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(geal pegs having tte badge) aa Cancer Treatment Industry In India bp ig ‘Cancer market in India is expected to emerge as one among the largest therapeatic segments inthe domestic kee market inthe coming years Sd YOUR LOGO HERE Contents Definition / Scope +t Dsfision Supe + Canceris a therapeutic hss 1 2atade Overien characterisd by uncontrolled cell key ees’ row, Tete ae over hind 1 stad sts sieront vate of cancer, and 15 Top Make Oppo very catogory of cance is + staae Drives itereniatd by the typeof el he 1 ota Resets is inal aod + Bind Chater + Cancer proves fo harm the body when 1 9 Testnlogy Tren alered ell divide ina deiactive + loPicng Trends Iranne fo form humps of issue or 1 Ueno Tene tissue masses called tumors which 1 zoey Marke Tends interfere and aller bodyfaneton 113 Me Sve and Forcast + Ths tht are ati abd dow 1 tt tase ook limited growth ee generally 1 Tecnology Roady considered tobe benign. Oa the ther 1 ts Disb Cain Anais hand ia tamer spreads to the pats 117 compete Landen ofthe body and advances by invading 1 is compete Fairs fd destroying other heathy tissues, 1 19 kxy Maker Pines itis said wo have mecasaszed 19.1 Fag lye of acer matin dia + Cancer maker in Indi is expected to + ISL Honan Roce AG eee as one among the lgest 1 1912s PL theapetesopment in tbe domes + 192ihdian yen canes tr rake inthe coming yet +1921 ¢piLd + Ininda a here ii in ow and 1 19.22 Dr Res Labor ed rile income counties which the 11923 Pramal Emin id Inajor reason majority of poplation +193 Key marks layer ofcncer imaging mkt in Inn cn'lfod the eaten. + 20 Ste Consion +The Indian National Caner Registry 1 a References Program (NCRP) supports number 1 22 Pere Reating of ence eit alnoat all ites 13 aspen inindia Market Overview = Oral cavity & lung cancers in men & cervix & breast cancer in females together account for 50% of eancer related deaths in India= Acconling to Frost & Sullivan, Current Oncology market in India i found tbe growing st 20% every yest and will be increasing for the coming 3-Syears, The cancer market in 2012 is valued at US$ 172m. There are many treatments available for cancer lke chemotherapy, biologics targeted therapy, hormonal therapy & Supportive therapy but among them inthe year 2012, chemotherapy occupied the highest market value of USS 104.97 m, 1 Acconding to WHO the mortality rate is found to increase from 2007 to 2030 feom 7.9 million to 11.5 mi aged population, Incidence of cancer cass is found to increase ftom 11.3 millon in2007 to 22 million in 2035, Cancer incidence, prevalence and morality rates for males and females ae given in the below table projected for 2015, accounting for death by (Graph 2-Esimated ats of cancer mortality (100s) or main cancer aged 30-69 yeas [Women) es enin —- Lmphoidan aemapaitic tod dgestve Linens. on phar Soy @ Py ne & & —— ried aD foe a a asm a) so oe ee tameny mage ase om vameo a Sie omy ‘eres tw Oataer sey so 8 SB he Saye pe ert meee Graph 1 Estimated rates of cancer mortal 1000s) for main cancer aged 30-69 years (Men as etna eesti ‘soph anya, anne Lipo avy. phar {stimsted Cancer Deaths fo 1008) rat we cunt une sare Sas ss a Prot) ts ms 197 sa sat Key MetriesMetrics Value Explanation Base Year 2016 | Researched through internet Market Risks Regulatory barriers in oncology trial procedures and compulsory licensing and patent revocation can pose to be threat tothe cancer ‘market. Increasing burden of launching new drugs, patent expries ofthe drugs and pricing structure of expensive drugs area threat tothe competitors in a fragmented market. Costs involved in infretruture end lack of suppor for requisite specialities and high gestation peri for such projects form the major to for this project. Lack of trained personnel majorly account for poor cancer treatment. ‘As they are few players who actually manufacture from India and most of the drugs are actualy imported from manufaturing sites from other counties therefore there is skyrocketing of prices which makes it les affordable forthe patients, ‘Top Market Opportunities Rising incidence of various cancer complications & blooming of various advance biological & drug targeted therapies, patent expity of bratded drugs paelled with commercialistion of biosiilar, CCommetcalization of immunotherapies & targeted therapies would reduce the restraint factors & accelerate