Thyrocare : Debt free Asset Light Healthcare Play

(Gary) #105

I had followed Dr Lal last few years and was disappointed how their business took hit when undercutting happened in their B2B business with hospitals. In fact i invested a bit in Dr Lal Knowing Mr. Mwnchanda and that has not gone anywhere.

Question - other than the difference in focus on wellness, what else sets thyrocare apart from Dr Lal. Because to my limited knowledge when it comes to diagnostic processes and control, Dr Lal is gold standard in India.

(stockcollector) #106

Thyrocare is asset light (only one laboratory and hence better capacity utilisation, 24 hour)
Dr Lal has several laboratories

Thyrocare concentrates on biochemistry and full blood count - analyzers are automated, interpretation of results does not depend on lab personnel
Dr Lal offers very wide variety of diagnostic tests - more capital and labour intensive, needs lab personnel for interpretation of more specialized tests and hence less amenable to automation

Quality - both are top class

Thyrocare diworcified into PET CT business which has not met the expectations and hence management has stopped further investments recently.

(sta) #107

IF thyrocare has only one lab then how do they transport the blood sample. More distance more spurious the results.

(stockcollector) #108

They transport samples by air freight in a temperature controlled environment. Thyrocare has internal and external quality control checks done on a daily basis - so their results will be accurate.

(phreak) #111

Does the transportation affect the quality of reports? Are the samples stable during transit?

All specimens reach Thyrocare within 12 to 48 hours’ time frame from different parts of the country in a triple packaging system as per WHO-IATA guidelines wherein the barcoded vial is the primary receptacle, the thermocol box with frozen cool packs is the secondary receptacle and the outer cardboard box is the tertiary receptacle. All specimens are not just checked for the transportation delays and temperatures but also for factors like hemolysis, clotting, samples without barcodes, leakages, lipemia, wrong vials, etc. and only those samples which pass through the pre-analytical checks are taken for processing.

Here is the source. Please do some basic research.

Disc: Invested

(weblinsolutions) #112

My father and mother got themselves tested last month with Thyrocare. They had went for a complete package comprising of multiple tests. They had went through the same tests again from a local pathology lab after 15 days which had their lab there itself. We did the same tests again as we wanted to be sure of the Thyrocare testing quality. Results were similar [10% + -] which is normal. Quality and service of Thyrocare is very good.

Disc: Not invested. Not interested due to the upcoming government regulations in this sector.

(Value Seeker) #113

For those who are invested, what is the moat they see in this company that can last many years? To me this seems like a “processor” type company with no specific pull due to brand name/ network. So, over time this will likely become commoditized with everyone playing a cost efficiency game.

Disc: Not invested

(stockcollector) #114

Please read Mridul’s post above - page 89/90 - an excellent summary

(sta) #115

Ya I am from medical background. Basic research. Glucose is measured with fluoride . But even after 1 hour delay there is a decrease in glucose content. 10% difference is massive. For HbA1C when up 5.8 it’s pre diabetic but 6.4 is diabetic. See the difference. The three box transport is basic that is used by everybody. IN periphery ask any doctor if they will trust the thyrocare results. If central lab is so economical then why are Lal path and everybody else having so many labs. And it’s well known that some well known labs get their tests done by 3rd party. IT’S common knowledge in medical fraternity.

Last. Please be a little humble.I am here to learn not to prove anybody wrong. Stay blessed

(phreak) #116

The calibration of ranges for low/normal/high vary based on testing methods and what Thyrocare specifies as the range in their test applies to numbers produced by their own tests.

(Kumar Saurabh) #117

Lalpath is one of most preferred labs in India for hep B n hep C testing. Also, though both lalpath n thyro work on central n regional hub model, for these 2 tests of hep B n C, lalpath conducts tests only in Gurgaon center. So, samples are collected from all over India and sent to Gurgaon. So, are you telling , all test outputs declared by lalpath for hep B n C might be false because none of these samples will reach Gurgaon in an hour ?

