Commercial Perspectives: Drug Treatment in End-Stage Renal Disease

Summary

Increased prevalence of diabetes, obesity, and cardiovascular disease, all causal factors of renal disease, drives growth of the end-stage renal disease (ESRD) sector. On average, an ESRD patient uses >$7,000 of drugs/year, representing a significant opportunity for pharmaceutical companies in treating the symptoms, comorbid conditions and treatment side effects of ESRD.

Highlights

The ESRD market is growing at a rate of 6% in the US, 7% in Japan and 4% in Europe. It is a large cost burden on healthcare payors with treatment costs increasing by a CAGR of 5% to over $60,000 per patient per year.Diabetes and hypertension are considered a causal factor in >72% of the cases of ESRD and cardiovascular disease is the cause of death for over 60% of ESRD patients. The ESRD market represents around 1% of the cardiovascular market, but the overall chronic kidney disease (CKD) market is a much larger target population.Costs of drugs directly treating symptoms of ESRD represent over 14% of the treatment costs. Erythropoietin treatment of renal-disease-related anemia represents over 70% of these costs, followed by vitamin D treatment of secondary hyperparathyroidism. Costs are expected to reduce with the introduction of biosimilars or biogenerics in 2007 to 2010.

Scope

• Analysis of the ESRD sector in the US, and in the 5 major European markets Germany, France, UK, Italy and Spain
• Analysis of issues facing the ESRD market: rising prevalence, treatment costs and greater focus on prevention, and differences in treatment patterns
• Insight into drugs in the treatment of comorbidities of ESRD including: hypertension, dyslipidemia and diabetes
• Review of drugs in the treatment of dialysis side effects including: erythropoietins, IV iron, vitamin D and phosphate lowering drugs

Reasons to Purchase

• Gain insight into the dynamics and key issues in the ESRD market
• Understand how to position drugs used to treat the comorbidities of ESRD patients
• Look at the opportunities in treating dialysis patients

Contents

• Chapter 1 Executive Summary
  • Objective of the analysis
  • Datamonitor insight into the ESRD market
• Chapter 2 Esrd Definitions & Scope
  • Strategic scoping and focus
• Chapter 3 Esrd Market Assessment
  • ESRD: a clearly defined disease
  • Treatment of ESRD
  • Renal replacement therapy (RRT)
  • Hemodialysis (HD)
  • Peritoneal dialysis (PD)
  • Key factors influencing the ESRD market
  • The increasing prevalence of ESRD
  • ESRD occurrence is increasing in an aging population
  • Increasing causal risk factors - diabetes and hypertension
  • Comparative use of RRT
  • Increasing costs of treating ESRD
  • Healthcare payors concerns in reimbursing dialysis treatment
  • Drug treatment of dialysis patients
  • Prevention is better than cure
  • Comorbidities, symptoms and side effects drive drug treatment costs
• Chapter 4 Comorbidities With Esrd
  • Introduction
  • Hypertension
  • Congestive heart failure
  • Hypertension-related drug usage in ESRD comorbidities
  • ACE inhibitors and ARBS are used to treat hypertension
  • Calcium channel blockers
  • Diuretics
  • Dyslipidemia
  • Drugs for dyslipidemia (lipid-lowering drugs)
  • Coronary artery disease (linked to dyslipidemia)
  • Statins
  • Fibrates
  • Niacin (nicotinic acid, vitamin B3)
  • Ion-exchange resins/bile-acid sequestrants
  • Cholesterol uptake inhibitors
  • Sevelamer
  • Diabetes
  • Myocardial damage
  • Respiratory diseases (e.g. COPD)
• Chapter 5 Drugs Treating Esrd Symptoms
  • Introduction
  • The ESRD anemia market
  • An overview of anemia
  • The role of erythropoietin in ESRD-induced anemia
  • Importance of managing serum levels of iron prior to EPO treatment
  • Patient treatment patterns
  • The erythropoietin market
  • Epogen/Procrit (epoietin alpha)
  • Aranesp (darbepoietin alpha)
  • NeoRecormon (epoietin beta)
  • CERA
  • Dynepo (epoietin delta)
  • Epomax (epoietin omega)
  • Competitive environment in the EPO market
  • Patent expiries and new entrants
  • Future dynamics in the ESRD erythropoietin market
  • The intravenous (IV) iron market
  • INFeD (iron dextran)
  • Ferrlecit (iron gluconate)
  • Venofer (iron sucrose)
  • Competitive environment in the IV iron market
  • Patent expiries and new entrants
  • Opportunities in the IV iron market
  • The ESRD secondary hyperparathyroidism market
  • An overview of secondary hyperparathyroidism
  • ESRD's impact
  • Vitamin D and the secondary hyperparathyroidism market
  • Patient treatment patterns
  • Competitive environment in the vitamin D market
  • Patent expiries and new entrants
  • Future dynamics in the ESRD vitamin D market
  • Hyperphosphatemia in ESRD patients
  • Patient treatment patterns
  • Competition in the ESRD phosphate binder market
  • Patent expiries
  • Future dynamics in the phosphate binders market
• Appendix A
  • Usual doses of antihypertensive medication
• Appendix B
  • Bibliography
  • Report methodology
  • About Datamonitor
  • About Datamonitor Healthcare
  • About the Cardiovascular Disease analysis team
  • Disclaimer