Regional prevalent diseases in Asia


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Regional prevalent diseases in Asia

  1. 1. Phacilitate’s 1st Asian Cell & Gene Therapy Forum Singapore, 2011Regional prevalent diseases in Asia:Where do the key market opportunities lie?Which diseases can and are being targeted with cell & gene therapies in Asia? September 21, 2011Dr. Milind Sabnis, MD, MBAPrincipal ConsultantHealthcare, Asia Pacific 1
  2. 2. Agenda• Introduction• Global trends & impact on health care in Asia• Key Diseases in Asia• Gene therapy• Cell therapy• Summary 2
  4. 4. Percent of world GDP – Last 500 yearsChina, India, Japan, Latin America, Western Europe and United States Share of World GDP in 2035 2005 15% 21% 27% 11% 15% 6%Source: Frost & Sullivan 4
  5. 5. Growing middle class is changing the mix in demand for healthcare services • Creation of “healthcare elite”: those that can, will spend money out of pocket for elective procedures, executive and personalized levels of care.Source: Frost & Sullivan 5
  6. 6. Changing demographics leads to changing disease patterns and health risksSource: Frost & Sullivan 6
  7. 7. Aging population will account for around 20% of the world population in2050Source: Frost & Sullivan 7
  8. 8. By 2020, two-third of the Asia-pacific population over 65 years will have at least one chronic disease Healthcare Industry: Population Aged 65 and The Burden of Disease in elderly, Asia Pacific Above, (Asia Pacific), 2009-2020 400.0 12.0% Percentage of Aged 65 and Above to 350.0 10.0%Population (Million) 300.0 Total Population (%) 250.0 8.0% 200.0 6.0% 150.0 4.0% 100.0 50.0 2.0% - 0.0% 2010 2015 2020 Year Aged 65 and Above (Million) Percentage of Aged 65 and Above to Total Population (%) In 2010, 7.6% (241.7 million) of the Asia Pacific population was aged 65 and above. By 2020, this will be more than 9.7% (333.95) 65.2% of those aged 65+ have one chronic conditionSource: Frost & Sullivan Source: WHO, Frost & Sullivan 8
  9. 9. Asia Pacific Healthcare Expenditure is growing Healthcare Expenditure and Growth Rate by Country (2010 & 2015) 700.0 18.0 Healthcare Expenditure ($ Billion) 600.0 571.20 16.3 16.0 13.8 14.0 Healthcare Expen diture by 500.0 561.90 428.50 12.0 400.0 9.9 10.0 (CAGR % ) Country 300.0 259.80 6.8 8.0 6.0 6.2 6.0 200.0 5.0 139.50 4.0 111.60 95.10 49.90 99.70 78.90 100.0 58.22 58.02 2.0 58.00 36.50 0.0 - Japan China ANZ India South SEA* Others Korea 2010 2015 Healthcare Expenditure CAGR (%) Note: All figures are rounded; the base year is 2010. Japan has the highest healthcare expenditure in 2010 and 2015, with 5% CAGR between 2010-2015 China has the second highest healthcare expenditure planned. Among other Asia Pacific countries, China has the highest healthcare expenditure growth of CAGR of 16.3% followed by India, with CAGR of 13.8% and SEA 9.9% The value of Asia Pacific healthcare expenditure is estimated at around $ 1080 billion in 2011.Source: Frost & Sullivan * SEA – South East Asia – Includes Singapore, Malaysia, Thailand, Indonesia and Philippines 9
  10. 10. Faster healthcare per-capita growth compared to per-capitaincome is unsustainable; healthcare needs innovative solutions Innovative therapies such as gene therapy and cell therapy will help treat various currently untreatable diseases Healthcare Spending Per Capita (2007, 2050) If current trends hold - by 2050, healthcare spending will double, claiming 20-30% of 20- GDP for some economies In most countries worldwide, per capita healthcare spending is rising faster than per capita income which is unsustainable Healthcare Spending by Type of Activity Due to rising costs of healthcare, future spending will move away from treatmentSource: Frost & Sullivan. 10
