Brazil: The Gem of Latin America. October 2011

Transcription

1 Brazil: The Gem of Latin America October 2011

2 The Importance of Latin America to Pharma The Latin American pharmaceutical market is among the fastest growing in the world and is expected to be $51.3 billion in 2014, for average growth of 10% per year. The region is better prepared to face global instability than in the past due to improved government finances, reduced external debt and higher international reserves, more flexible exchange rates, and strengthened financial regulation and oversight. 1 Growing populations, improved infrastructure and increased government spending on healthcare are helping create a thriving pharmaceutical market in Latin America. The region s dedication to reducing timelines for drug registration and R&D requirements should make market access easier. 2 MEXICO PUERTO RICO GUATEMALA VENEZUELA NICARAGUA COSTA RICA COLOMBIA ECUADOR PERU CHILE BOLIVIA BRAZIL PARAGUAY URAGUAY ARGENTINA The largest markets in Latin America, by both population and value, are Brazil, Mexico and Argentina. 1 Eyzaguirre Nicolas. Sustaining Latin America s Transformation. International Monetary Fund: Finance & Development Mar;48(1). 2 Doctor s Guide Publishing Ltd. Pharmaceutical Market Access in Latin America: A FirstWord Market Intelligence Report Aug. 1

3 Argentina, Brazil and Mexico Lead the Region Argentina Brazil Mexico Impressive growth rate expected to slow down Dominated by branded products 60% of market dominated by local players Employees and retirees have private medical insurance Strong growth Represents 30% of total market (volume) and 50% of value Some OTC medications are no longer sold without Rx Generics growing at higher rate than branded sector and will represent 25% of the market by end of 2011 Stagnant growth Represents 30% of total market (volume) Branded usage profoundly dependent on macro-economic growth rate Generic market expected to double in size in 2011 (40 blockbuster drugs off patent by 2012) Aims to be global leader in regulation of biologic and biosimilar medicines 2

4 But Brazil Is by Far the Largest Country. Brazil has the largest population in South America. However, it also has the second-lowest birth rate and population growth rate in the region. About 87% of Brazil s population lives in urban centers. Brazil s life expectancy is 72.5, among the lowest in South America. However, its population is aging. It is estimated that by 2020 close to 30 million people will be older than 60. This rapidly aging population provides enormous opportunities for the Pharma industry. Prime areas for growth include Alzheimer s disease, rheumatoid arthritis and osteoarthritis. Brazil Demographics Gross national income per capita (Intl $, 2009) 10,260 Life expectancy at birth males/females (years) 69/76 Total expenditure on health per capita (Intl $, 2006) 765 Total expenditure on health as % of GDP (2006) 7.5% Internet penetration, total population 37.8% Total population 201,103,330 Area size 8,514,877 km 2 Total number of doctors 320,013 Total number of beds 482,647 Source: World Health Organization (WHO), World Health Statistics

5 Brazil s Government Is Stepping Up Access to Healthcare. Brazil s public healthcare system (Sistema Unico de Saude, SUS) offers full coverage for every citizen. However, the quality of care is not high, so people in middle to high socioeconomic groups purchase private health insurance. Prescription medication provided to public care patients within the hospital setting is covered by the government. In addition to the public sector, there is a large and wide private health network that complements the public services. This represents approximately 25% to 30% of the population. People who are employed get basic private insurance coverage. The SUS has the challenge of ensuring citizens' right to healthcare, regardless of social status. The SUS s responsibilities include: National health policy Coordination and supervision of the health system Environmental health and health promotion, protection and recovery of individual and collective health, including workers and Indians Health information Critical inputs to health Preventive measures in general, surveillance and sanitary control of borders and seaports, river and air Health surveillance, especially drugs, medicines and food Scientific research and technology in healthcare Source: SUS official website With the 2010 government regulation that no longer allows certain medical treatments to be sold over the counter in pharmacies, medications such as antibiotics are now restricted to prescriptions by physicians. Private insurance fully reimburses hospitals and primary care services and partially reimburses for drug prescriptions. SUS fully subsidizes generic drugs, but the system doesn t have a wide range of generics available. Therefore, almost half of the population pays 100% for prescription drugs. 4

6 Brazil s Health Profile Is Different from Other Emerging Markets. To learn more about how Kantar Health can help identify opportunities in Latin America, download our case study Uncovering unique opportunities through product differentiation in Latin America. Brazil s health profile is different from both other emerging and developed markets. Although nearly the same size as the United States, Brazil s population cannot be easily compared with that of the US. For example, Brazil has a lower proportion of the population with most therapeutic areas compared with the US. Also, a much lower percentage of the Brazilian population is obese or overweight compared with the US population 48% versus 66%. The percentage of the population with a college education or higher is also lower in Brazil 22% versus 27%. Likewise, Brazil s diagnosed population is not comparable with other emerging markets, such as China. As seen below, diagnosed populations are much higher in Brazil than in China in therapeutic areas such as cardiovascular disease, metabolic disease and pain. Diagnosed Populations by Country 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Source: Kantar Health. September National Health and Wellness Survey, 2011 [Brazil]. Princeton, NJ. Brazil China US 5