the growth, As oncology is @ hospital based business thereby a pharma company builds a strong sales network it can tap into new opportunities Huge eap in demand and supply of treatment which makes affordability and accessbiltya problem. This huge gap presents an opportunity for hospital adminsitrators and entrepreneurs to dig into new opportunities to accomodate more number of eaner patients As there is improvement in treatment of cancer entreprenuers and administrators are finding new ways to bring the demand and supply to eulium, New opporutnties for development are majorly seen in three departments: surgical oncology, medical oncology, ration oncology. ‘New opporuinities for investment arise in early detection and prevention, More infrastructure end manpower and technological investment are the fields to invest and grow, Lions share of Investment in Cancer treatment is done on technology and equipment and thus the equipment markets said fo hold 45% of total budget spent on eancer care. In India, during the year 2001, nearly 080 million new eancer cases were estimated and this would get increased to | 22 million by 2016 8a raul of change in size and composition of population. Three top most occurring cancers namely those of tobacco related cancers in both sexes, breast and cervical eancers in women account for aver 50 to 60 percent of all cancers. Tis provides a major opportunity for developing drugs and various measures relating to this type of cancer and hence tapping the market et, Bint 2a ban ‘er Omar oeTable 6. Estimated Number of Gynaecological Related Cancers by Years - India - (2010-2020) ICD10 Site of cancer 201020152020 Vulva 1762 ‘Vagina 2.238 C53 Cervix 103821 113,138 C34 Corpus uteri 16,181 C36 Ovary ete. 33.218 C57 Other Female genital C58 Placenta C1 58Gynaecological cancers. 1 167,658 Breast Market Drivers 1 India is « populous country with increasing cancer incidence which serves as the key driver for growth of cancer market in Indi. Various advance cancer cases and huge potential for clinical research data & trained researchers with quality data offer «unique opportunity for ‘conccting research & clinical ral in different pars of the country. + Rise in awareness in people who take treatment not considering the disease as "termin patients to opt for treatment rather than ignoring i. += Rise in technology and advanced treatments with better outcomes is a key market trend. = Government as been taking many intiatves to reduce the prices of the drugs and negotiations underway with pharma companies which makes the treatment affordable and accessible to the patients. + Many cancer centers are setup to teat patents with many facilities under one roof which makes th treatment feasible, = Rise in particular number of eancer cases like Tobacco and gynaecological cancer provide the chance for pharma companies to invest in their RED, Market Restraints = Major restrsints ofthe cancer market ate unclear patent law, restrictive pricing & reimbursement policies, low patient affordability, ailing lnffastructure & insufficient government ai. Further growth of eancer market ean occur ifthe reimbursement and insurance policies are solved. 1 Detection of cancer in the first stage is crucial ut in many types of cancer ths fails as it involves huge amount of costs in screening ‘Insurance schemes like Rashtriya Swasthya, Bima Yojana, Rajiv Arigya Sri scheme often involve small part of expense incurred by patient. ‘Health insurance is another factor which hampers the growth of cancer market questioning their affordability to patents. Only 15 % of patients are covered under health insurance and majority are under insured, Average bill of cancer patients Rs 1Olakh while they average ‘mount of policy of health plan soli 1 lakh, illness" but as "treatable illness” makes the Industry Challenges = Key challenges faced by cancer market are shortage of specialized surgical & medical oncologists where thee ae only 1600 oncologists including Medical, Surgical & Radiation oncologists which in tur crestes shortage of Surgical & medical oncologists 1 There ae only 30 Regional Care Centers (RCS) & only 5-6 RCCs employ skilled & trained medical oncologists. Infrastructure facilities remain poor in India to handle high incidence of cancer. ‘Equipment used in eancer treatment i costly where particulary in india is imported from other countries