  12. 12. More DALY are lost due to cardiovascular diseases in Asia than in the rest of the world Total DALYs (000s, all ages) lost due to cardiovascular disease in the Asia Pacific, 2005 • Globally, CVDs are the No.1 cause of mortality (~ 29% of all deaths) • 82% of CVD deaths take place in low- and middle-income countries • ~17.1 million deaths in 2004, expected to reach ~23.6 million by 2030 • The largest increase in number of deaths will occur in the South-East Asia Region • DALY=Daily adjusted life years; Cardiovascular diseases excludes rheumatic heart diseaseSource: Health in Asia and the Pacific. Priority noncommunicable diseases and conditions. 2011. 287-332. Frost & Sullivan. 12
  13. 13. Lung, Stomach, and Liver cancers are the top three male cancers in Asia Pacific Non- All Lip, oral Cancer Lung Stomach Liver Colorectal Esophagus Prostate Bladder Leukemia Hodgkin cancers cavity lymphomaIncidence 3241249 604629 484411 416589 283596 247060 133212 101776 95941 91327 75866Mortality 2353611 523899 342163 376006 144980 204919 59669 44316 76962 54518 50707 • Globally, ~ 7.6 million total cancer deaths (around 13% of all deaths) in 2008 • Deaths from cancer worldwide are projected to reach over 11 million by 2030Source: GLOBOCAN 2008: Cancer incidence, mortality and prevalence worldwide; Frost &Sullivan. 13
  14. 14. Breast, Cervix/uterus, and Lung cancers are the top three female cancers in Asia Pacific All Cervix Corpus Cancer Breast Lung Stomach Colorectal Liver Esophagus Ovary Leukemia cancers uteri uteri Incidence 2851110 528927 312990 268434 243154 225688 167851 131178 124507 102408 76111 Mortality 1718721 193497 159894 229778 188427 122034 157719 35044 103313 60142 60298 • Lung cancer is the top cancer killer both in males & females in Asia • More than 30% of cancer deaths can be preventedSource: GLOBOCAN 2008: Cancer incidence, mortality and prevalence worldwide; Frost &Sullivan. 14
  15. 15. Prevalence of diabetes is expected to continue to rise in Asia pacific and globally Diabetes Prevalence of diabetes (million) in Asia-pacific • 346 million people worldwide have diabetes • ~157 million people suffer from diabetes in Asia Pacific • More than 80% of diabetes deaths occur in low- and middle-income countries • Globally, ~ 3.4 million people died from consequences of high blood sugar in 2004 • WHO projects that diabetes deaths worldwide will double between 2005 and 2030Source: Frost & Sullivan. 15
  16. 16. GENE THERAPY 16
  17. 17. Two-thirds of all current gene therapy trials are for various cancer indications Severe Combined Immune Deficiency (ADA-SCID) Chronic Granulomatous Disorder (CGD) Genetic Disorders Hemophilia Other genetic disorders* Gene therapy Cancer Acquired Diseases Neurodegenerative Diseases Other acquired diseases** *Congenital blindness, lysosomal storage disease and muscular dystrophy, etcSource: Frost & Sullivan. ** Viral infections (e.g. influenza, HIV, hepatitis), heart disease and diabetes, etc 17
  18. 18. Most gene therapy phase 3 trials are for cancer and cardiovascular diseases indications Most Advanced Gene Therapy Products, March 2010 Product Name Constructs Company Indication Development Stage Si Bono / Benda Head & Neck Gendecine (genkaxin) Ad5p53 Marketed (China); 2003 Pharmaceutical Cancer Amsterdam Molecular Glybera (alipogen tiparvovec) AAV-mLPL LPL Deficiency MAA Filed with EMA Therapeutics Collategene (beperminogen Peripheral Vascular BLA Submitted in Japan pHGF AnGes /Daiichi Sankyo perplasmid) Disease (2008) Phase 3 (U.S. / EU) Allovectin-7 (velimogene Metastatic Immunotherapy Vical / AnGes Phase 3 aliplasmid) Melanoma HVS-TK TK-DLI (TBI-0301) MolMed / Takara Bio Leukemia Phase 3 transfected HSC Generx (alferminogene Coronary Artery Ad5FGF-4 Cardium Phase 3 tadenovec) Disease Critical Limb riferminogene pecaplasmid NV1FGF1 Sanofi - Aventis Phase 3 Ischemia Another Adenovirus (Replication-competent adenovirus) was commercialized in China in 2005 • The first gene therapy to be marketed was in ChinaSource:;;accessed: June 2011. LPL=lipoprotein lipase 18
