Cancer market in India is expected to emerge as one among the largest therapeutic segments in the domestic market in the coming years.

Definition / Scope

• Cancer is a therapeutic class characterized by uncontrolled cell growth. There are over hundred different varieties of cancer, and every catogory of cancer is differentiated by the type of cell that is initially affected.
• Cancer proves to harm the body when altered cells divide in a destructive manner to form lumps of tissue or tissue masses called tumors which interfere and alter body function.
• Tumors that are static and show limited growth are generally considered to be benign. On the other hand if a tumor spreads to other parts of the body and advances by invading and destroying other healthy tissues, it is said to have metastasized
• Cancer market in India is expected to emerge as one among the largest therapeutic segments in the domestic market in the coming years.
• In India as there is rise in low and middle income countries which is the major reason majority of population can’t afford the treatment.
• The Indian National Cancer Registry Program (NCRP) supports a number of cancer registries in almost all cities in India.

Market Overview

• Oral cavity & lung cancers in men & cervix & breast cancer in females together account for 50% of cancer related deaths in India.
• According to Frost & Sullivan, Current Oncology market in India is found to be growing at 20% every year and will be increasing for the coming 3-5years. The cancer market in 2012 is valued at US$ 172m. There are many treatments available for cancer like chemotherapy, biologics, targeted therapy, hormonal therapy & Supportive therapy but among them in the year 2012, chemotherapy occupied the highest market value of US$ 104.97 m.
• According to WHO the mortality rate is found to increase from 2007 to 2030 from 7.9 million to 11.5 million accounting for death by aged population.
• Incidence of cancer cases is found to increase from 11.3 million in2007 to 22 million in 2035.
• Cancer incidence, prevalence and mortality rates for males and females are given in the below table projected for 2015.

Market Risks

• Regulatory barriers in oncology trial procedures and compulsory licensing and patent revocation can pose to be threat to the cancer market. Increasing burden of launching new drugs, patent expiries of the drugs and pricing structure of expensive drugs are a threat to the competitors in a fragmented market.
• Costs involved in infrastruture and lack of support for requisite specialities and high gestation period for such projects form the major limitaiton 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 actually imported from manufaturing sites from other countries therefore there is skyrocketing of prices which makes it less affordable for the patients.

Top Market Opportunities

• Rising incidence of various cancer complications & blooming of various advance biological & drug targeted therapies, patent expiry of branded drugs parelled with commercialisation of biosimilars.
• Commercialization of immunotherapies & targeted therapies would reduce the restraint factors & accelerate the growth. As oncology is a hospital based business thereby if a pharma company builds a strong sales network it can tap into new opportunities.
• Huge gap in demand and supply of treatment which makes affordability and accessbility a problem.
• This huge gap presents an opportunity for hospital adminsitrators and entrepreneurs to dig into new opportunitites to accomodate more number of caner patients.
• As there is improvement in treatment of cancer entreprenuers and administrators are finding new ways to bring the demand and supply to equilbrium.
• New opporutnities for development are majorly seen in three departments : surgical oncology, medical oncology, radition oncology.
• New opporutnities for investment arise in early detection and prevention.
• More infrastructure and 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 market is said to hold 45% of total budget spent on cancer care.
• In India, during the year 2001, nearly 0.80 million new cancer cases were estimated and this would get increased to 1.22 million by 2016 as a result 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 cancers in women account for over 50 to 60 percent of all cancers. This provides a major opportunitity for developing drugs and various measures relating to this type of cancer and hence tapping the market.

