|
|
Stakeholder Insight: Hepatitis in China - Liver Let Die?Published by: Datamonitor Published: Dec. 21, 2005 - 310 Pages Table of ContentsTABLE OF CONTENTS CHAPTER 1 EXECUTIVE SUMMARY 3 Scope of the analysis 3 Datamonitor insight into the Chinese Hepatitis B & C market 4 China is undergoing an economic boom, generating 12% of global economic trade, and it is currently the leading recipient of foreign investment. Since 34% of the world’s chronic hepatitis B patients and 24% of the world’s chronic hepatitis C patients live in China, the Chinese hepatitis B (HBV) and C (HCV) markets have historically represented a significant growth opportunity, with a realistic current valuation of $1.0 billion (HBV) and $0.9 billion (HCV). However, the Chinese healthcare system has been ranked 144th out of 191 by the WHO, prompting it to be denounced as one of the most unfair systems in the world. These problems, together with the inability of many patients to afford these drugs and concerns over their efficacy in Asian patients, are retarding Western pharmaceutical penetration. 4 Chinese physicians indicated that HBV incidence is decreasing and is set to continue to fall. In contrast to the seven major markets, where most patients acquire HBV sexually, the dominant route of HBV transmission in China is perinatal transmission, which increases the likelihood of becoming immune tolerant and impacts on HBV disease progression and the effectiveness of drug therapy. In China, physicians do not consider any of the currently available therapies a gold-standard, although lamivudine is the most prescribed first-line therapy, while adefovir is the most prescribed second-line therapy. 4 Chinese physicians indicated that HCV incidence may be increasing. Blood transfusion is thought to be the dominant HCV transmission route in China, while in the seven major markets, HCV is mainly acquired through intravenous drug use. The Chinese HCV treatment market is highly fragmented, with treatment differing significantly between regions. For example, in Hong Kong, all HCV patients receive pegylated interferon/ribavirin combination therapy, currently considered the global standard of care. However, across mainland China, unmodified interferons are more commonly prescribed than pegylated interferons, and interferon monotherapy is more frequently used than interferon/ribavirin combination therapy. 4 Due to the high cost of pharmaceuticals and the cost-conscious nature of the Chinese healthcare system, the hepatitis market faces a number of threats, including TCMs, generic drugs and counterfeit drugs. 5 Similar to the seven major markets, efficacy is the most important factor driving HBV and HCV pharmaceutical prescription in China, with cost and reimbursement in second place. Interestingly, the side-effect profile ranked third in China, while this factor ranked second in the seven major markets. 5 CHAPTER 2 COVERAGE 15 Coverage of the Stakeholder Insight Survey 15 CHAPTER 3 CHINA: AN OVERVIEW 16 Overview of China 16 Country profile 17 Economy 17 Shift from a centralized to a market economy 17 Benefits from World Trade Organization (WTO) membership 19 China: still a restricted society? 21 Healthcare in China 21 The current scenario 21 Symptoms of an ailing healthcare system 24 The urban-rural divide 25 Reforms on the horizon? 26 Economic potential of the Chinese healthcare market 27 Drug approval in China 28 China’s pharmaceuticals market 28 China’s biotechnology market 30 International presence 31 China as a foreign investment target 31 Western pharmaceuticals in China 31 CHAPTER 4 ETIOLOGY & EPIDEMIOLOGY 33 Overview of infectious diseases in China 33 Infectious diseases in China 34 Overview of infectious diseases in China 34 Hepatitis in China 35 Viral hepatitis: a brief introduction 35 Disease definition and epidemiology 37 HBV 37 Disease characteristics 37 HBV genotypes 39 Disease progression 40 Chronic hepatitis B serological markers 45 Complications and risk factors 46 Transmission 48 HCV 53 Basic virology and serology 53 Disease progression 56 Clinical manifestations 59 Risk factors 60 Transmission 61 Coinfection 68 Coinfection with HIV 68 HBV/HCV coinfection 71 Coinfection with other hepatitis viruses 72 Comorbidities 73 Liver fibrosis/cirrhosis 73 The high prevalence of hepatitis in China boosts prevalence of hepatocellular carcinoma (HCC) 74 Fatty liver (steatosis) 76 Transplant patients 77 HBV & HCV epidemiology 77 Global HBV & HCV epidemiology 77 China HBV & HCV epidemiology 79 CHAPTER 5 DIAGNOSIS RATES AND PRESENTATION 91 Overview of diagnosis rates and presentation 91 Presentation and diagnosis rates 92 HBV diagnosis 92 Successful diagnosis rates 92 Markers used in HBV diagnosis & screening 96 HCV diagnosis 98 Successful diagnosis rates 98 Markers used in HCV diagnosis 100 Treatment rates 103 HBV treatment 103 HCV treatment 105 CHAPTER 6 TREATMENT OPTIONS 108 Overview of treatment options 108 Treatment goals 110 HBV disease management 110 Criteria for initiation of treatment 