  19. 19. Japan has a strong pipeline for gene therapy products in late stages of development Gene therapy clinical trials in Japan by stage of development Number of clinical trials c d e f Target diseases Currently in Asia, Japan has the most gene therapy products that have completed phase 2 clinical trials/ entered phase 3; majority of these products are for cancer treatment *ASO/Buergers Disease. c=Lung cancer (NSCC)(5); Esophageal cancer(1); prostate cancer(1); breast cancer(1); leukemia(1); glioma(1); melanoma(1). d=Prostate cancer. e=Renal carcinoma. f=ADA Deficiency. SCID=Severe combined immunodeficiency. ADA=Adenosine deaminase . ASO=atherosclerosis obliteransSource: Kim S, Peng Z, Kaneda Y. Current Status of Gene Therapy in Asia. The American Society of Gene Therapy. 2008;16:237–243. Frost & Sullivan. 19
  20. 20. China approved the world first gene therapy for cancer treatment Gene therapy clinical trials in China by stage of development Number of clinical trials a b Target diseases • World’s 1st approved gene therapy product (2003) gendicine (recombinant human p53 adenovirus) • Chinese Governments 863 Program: In 2007, ~$52.0 million was allotted to projects in 11 priority biotechnology areas, including gene therapy and cell therapy for major diseases a=Ischemic disease b=AIDS(1); Hepatitis B(1)Source: Kim S, Peng Z, Kaneda Y. Current Status of Gene Therapy in Asia. The American Society of Gene Therapy. 2008;16:237–243. Frost & Sullivan. 20
  21. 21. Korea has a few gene therapy products in early stage of development Gene therapy clinical trials in Korea by stage of development Number of clinical trials g h j l i k b m Target diseases Currently, Korea has 3 products in phase 2 funded mainly by small sized venture companies; pharmaceutical companies are still hesitant about getting involved in gene therapy b=AIDS(1); g=Prostate cancer. h=melenoma (1); melanoma, breast cancer,head-and-neck cancer (1). i=liver cancer. j=Ischemic limb disease. k=coronary artery disease. l=Chronic granulomatous disease. m=osteoarthritis.Source: Kim S, Peng Z, Kaneda Y. Current Status of Gene Therapy in Asia. The American Society of Gene Therapy. 2008;16:237–243. Frost & Sullivan. 21
  22. 22. CELL THERAPY 22
  23. 23. Most common cell therapies are targeted toward blood disorders Hemophilia A,B: blood transfusion Leukemia, Lymphoma: bone marrow transfer Cell Therapy Thalassemias SCID Others* • Most cell therapies are for treating hemophilia, leukemia, lymphoma, thalassemias • Both approved and experimental stem cell products are used in Asia to treat multiple disorders *Skin, Eye, orthopedics, cerebral palsy, diabetes, etc ; eg. skin regeneration and healing (Apligraf®), diabetic foot ulcers (Dermagraft®, skin substitute), nasolabial fold wrinkles (LaVív),cerebral palsy (umbilical cord blood transplantation), etcSource: Frost & Sullivan. 23
  24. 24. FDA has approved only two cellular therapy products Cell Therapy Products that recently got FDA approvals Product Name Constructs Company Indication Only FDA approved Treatment of asymptomatic or minimally PROVENGE Autologous, cellular, Dendreon symptomatic, metastatic, castrate resistant (sipuleucel-T) immunotherapy (hormone refractory), prostate cancer. (2010) First FDA approved autologous cell therapy for LaVív Autologous cell therapy Fibrocell Science, Inc. the treatment of moderate to severe (azfibrocel-T) (2011) nasolabial fold wrinkles in adults • LaViv a recently (2011) approved cell therapy drug is for treating naso-labial fold wrinkles • Apligraf® (1998) & Dermagraft® (2001) are cell therapies (classified as devices by FDA) for treating diabetic foot ulcers • Skin disorders could be the other focus area for cell therapy in AsiaSource: Frost & Sullivan. 24