Market Trends

• India is a populous country with increasing cancer incidence which serves as the key driver for growth of cancer market in India. Various advance cancer cases and huge potential for clinical research data & trained researchers with quality data offer a unique opportunity for conducting research & clinical trials in different parts of the country.
• Rise in awareness in people who take treatment not considering the disease as “terminal illness” but as “treatable illness” makes the patients to opt for treatment rather than ignoring it.
• Rise in technology and advanced treatments with better outcomes is a key market trend.
• Government has been taking many intiatives 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 treat patients with many facilities under one roof which makes the treatment feasible.
• Rise in particular number of cancer cases like Tobacco and gynaecological cancer provide the chance for pharma companies to invest in their R&D.
• Major restraints of the cancer market are unclear patent law, restrictive pricing & reimbursement policies, low patient affordability, ailing infrastructure & insufficient government aid.Further growth of cancer market can occur if the reimbursement and insurance policies are solved.
• Detection of cancer in the first stage is crucial but in many types of cancer this 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 patients. Only 15 % of patients are covered under health insurance and majority are under insured. Average bill of cancer patient is Rs 10lakh while they average amount of policy of health plan sold is 1.9lakh.

Industry Challenges

• Key challenges faced by cancer market are shortage of specialized surgical & medical oncologists where there are only 1600 oncologists including Medical, Surgical & Radiation oncologists which in turn creates shortage of Surgical & medical oncologists.
• There are only 30 Regional Care Centers (RCCs) & only 5-6 RCCs employ skilled & trained medical oncologists. Infrastructure facilities remain poor in India to handle high incidence of cancer.
• Equipment used in cancer treatment is costly where particulary in india is imported from other countries and makes it available only to the rich as it involves huge costs.

Technology Trends

• Technological trends that impact the cancer market are drying pipelines where lot of time & money is invested with low success rate in the development of new anticancer drugs. Global pharma majors spend nearly US$ 1.5bn in India for drug trials of which major part belongs to cancer. This indicates the need to explore new methods of cancer treatment and also explore quality of life issues.
• “Stand alone day care centers” which are equipped with all specialities needed like day care chemotherapy, diagnostic lab etc.
• Even as technology unfolds there are many centers sprouting where they provide chemotherapy, palliative care, psycho- oncology, FNAC, 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.
• Curative treatment for cancer involves surgery, radiation, chemotherapy, hormone therapy or some other combination of these modalities. However, over 70% of cases in the country report for diagnostic and treatment services in advanced stages of the disease, resulting in radiotherapy as one of the main modality of treatment.
• 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 Brachytherpy 103) in 237 centres across the country during the year 2007.

• The sate-wise distribution of Regional Cancer Centres, teletherapy units and brachytherapy installation in the country are shown in the table below.
• The distribution shows that in some of the major populous state the availability of the Teletherapy units for cancer treatment are very scanty.
• Paediatric cancers are highly curable but this has not been achieved in India due to lack of access to quality care and lack of support systems.

Pricing Trends

• There is a reduction in the price of branded products for breast cancer, colorectal cancer, lung cancer & NHL when 348 drugs listed in National List of Essential medicines (NLEM) are included under price control regulations, which in turn attributes for slow growth of cancer market in India.
• Increasing cost of launching new drugs also impact the market.
• Further Pricing structure of expensive drugs also impacts the pricing trend in the market, where many of the foreign multinationals and local drug makers have changed their pricing strategy and decreased their prices to increase the affordability of the medicines to the patients and also to face the stiff competition from the generic drugs.
• Even though global burden ratio of India is 20% only 15% of Indian population is included under health insurance along with government supported schemes & only 2.2% of population is covered under private health insurance. Further this situation indicates that 60% of total health expenditure is borne by the patient.
• In the year 2014, the price of Glivec , anticancer tablet, has increased from 8500 to 1.08 lakh and the price of Geftinate has increased from 5900 to 11,500.
• 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

• 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 of the Indian market of having a transparent regulatory regime.
• The funds for the cancer programme are mainly from the Government and needs to be augmented. Private initiatives are few and are unlikely to cater to a large population across different socioeconomic strata, as it is often not a financially viable venture.

