Sanjay Mittal, a representative of Molbio Diagnostics, the company responsible for producing TrueNAT Covid-19 detection chips in India.

“Soon we will be releasing a chip for Rs 1,000, which won’t need a two-step verification process and will be more economical for labs,” he said.

Dr Narender Saini, who runs Saini Diagnostics in Shahdara, and uses the TrueNAT machine for Covid testing said, “A bulk of tests are coming out positive these days, which means the cost of running the test is much higher than the RT-PCR. The only advantages of this test are that the results come faster. Otherwise we are just doing a public service.”

RT-PCR cost

When the pandemic first hit India, RT-PCR tests were capped at Rs 4,500 because the components of the test, such as reagents, dyes and the machine, were expensive and had to be imported.

Doctors say the cost of conducting the RT-PCR test has since reduced due to more competition and indigenous production.

“Now, it costs about Rs 1,000 to Rs 1,500 operationally for us to run RT-PCR tests. The CBNAAT, in comparison, is much higher — over Rs 3,000,” said a doctor at Max Healthcare’s microbiology department who didn’t wish to be named.

Limited sample space

Along with the cost factor, labs also said that the limited sample size of CBNAAT and TruNAT tests make them less useful. 

“TrueNAT machines can only take a maximum of 25 samples a day. While it takes 30 minutes to 2 hours to finish the test, we can only run up to 20 samples in a day. That’s why we are only running TrueNAT tests for in-house patients when we need the results fast,” said Yadav. 

CBNAAT also has the same sample space while RT-PCR can run up to around 90 samples. As a result, several private labs are not even running these tests despite having the machines.

“While it is a quicker test, less number of samples are tested at a time. We are only doing RT-PCR tests now, because at a time we can test 96 samples which is allowing us to do around 400 samples a day,” said Dr Shalley Mahajan, who runs Mahajan Imaging Pvt Ltd. 

Emergency use

The labs added that CBNAAT and TrueNAT tests work better in emergency situations where results are needed fast.

“It’s more of a point of care test in hospitals in gynaecology or orthopaedic departments due to its fast turnaround time but otherwise the RT-PCR test is considered more feasible,” a doctor at Sterlis Accuris Diagnostics Pvt Ltd said on condition of anonymity.