  25. 25. Asides approved cell therapies, experimental cell therapies are widely used in Japan and China †*In Japan, autologus cell therapy can be regulated as clinical treatment under doctor’s own decision. Hence Japan is thought to be a easy country to runclinical application without regulatory control. In fact, a Korean company is running its trial in Japan; but recently the Korean government committed nearly100 billion won (S$111.7 million) in stem cell research next year and ensured to reform related regulations to make clinical and licensing procedures easier**VistaStemCell, a company in China, claims to treat (with cell therapy) multiple conditions that include neurological diseases, endocrine diseases, cancer,immune system diseases, others including myocardial infarction, femoral head necrosis, kidney disease, liver disease† 2009: The Chinese Ministry of Health has implemented regulations on the clinical application of stem-cell injections. The new regulations, designate allforms of stem-cell therapy as category 3 medical technologies — those deemed "ethically problematic", "high risk" or "still in need of clinical verification".The ministry will take direct responsibility for regulating all category-3 procedures, which include cell & gene therapy.Source: Frost & Sullivan. 25
  26. 26. In Asia, most common cell therapies available at hospitals are for the treatment of blood disorders and heart diseases Hospitals in some countries in Asia with various stem cell therapy facilities • In some Asian countries, hospitals offer cell therapies in multiple areasSource: Frost & Sullivan. *Cerebral Palsy, Diabetes, Motor neuron disease, Multiple Sclerosis, Parkinsons Disease, rejuvenation therapy 26
  27. 27. In Asia, there are multiple stem cell banks that collects, processes and stores stem cells for potential future use BIONET CryoLIFE (Hong StemLife Berhad Corporation Cordlife Pte Ltd Kong) (Malaysia) – (Taiwan) (Singapore) / PT. SECRETARIAT OF Cordlife (Indonesia) THE APCBBC Banks in: China, Hong Kong. Being extended to India &Indonesia LIFECORD (Korea) StemCell THAI StemLife StemOne Institute Ltd (Thailand) Biologicals (Japan) (India) • Multiple private stem cell/cord blood bank exist in AsiaSource: Frost & Sullivan. 27
  28. 28. Summary Asia Pacific shows the highest mortality rate from non-communicable diseases compared with other regions Cardiovascular diseases, cancer, and diabetes are the top 3 non-communicable diseases in Asia Two thirds of the gene therapy clinical trials are in cancer; most phase 3 gene therapy trials are in cancer and cardiovascular diseases In Asia, most common cell therapies available at hospitals are for the treatment of blood disorders and heart diseases; skin disorders could be another area of focus Asides approved cell therapies, experimental cell therapies are widely used in Japan and China Cell therapy and gene therapy has enormous opportunity in Asia because of the large target population and comparatively relaxed restriction on the use of experimental products However, regulators in Asian countries should be cautious to prevent misuse that could bring disrepute to the use of these innovative therapies that hold immense promise for the future 28
  29. 29. For additional information Dr. Milind Sabnis, MD, MBA Donna Jeremiah Corporate Communications Principal Consultant Asia Pacific Healthcare, Asia Pacific +603 6204 5832 Jessie Loh Carrie Low Corporate Communications Corporate Communications Asia Pacific Asia Pacific +65 6890 0942 +603 6204 5910 29