(stockcollector) #118


Doctor saab, please don’t take things personally and this post certainly is not intended to be. I am going to counter your points one by one since I don’t think you have got a clue about laboratory medicine:

Ya I am from medical background. –
But you are purely a clinician with no laboratory background and don’t know how lab science works! Vast majority of clinicians are like that except for a few who specialises in biochemistry, haematology or microbiology. Most clinicians don’t realise the importance of quality of results and accuracy etc. Most local labs still don’t have quality assurance programs in place – this is costly and recurring exercise and hence skipped by most labs.

Glucose is measured with fluoride . But even after 1 hour delay there is a decrease in glucose content. 10% difference is massive.
Clear that you don’t know why fluoride is used. Blood is taken in a tube with fluoride in it which will inhibit glycolysis and which prevents consumption of glucose (so the sample could be stored or transported for testing later). You probably assumed the claim made by Weblinsolutions that 10% variation is true. Wrong assumption again (variation depends on the test). You are a doctor, so please do not believe the hearsay!

For HbA1C when up 5.8 it’s pre diabetic but 6.4 is diabetic
HbA1C is not measured in the same way as glucose and also 10% variation is too much variation for HbA1C. Inter-lab or intra-lab variation for HbA1C should be <3% (if more than 3% then the result from one lab is wrong and will usually be the local lab with no quality controls)

IN periphery ask any doctor if they will trust the thyrocare results
Unfortunately Thyrocare does not give kick-backs to doctors and hence they are not popular with doctors! If doctors truly care about their patients (quality of the tests/results and at a very cheap price) they should refer patients to thyrocare! Local labs (vast majority of them) quality of work is poor and their results unreliable.

If central lab is so economical then why are Lal path and everybody else having so many labs.
You should be asking this question to Dr Lal. Thyrocare has limited array of tests and Dr Lal has a wide spectrum. Thyrocare is focused and Dr lal diversified.

I am also a clinician, I also work in the lab.

(stockcollector) #119

Now the point of variation of tests results (CV is the term used in the laboratory world). This depends on the test. Some tests are either positive or negative. Other tests give you a number (quantifiable) and hence there could be variation inter-lab and even intra-lab if you test at different times.
Haemoglobin for example the variation should be <1.5%
Platelet count variation could be <4-6%
Basophil count could be as high as 40% (absolute number is very very small and hence the huge variation)
HbA1C – CV should be <3%

(stockcollector) #120

Quality assurance – most labs skip this since expensive and not necessary (no regulatory body). When regulation eventually is implemented they will target this area first. You need to be able to believe the report.
Basically 2 kinds of quality assurance – internal and external
Internal – use either a blood sample with known values or test fluid with known values. Run the test daily and upto three times a day and the analyser should give the values within the CV mentioned above. If out of range the lab needs to check why out of range – check reagent (expiry date), check the tubes, flows etc. Change the calibration if required.

External quality assurance – a regulatory body will send sample to various participating labs and will collate the results. All the labs should be in range (with in the CV for the tests). If out of range the lab should provide an explanation for the deviation and implement corrective action. If repeatedly out of range then the regulatory body will ping the lab and in extreme cases withdraw accreditation.

Thyrocare has quality control activities in place as mentioned above

(stockcollector) #121

(weblinsolutions) #122

I wish to clarify regarding the above. There was a difference of 10% in HbA1C test between Thyrocare and Local Lab. These tests were made at an interval of 7 days and my parents reduced the intake of sugar in this period. So I feel that must have caused the difference in the results. Other than HbA1C all other test results were similar and little difference somewhere due to the calibration range specified. But there is a massive difference in price and quality. So I will prefer Thyrocare any day compared to the local labs.

Best regards,

Disc. Not invested.

(stockcollector) #123


HbA1c does not change in a matter of 7 days. The recommendation is to test HbA1C every 3 months(because HbA1c measures glucose bound to the haemoglobin, RBC/haemoglobin life span is 3 months and hence the value changes only very slowly). Glucose does change on a daily basis but not HbA1C. So one lab is wrong either Thyrocare or local lab. I would say your local lab’s HbA1c is wrong!


(weblinsolutions) #124

Thanks for sharing your knowledge. I will ask my parents to test for HbA1C again from Metropolis or Suburban to confirm.

(sta) #125

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(stockcollector) #126

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