and makes it available only to the rch as it involves uge costs Technology Trends ' Technological trends that impact the cancer market ate drying pipelines where lot of time & money is invested with low suecess rat in the development of new anticancer drugs. Global pharma majors spend nese!y USS 1.Sbn in India for drug tials of whieh major part belongs to cancer. Tis indicates the need to explore new methods of cancer treatment and also explore quality of life issues, stand alone day care centers" which ate equipped with all specialities needed like day care chemotherapy, diagnostic lab ete 1 Even as technology unfolds there are many centers sprouting where they provide chemotherapy, palliative care, psycho- oncology, ENAG, biopsy, supportive care to oncology treatment, blood transfusion and brach therapy, among others services. Services similar to it can deeply penetrate into other parts of country with more funding. 1 Curative treatment for cancer involves surgery, radiation, chemotherapy, hormone therapy or some other combination ofthese modalities. However, over 70% af eases in the country report for diagnostic and treatment services in advanced stages ofthe disease, resulting in radiotherapy as one ofthe main modality of treatment. 1 Considering all the sources, it is noted that there were 347 Teletherapy units (Telecobalt 258 units, Telecesium 4 units, Accelerator 85 units) and 240 Brachytherapy installations (Remote Brachytherapy 137; Manual setoss the country during the year 2007, sachytherpy 103) in 237 centres= The sate-wise distribution of Regional Cancer Centres, teletherapy units and brachytherapy installation inthe country are shown in the imicbeoe «Theda sows insane oe mar opus shes a be Techy ni re ene ae) woe «Ponce bp bursa maten hive nn do aks ge and ak of pr Hoa “Te i omy mei Tn es fe ce Pricing Trends 1 ‘There isa reduction inthe price of branded products for breast cancer, colorectal cancer, lng cancer & NHL when 348 drugs listed in National List of Essential medicines (NLEM) are included under price control regulations, which in tur atributes for slow growt of cancer market in India, 1 Increasing cost of launching new drugs also impact the market ' Further Pricing structure of expensive drugs also impacts the pricing rend in the market, where many ofthe foreign multinationals and local drug makers have changed their pricing strategy and decreased thie prices to inerease the affordability of the medicines tothe patients and also fo face the stiff competition from the generic drugs ‘Even though global burden ratio of Inia is 20% only 15% of Indian population is included under health insurance along with government supported schemes & only .2% of population is covered under private health insurance, Futher this situation indiates that 60% of total health expenditure is bore by the patient 1 Inthe year 2014, the price of Givee , anticancer tablet, has increased from 8500 to 1.08 lakh and the pre of Geftnate has increased from $900 to 11,500, 1 Power of NPPA rests with the government which in turn negotiates with pharma companies and helps in regulating prices. This move is initiated to reduce red tapism ' Government in turn expects the pharma companies to invest and spend on R&D. Regulatory Trends 1 Regulatory challenges faced by Indian cancer market include the regulatory barriers in clinical trials procedures, Even the restriction of budgets further narrows the use of new therapies in oncology. Compulsory Licensing & Patent revocation have reduced the image ofthe Indian market of having a transparent regulatory regime. = The funds for the cancer programme are maaly [rom the Government and needs tobe augmented. Private initiatives ae few and are unlikely to cater toa large population across different socioeconomic strata, as itis often nota financially viable venture Other Key Market Trends = Cost of treatment is key trend which majorly affects cacner markel, Many people who take caencer medication are people who detect cancer at late stages and are thereby burdened with huge costs of medicine, further as they cant bear the huge costs thereby discontinue there treatment, Majority of targeted medication isnot affordable by the patent which costs upto 20 Takh per patient. * The per capita income ofa patient in India is less than one developed country which makes the treatment expensive to a