110 HBV drug therapy 112 Treatment guidelines for HBV in Asia and China 114 HBV drugs 117 Immune modulators 117 Nucleoside analogues (nucleoside reverse transcriptase inhibitors; NRTIs) 123 Combination therapy 129 Maintenance therapy 131 HBV drugs in the pipeline 132 Actual prescription choices for HBV 134 Percentage of HBV patients on 1st line, 2nd line and 3rd line + in China 134 Choice of therapy for first-line HBV patients 135 Choice of therapy for second-line HBV patients 137 Treatment of HBV sub-populations 139 HCV disease management 143 Criteria for initiation of treatment 143 HCV drug therapy 143 Treatment guidelines for HCV in Asia and China 144 HCV drugs 146 Interferon monotherapy 146 Combination therapy 147 Genotype dependence on response rate 150 HCV drugs in the pipeline 151 The treatment of coinfected patients 153 Actual prescription choices for HCV 153 Percentage of HCV patients on 1st line, 2nd line and 3rd line+ in China 153 Choice of therapy for first- and second-line HBV patients 155 Vaccination 163 HBV vaccine 163 HBIG 166 Transplantation 167 Prevention 169 CHAPTER 7 VALUING THE CHINESE HEPATITIS MARKET: THREATS, DRIVERS AND THE FUTURE 172 Overview of diagnosis rates and presentation 172 Threats to the Chinese pharmaceutical market 173 Traditional Chinese Medicine (TCM) 174 Counterfeit drugs and generics 177 Counterfeit drugs 177 Generics 178 Factors governing treatment choice 179 Prescription-governing factors 179 Genotyping 183 Type of physician 184 Estimating the value of the hepatitis market in China 185 HBV 187 HBV market valuation scenarios 190 HCV 191 HCV market valuation scenarios 193 The geography of hepatitis in China 195 Treating hepatitis in China: the future 196 The future of HBV in China 196 The future of HCV in China 197 OPINION LEADER TRANSCRIPTS 200 Key opinion leader 1 - Mainland china opinion leader 200 Key opinion leader 2 - Mainland china opinion leader 209 Key opinion leader 3 - Mainland china opinion leader 217 Key opinion leader 4 - Hong Kong opinion leader 226 Key opinion leader 5 - Mainland China opinion leader 240 Key opinion leader 6 - Mainland China opinion leader 253 Key opinion leader 7 - Hong Kong opinion leader 258 APPENDIX A 272 Bibliography 272 Journal articles 272 Conference presentations 280 Press releases 281 Organizations and websites 284 Datamonitor Reports 285 Miscellaneous 286 APPENDIX B 288 Physician research methodology 288 Physician sample breakdown 288 Hong Kong 288 Beijing 289 Shanghai 289 Ghangzhou 290 Wuhan 290 APPENDIX C 291 Questionnaire 291 About Datamonitor 309 About Datamonitor Healthcare 309 Datamonitor Healthcare’s research and analysis methodologies 310 Disclaimer 310 AbstractIntroductionHepatitis is a major health problem in China, which is home to one third of hepatitis B patients and one quarter of hepatitis C patients globally. HBV vaccination, together with HBV and HCV screening have helped to reduce transmission, but continued transmission from mother to child (for HBV) and transmission via blood transfusions (HCV) means that HBV and HCV are likely to remain a problem. Scope Analysis of the current dynamics of the Chinese hepatitis market through primary research data from 176 physicians, supported by key opinion leaders Identification of drivers and resistors of the Chinese hepatitis market, and how the Chinese healthcare system impacts these market-shaping factors Examination of key hepatitis drug regimens for hepatitis in China, and factors affecting prescription trends underlying these regimens Assessment of the differences between China and the 7 major markets in terms of HBV and HCV transmission and diagnosis Highlights Datamonitor physician research indicated that HBV incidence is decreasing in China. In contrast to the seven major markets, where most patients acquire HBV sexually, perinatal transmission is the dominant HBV transmission route, which impacts on HBV disease progression and effectiveness of drug therapy. Chinese physicians believe that HCV incidence may be increasing in China. Blood transfusion is though to be the dominant HCV transmission route in China, while in the seven major markets, HCV is mainly acquired through intravenous drug use. Chinese physicians do not consider any HBV therapy a gold-standard, although lamivudine is the most prescribed first-line therapy, while adefovir is the most prescribed second-line therapy. While treatment choice is more limited for HCV, the Chinese HCV market is highly fragmented, with treatment differing significantly between regions. Reasons to Purchase Review the clinical and commercial factors shaping the uptake of hepatitis products in China, and the opportunities and threats facing the market Gain insight into HBV and HCV prevalence, transmission and coinfection in China Evaluate unmet needs in China's hepatitis market and capitalize on these opportunities to develop commercial strategies to increase market penetration Get Full Details About This Report >> |
|
|||
|
About MarketResearch.com
|
||||