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Stakeholder Opinions: Renal Anemia Early diagnosis and management of anemia: reducing costs and improving the outcomes in chronic kidney disease

Published by: Datamonitor

Published: Apr. 10, 2009 - 83 Pages


Table of Contents


ABOUT DATAMONITOR HEALTHCARE
About the cardiovascular analysis team
CHAPTER 1 EXECUTIVE SUMMARY
Scope of the analysis
Datamonitor insight into available therapies in renal anemia
Contributing experts
Related reports
CHAPTER 2 RENAL ANEMIA - DEFINITIONS AND OVERVIEW
Chronic kidney disease
Anemia in chronic kidney disease
Etiology and pathogenesis of renal anemia
Normal erythropoiesis
Physiologic compensation mechanisms
Decreased hemoglobin oxygen affinity
Redistribution of blood flow
Increased cardiac output
Diagnosis
Symptoms
Diagnostic methods and classification of anemia
CHAPTER 3 RENAL ANEMIA TREATMENT STRATEGIES
Iron supplementation
Iron metabolism
Iron deficiency
Oral iron supplementation
Parenteral iron supplementation
Iron overload
Blood transfusions
Pharmacotherapy
Erythropoiesis-stimulating agents (ESA)
First generation epoetins
Second generation epoetins
Novel ESA pipeline
CHAPTER 4 ISSUES IN RENAL ANEMIA MANAGEMENT
Current guidelines summary
Key clinical trials controversy
The Correction of Hemoglobin and Outcomes in Renal Insufficiency (CHOIR) trial
The Cardiovascular risk Reduction by Early Anemia Treatment with Epoetin beta (CREATE) trial
The Trial to Reduce Cardiovascular Events with Aranesp (darbepoetin alpha) Therapy (TREAT)
Incomplete response rates
Patient compliance
Cost of therapy
Anemia management in chronic kidney disease patients after kidney transplantation
CHAPTER 5 COMMERCIAL OUTLOOK
Market assumptions
Epoetin market attractiveness
Amgen's patent disputes
Dynepo
Mircera
Introduction of generic epoetin
Country-specific prescription patterns in the seven major markets
US
Japan
France
Germany
Italy
Spain
UK
APPENDIX
Report methodology
Bibliography
About Datamonitor
About Datamonitor Healthcare
About the cardiovascular analysis team
Disclaimer
List of Tables
Table 1: Diagnosis of hypoproliferative anemias
Table 2: Selected key iron supplement preparations by manufacturer
Table 3: Key branded epoetins, 2009
Table 4: Key differences between current guidelines (KDOQI Anemia 2006) and previous guidelines (KDOQI 2000 and EBPG 2004) on the management of anemia in chronic kidney disease
Table 5: Costs of medication for treatment of renal and non-renal anemia 2006
Table 6: Sales revenue ($000s) for renal and non-renal anemia therapy in the seven major markets, 2008 ($000s) and year-on-year growth 2007-08.
Table 7: US market shares in anemia therapy 2007 ($000s) and year-on-year growth 2007-08.
Table 8: Japan market shares for renal and non-renal anemia therapy 2008 ($000s) and year-on-year growth 2007-08.
Table 9: France market shares for renal and non-renal 2008 ($000s) and year-on-year growth 2007-08.
Table 10: Distribution of erythropoiesis-stimulating agent sales ($000s) in Germany by manufacturer, 2008
Table 11: Italy market shares in for renal and non-renal therapy 2008 ($000s) and year-on-year growth 2007-08.
Table 12: Spain market shares for renal and non-renal therapy 2008 ($000s) and year-on-year growth 2007-08.
Table 13: UK market shares for renal and non-renal anemia therapy 2008 ($000s) and year-on-year growth 2007-08.
List of Figures
Figure 1: Erythropoietin production
Figure 2: Diagnostic flow and classification of anemia
Figure 3: Distribution of market share ($000s) for erythropoiesis-stimulating agent (ESA) therapy versus iron supplements in renal and non-renal anemia across the seven major markets, 2008
Figure 4: Market share ($000s) of erythropoiesis-stimulating agent (ESA) therapy and iron supplements in renal and non-renal anemia therapy in the US and five major EU markets, 2008 ($000s)
Figure 5: Porter's 5 forces in relation to epoetin market attractiveness
Figure 6: Key milestones in the epoetin market, 1989-2008
Figure 7: Market share ($000s) of epoetin therapy for renal and non-renal anemia by manufacturer ($000s)
Figure 8: Epoetin market shares ($000s) revenue for renal and non-renal anemia therapy by manufacturer and geographical region across the seven major markets, ($000s)
Figure 9: US market shares in anemia therapy 2007 ($000s)
Figure 10: Market shares ($000s) for renal and non-renal anemia therapy in Japan, 2008
Figure 11: Market shares ($000s) for renal and non-renal anemia therapy in France , 2008
Figure 12: Market shares ($000s) for renal and non-renal anemia therapy in Germany, 2008
Figure 13: Market shares ($000s) for renal and non-renal anemia therapy in Italy, 2008
Figure 14: Market shares ($000s) for renal and non-renal anemia therapy in Spain, 2008
Figure 15: Market shares ($000s) for renal and non-renal anemia therapy in the UK

Abstract

Introduction

The diagnosis of renal anemia is routinely performed and relatively straightforward, while treatment with highly effective erythropoietin-stimulating agents is widely available in all major markets. However, the extremely high cost of treatment prevents many healthcare providers from delivering this treatment to all eligible patients.

Scope
  • What are the current definitions, pathophysiological stages and the classification of renal anemia?
  • What are the currently available diagnostic methods, the issues and the unmet needs in diagnosis and early detection of renal anemia?
  • What is the current state of pharmacological management, available treatment approaches in renal anemia, unmet needs and future trends?
  • What are the current issues and the commercial landscape of renal anemia marketplace?
Highlights

In Europe, biogeneric epoetins were expected to address the cost issue, however, so far they have not been particularly well received. This seems to be mostly due to physician conservatism and the fear of poor generic drug quality with attendant higher risk of side effects. Only Germany has displayed any degree of enthusiasm for biogenerics.

A number of large clinical trials, such as CHOIR and CREATE, have demonstrated some controversial results with regards to the relative inefficiency of higher hemoglobin targets. This has encouraged healthcare providers to be conservative in the choice of epoetin therapy creating an additional barrier to epoetin revenue growth.

New epoetin drug therapies predominantly address the length of drug action, allowing for less frequent administration, but unfortunately they provide neither substantial superiority nor significant reduction of costs. In addition, a very small upcoming pipeline does not yet promise any advancement in the area of superiority or reduction of cost.

Reasons to Purchase
  • Understand current definitions, diagnostic methods and treatment approaches in renal anemia
  • Current challenges and future opportunities in renal anemia management
  • Differences, advantages and disadvantages of pharmacological disease management
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