patient. ‘= Physicians stressing more on treatment rather than sereenng and prevention and public health programmes is another issue that affets cancer market + Oral morphine isthe mainstay for cancer pain relit and i till not widely avaiable inthe county. There is a serious limitation of ‘manpower for providing palliative eat, Market Size and Forecast ' Total market value of cancer market in India is USS 153m in 2011 with a compound annual growth rate of 12.7% from 2004, In 2012 the market is valued at USS 172m, 1 The future projected size ofthe market is valued at USS $74m in 2017 with Compound Annual Growth (CAGR) of 15.46% Market Outlook ' very year there are 28 lakh prevalent cases and § lakh new cases in India. Thre willbe a increase inthe market share of biologics & targeted therapy whieh are assumed to be the preferred treatment option to chemotherapy. Ifthe acess to quality oncology healthcare &affordability of medicine is improved to rural population then in the future it ean provide a big opporcunity for exploring public-private partnerships = Future growth segments include the therapies for eancers that affect the bran, colon, lags, white blood cells and the rectum which are identified as the most prevalent cases globally as well as in Indi, The current matket size of the drugs treating these type cancers sccounts tobe around $40 -$50 billion. Reliance Life Sciences ha introduced six anti-cancer drugs in India which fall under above said therapies Technology Roadmap 1 The cost involved in setting up a can range of Rs 6 crores to 18-19 crores basing on the work it performs = The import duty is also more and the cost ofthe surgical pat of eyber knife i 20-28 crore which is why even the latest technology is not affordable to the patents and involves mundane costs = Medical device companies don't often take into consideration the need of Indian patients which i the reason for major import of technology aad devices in India, This sin tum makes it less affordable to small players despite few suecessful initiatives which can Increase affordability of cancer sereening devices = With the advanced diagnosis onthe way cancer therapy is found to inerease with new treatment options like gene therapy, targeted therapy, proton beam therapy & radiosurgery, biological and monoclonal and polyclonal antibodies for various cancers are set to ieyprove the cancer treatment, cr unit isthe major reason for increased cost of cancer care. A linear accelerator involves cost ata Distribution Chain Analysis + Cancer rte in India has been inereasing at great momentum which is accounted due to less numberof organized national cancer screening programmes. On the other hand there is improper distribution of care providers in southern and norther states, 1 Rugged competition exists inthe markst as many foreign and local érugmakers offer generic and branded drugs after government reduced taxes & import duties t aise the affordability of cancer drugs othe patients, 1 Major players in setting up a comprehensive cancer centres are max, Fortis, Apollo. They have invested huge amount in cancer center with more than 200 crores and the grow in such centers are found to increase at 20%. Competitive Landscape '= To keep the market forces impacted by compulsory licensing & patent revocation in equilibrium the government should purchase the expensive drugs & make them available at subsidized prices tothe population, 1 Keeping on the momentum India issued its first compulsory license in February 2012 to Natco pharma to manufacture & market cheaper versions of Bayer Healthcare AG's branded lung cancer drug Nexvar (sorfenib) = Further the health ministry has also proposed to issue a compulsory license to Sprycel (dastinb), a branded patented drug of Bristol Myers Squibb Co, = Out of 20 major drugs used in cancer treatment only 3-4 players have their man medicines bie ‘= Ifmore Indian drug makers are involved then the cost of treatment by medication can be reduced. This scenario can be explained by an example where an Indian drug maker prices the drug at Rs 8000 but its foreign counterpart cost elmost a lakh. = Cancer treatment in India whea compared to UK and US is worse and also expensive due to less per capita income of person in India. turing units in India which makes the cost of Competitive Factors ‘Cancer market in India faces a tough competition due to various