Other Key Market Trends

• Cost of treatment is key trend which majorly affects cacner market. Many people who take cacncer 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 is not affordable by the patient which costs up to 20 lakh per patient.
• The per capita income of a patient in India is less than one developed country which makes the treatment expensive to a patient.
• Physicians stressing more on treatment rather than screening and prevention and public health programmes is another issue that affects cancer market
• Oral morphine is the mainstay for cancer pain relief and is still not widely available in the country. There is a serious limitation of manpower for providing palliative care.

Market Size and Forecast

• Total market value of cancer market in India is US$ 153m in 2011 with a compound annual growth rate of 12.7% from 2004. In 2012 the market is valued at US$ 172m.
• The future projected size of the market is valued at US$ 574m in 2017 with Compound Annual Growth (CAGR) of 15.46%.

Market Outlook

• Every year there are 28 lakh prevalent cases and 8 lakh new cases in India. There will be a increase in the market share of biologics & targeted therapy which are assumed to be the preferred treatment option to chemotherapy. If the access to quality oncology healthcare & affordability of medicine is improved to rural population then in the future it can provide a big opportunity for exploring public- private partnerships.
• Future growth segments include the therapies for cancers that affect the brain, colon, lungs, white blood cells and the rectum which are identified as the most prevalent cases globally as well as in India. The current market size of the drugs treating these type cancers accounts to be around $40 – $50 billion. Reliance Life Sciences has introduced six anti-cancer drugs in India which fall under above said therapies.

Technology Roadmap

• The cost involved in setting up a cancer unit is the major reason for increased cost of cancer care. A linear accelerator involves cost at a range of Rs 6 crores to 18-19 crores basing on the work it performs.
• The import duty is also more and the cost of the surgical part of cyber knife is 20-23 crore which is why even the latest technology is not affordable to the patients and involves mundane costs.
• Medical device companies don’t often take into consideration the need of Indian patients which is the reason for major import of technology and devices in India. This is in turn makes it less affordable to small players despite few successful initiatives which can increase affordability of cancer screening devices.
• With the advanced diagnosis on the way cancer therapy is found to increase 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 improve the cancer treatment.

Distribution Chain Analysis

• Cancer rate in India has been increasing at great momentum which is accounted due to less number of organized national cancer screening programmes. On the other hand there is improper distribution of care providers in southern and northern states.
• Rugged competition exists in the market as many foreign and local drugmakers offer generic and branded drugs after government reduced taxes & import duties to raise the affordability of cancer drugs to the patients.
• 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 growth 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 to the population.
• 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 (sorafenib).
• Further the health ministry has also proposed to issue a compulsory license to Sprycel (dasatinib), a branded patented drug of Bristol Myers Squibb Co.
• Out of 20 major drugs used in cancer treatment only 3-4 players have their manufacturing units in India which makes the cost of medicines high.
• If more 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 costs almost a lakh.
• Cancer treatment in India when compared to UK and US is worse and also expensive due to less per capita income of person in India.

Competitive Factors

• Cancer market in India faces a tough competition due to various factors that disrupt the market.
• The cut throat competition is of huge concern due to few domestic companies and all other multinationals have a foot in this segment.
• Decreasing prices of cancer medicines serve as serious risk to the viability segment.
• In this regard keeping track of the competition from generic drugmakers in the local market, Swiss drug maker F.Hoffmann-La Roche Ltd, had slashed the prices of three key cancer drugs in India.
• Even the local drugmaker, Cipla Ltd, has reduced the price of its generic drugs in the third quarter of fiscal 2013.
• Roche also followed the same strategy of reducing costs to reach the market of its flagship product, Herceptin, to the patients.

Key Market Players

• Key Market Players of Indian Cancer market are the multinational companies which dominate the few domestic players thus capturing majority of the market share.
• Key international players include Roche which captures 24% share with its blockbuster drug Herceptin, breast cancer drug. Other key international players include GSK, Astrazeneca, Sanofi-Aventis.
• Key domestic players include Cipla, later Dr.Reddys and Natco pharma which captured a market share of 10% and 5% respectively. Other key players include Biocon and Piramal healthcare