factors that disrupt the market The cutthroat competition is of huge concer duc to few domestic companies and all other multinationals have foot inthis segment. Decreasing prices of cancer medicines serve as serious risk to the viability segment, In this regard keeping track ofthe competition from generic drugmakers in the local market, Swiss drug maker F Hoffmann-La Roche Ld, ha slashed the prices of three key cancer drugs in India + Even the local drugmaker, Cipla Ltd, has reduced the price of ite generic drug in the third quarter of fiscal 2013, 1 Roche also followed the same strategy of reducing costs to reach the market of its agship product, Herceptin, othe patients Key Market Players ‘= Key Market Players of Indian Cancer market are the multinational companies which dominate the few domestie players ths capturing majority ofthe marketshare = Key international players inelude Roche which captures 24% share with its blockbuster drug Herceptin, breast eancer drug, Other key Jnemational players include GSK, Astrazeneca, Sanofl-Aventis 1 Key domestic players include Cipla, later Dr Reddy and Natco pharma which captured a market share of 1 Other key players include Biocon and Piramal healtheare and 5% respectively Foreign Players of cancer market in India F, Hoffmann-La Roche AG Corporate Address: Roche Products (India) Pvt Ltd, 1503, [Sth Floor, ‘The Capital’, Plot no. C-70, Behind ICICI Bank, BKC, Bandra (E), “Mumbai 400051 Telephone number:+91 (22) 33941414 Fax number: ~91 (22) 33941054 Website: htp:lwwwroeheindi.com) ‘Year of incorporation: 1896 Ticker symbol: ROG. VX Stock Exchange: 238.60 CIIF Products and services: Healthcare and BiotechnologyKey people: Founder: Fritz Hoffinann-La Roche CEO : Severin Schwan Chairman: De Christoph Franz Key Business Segments: Oncology, Transplantation, Angemia, Rheumatoid Arcritis Corporate Address: GlaxoSmithKline Pharmaceutials LimitedDr, Annie Besant RoadWorliMumbsi- 400030 Telephone number: +91 22 24959595 Fax number: +91 22 2495 9494 Website: hip:/www.gsk-india.com! ‘Year of incorporation: 1924 Ticker symbol: GSK Stock Exchange: 1,385.000BX Key people: Chairman: Sir Philip Hampton: CEO: Andrew Wity Key Business Segments: Prescription medicines and Vaccines. Key Geographic Segments: Australia, America, Asia Indian Players in cancer market Cipla Lia Corporate Adress: Cipla Lt. Cipla House, Peninsula Business Park, Ganpatrao Kadam Marg, Lower Parl, Mumbsi-400013 Telephone number: +91 22 24826000, +91 22 24826701, +91 22 24826800 Fax number:+91 22 24826120 Website: htp:www.cipla.com! ‘Year of incorporation: 1935 Ticker symbol: CIPLA Stock Exchange: 528.95INR Key people: Founder: Dr. K.A, Hamied Chairman: DR. Y.K. HAMIED Vice-Chairman: MR. M.K, HAMIED Key Business Segments: API, Respiratory, Versinay, Cipla Global Access Key Geographic Segment: India, South Affica, Europe, Nowth America Dr. Reddy's Laboratories Ltd Corporate Address: Dr. Reddy’s Laboratories Lid, 82-337, Road No. 3, Banjara Hills, Hyderabad, Telangana 500034, INDIA Telephone number: +91,40,4900 2900 Website: hip: wwwdrreddys.com ‘Year of incorporation: 1984 Ticker symbol: DRREDDY Stock Exchange: 3,164.00INR. Key people: Founder: Kallam Anji Reddy CEO: G, ¥, Prasad Key Business Segments: Generics, Over-the-counter, APs, Biologics, Differentiated Formulations Key Geographic Segments: Asi, Aftica, North America, South America Piramal Enterprises Ltd Corporate Address: Piramal Enterprises Limited, 247 Business Park, A ~ Wing, 6th Floor, LBS Marg, Vikhroli (West), Mumbai 400083, “Maharashtra, India Telephone number: +91-22-309566666 Website: hup:/hwww-piramal.com/ ‘Year of incorporation: Early 1980's Ticker symbol: PEL Stock Exchange: 964,001NR Key people: Chairman: Ajay Piramal Vice Chairperson: Dr. Swati A Piramal Key Business Segments: Piramal Enterprises, Piramal Glass, Piramal Realty, Prumal Foundation Key Geographic Segments: India Key market Players of cancer imaging market in India Siemens = Philips Strategic Conclusion ' Cancer market captures a lions share in therapeutic segment of India. The market is predicted o rise in the coming years of 2017 but due to certain forces like low affordability & unorganised healthcare services the growth can't be a the rate predicted, = A large group of patients remain untapped and donot receive the medical treatment thus making the expandability of he matket dificult, If this scenario prevails then neither the patient nor the manufacturer ean benefit = 5 years ago the numberof eases disgnosed was 250 but today itis doubled that is S00 new eases which why it raises huge eoncems for ‘weatment ' Poor seategy in India where mainly physiians concentrate on treatment rather than prevention and sereening ' Public beath activites are given less importance 2k of proper health laws and national health policy which mainly hampers the eancer market in India,References = Cancer: Facts, Types and Causes. Medical News Taday hii: www: medicalnewstoday convinfo‘caneeroncology!, Published September 17, 2015, Accessed January 7, 2016 1 Livemint Reliance Life Sciences enters anti-cancer market. htp:wwwlivemint com Companics/7kAokJLbMI2vzHe71 UHHUReliance 22, 2013, Accessed January 09, 2016, + BioSpectrum india, Competition heats up in oncology market. hip: biospectrumindia.comy/biospecindi! features/1941168/competition-hots-oncology-market, Published August 27,2013. ‘Accessed january 07, 2016 + BioSpoctrum India, Indian oncology market to grow 15.46% by 2017 says report. itp: ww-biospectrumindia.comy/bispevindia eports-white-papers/IS8385indian-oncology-markel May 9, 2013, Accessed January 7, 2016. ' Cancer Scenario in India. MAX NEEMAN CONTRACT RESEARCH. butp:/www.neeman- medical com/sites/defuul ls/iles’Cancer*420in%420lndia pdf. Accessed January 8, 2016 = GBI Research, Upeoming Pharma Price War to Damage Indian Oncology Mazket Growth, lp:/gbiresearch.comimedia-centerlpress releases/upeoming-pharma-price-war-to-damage-indian-oncology-mazkel-growth, Published Apel 16,2013, Accessed Fanuaty 8, 2016 = GBI Research, Oncology Therapeutics Market in India to 2018 Inteoduction of Market-Based Pricing to Fuel Price Wats and Intense Competition Among Domestic and Multinational Players, htp/gbresearch com/report-storelmarket-reportstherapy-analysis/oncology- ‘therapeuties-marke-in-india-o-7018-itroduetion-of-market-based-prieing-to-uel-price-warsand-infense-competiton. Published Apri, 2013. Accessed January 8, 2016 ‘= Why is Cancer Care expensive in India? ETHeathworld.com. htp/hcalth economictimes indiatimes com/aewsindustrywhy care-oxpensive-in-india/46942857, Published 16 April 2015. Accessed 16 March, 2016, 1 A study of medicine pricing issues with rocommendations for improving access to cancer medication, ACC ‘TREATMENT. Published 2 May 2014, Accessed 16 March, 2016 = Cancer Economics. Express healthere,htp//archivchealthcarefinancialexpress.cony/201102/marketOl shtml, Published february 2011 Accessed 17 March 2016. 1» NAIR MK, VARGHESE C, SWAMINATHAN R. Cancer: Curent scenario, intervention strategies and projections fe entors-anticancer-market html. Published September yw-1846-2017-report Published CESS TO CANCER for 2018. p/w sear. who intindialopies/eancer/Cancer_ resource Commision_on_Macroeconomic_snd_ Health Bg_P2_Cancers_current_scenato.pd. Accessed March 23, 2016 = Murthy NS , Chaudhty K, Rath GK. Burden of Cancer and Projections for 2016, Indian Scenario Gaps inthe Availabilty of Radiotherapy Treatment Facilities. Asian Pacifi J Cancer rey, 9, 671-677. pwr. dereddiys.com! hsp gsk-ndia.com ‘ww praral.com hip: worwcipla.com! hip:iworw-rocheinda.com! = Further Reading For further reading on Market research and competion and trends kindy refer othe lis tha allows 1. Introducing Marketing Research by Paul Baines and Bal Chansarker, Wiley 2002 2. Intemational Marketing Research by C-Samuel Craig; Susan PDouglas; Wiley, 2005(3rd edition) 3. The Art & Science of Interpreting Market Research Evidence by D. VL Smith; fletcher; Wiley, 2001 4. Inside Information: Making sense of Marketing Data By D.V.L Smith; .Hfletcher, Wiley, 2001 5, Market Research matters: Tools and Techniques for aligning Your business by Robert Dubof; Jim Spacth; John Wiley & Sons, 2000) Appendix = Drug: A medicine or other substance which his a physiological effect when ingested or otherwise introduced into the body 1 Biosimilar Biopharmaceutial drug designed to have ative properties similar to one that has previously been licensed. = Red Tapism: The practice of requiring excessive paperwork and tedious procedures before official aetion ean be considered or completed, Alto called rediapery + NLEM: National List of Essential medicines = CAGR: Compound Annual Growdh = RCC: Regional Care Centers = NCRP: National Cancer Registry Programa