7 Hypertension Is the Most Prevalent Disease in Brazil. Hypertension, or high blood pressure, is the most prevalent condition in Brazil, and it continues to grow. Hypertension increases the risk of having a stroke, heart attack, kidney failure and early death. Prevalence of Hypertension and Pre-Hypertension in Brazil 100,000,000 90,000,000 80,000,000 70,000,000 60,000,000 50,000,000 40,000,000 30,000,000 20,000,000 10,000, Hypertension Pre-Hypertension Source: Epi Database. Kantar Health. Available from Accessed 19 Oct

8 Cardiovascular Disease Is the Leading Cause of Death in Brazil. Cardiovascular disease is the leading cause of death and disability among both men and women in Brazil. Predictions for the next two decades include near tripling of ischemic heart disease and stroke mortality. Stroke is one of the leading causes of mortality in Latin America. The incidence and prevalence of stroke varies, reflecting regional and socioeconomic differences. In Brazil, stroke has been the leading cause of death over the past 20 years. It has been declared an epidemic in Latin America by the Pan American Health Organization. The age-adjusted mortality rates for stroke, in Brazil, are the highest among Latin American countries. This is true for both men and women. Prevalence of Stroke in Brazil 1,800,000 A 69% increase in stroke prevalence is predicted from 2012 to Click here to learn more about Epi Database in Brazil. 1,600,000 1,400,000 1,200,000 1,000, , , , , Source: Epi Database. Kantar Health. Available from Accessed 19 Oct

9 Cancer Is the Second Leading Cause of Death in Brazil. Breast cancer is a major health burden worldwide and is the most common cancer among women in both high-resource and low-resource settings. It is the most prevalent cancer in Brazil, with a 5-year prevalence nearly double the next most common cancer type. Colorectal cancers are the second most prevalent cancer in Brazil. Epidemiologic studies find consistent evidence that physical inactivity and excess body weight have a major influence on risk of colon cancer. The risk of colon cancer is quite labile to environmental change; when populations move from low-risk to high-risk areas, the incidence of colorectal cancers increases rapidly within the first generation, implying that dietary and other environmental factors constitute a major component of risk. 5-Year Prevalence of 5 Most Prevalent Cancers in Brazil 400, , , , , ,000 To learn more about Kantar Health s oncology experience in Latin America, download our case study Identifying the real stakeholders for leukemia genetic testing in Latin America. 100,000 50,000 0 Breast Colorectal Gastric Lung Bladder Source: Epi Database. Kantar Health. Available from Accessed 19 Oct

10 Brazil Has a Unique Classification for Socioeconomic Status. Brazil s government has developed a system of classifying its citizens by socioeconomic level A1, A2, B1, B2, C1, C2, D and E with A1 being the highest and E being the lowest based on education and ownership of consumer durable goods. Kantar Health s 2011 survey with 12,000 Brazilian adults segments results by these socioeconomic levels to determine how patients health status, attitudes, behaviors and outcomes vary by socioeconomic status. Some interesting demographic differences emerge from this data. Those in the higher socioeconomic groups are more likely to be white and male and are better educated, and they are more likely to drink alcohol and to be overweight or obese. Demographic Differences by Socioeconomic Status 90% 80% 70% BCD CD BCD BCD CD 60% 50% C C D CD BCD CD D 40% 30% 20% 10% Click here to learn more about the National Health and Wellness Survey in Brazil. 0% Men White College graduate or more Overweight/obese Drink alcohol Total Brazilian Population Group A Group B Group C Groups D and E Source: Kantar Health. September National Health and Wellness Survey, 2011 [Brazil]. Princeton, NJ. Letters indicate statistically significant difference at 95% confidence level between subgroups. 9

11 Physical Quality of Life Falls Along with Lower Socioeconomic Status. Physical quality of life, as measured by the SF-12 validated instrument, is higher among patients in the higher socioeconomic groups and drops in the lower groups. Interestingly, mental quality of life remains constant across all socioeconomic groups. Another difference among socioeconomic classes is the use of healthcare resources. Brazilians in Groups A and B have visited a healthcare provider significantly more often in the past six months than those in Groups C, D and E. More Brazilians in Groups A, B and C have visited the ER than those in Groups D and E. This is not surprising given that Brazilians in Groups A and B generally have insurance and the resources to pay for prescriptions. Quality of Life Healthcare Resource Utilization 52 90% BCD CD 51 CD CD 80% 70% 50 60% 49 D 50% % 30% 20% 10% D D 45 0% Mental SF-12 Physical SF-12 Visited any HCP in past Visited ER in past 6 6 months months Total Brazilian Population Group A Group B Group C Groups D and E Source: Kantar Health. September National Health and Wellness Survey, 2011 [Brazil]. Princeton, NJ. Letters indicate statistically significant difference at 95% confidence level between subgroups. 10

12 Patient Attitudes and Behaviors Also Vary by Socioeconomic Status. Not only do wealthier Brazilians visit their healthcare provider significantly more often than Brazilians at lower socioeconomic levels, they also are more likely to feel that their doctor is very attentive to their needs and concerns: 61% in Group A versus 45% in Groups C, D and E. Those in Groups D and E are also more likely to prefer to treat themselves with an over-thecounter medication than to depend on their physician for a prescription (17% versus 12%) and wait to see what their friends and family think of a medication before trying it (36% versus 26%). Healthcare Attitudes by Socioeconomic Status I feel that my doctor is very attentive to my needs and concerns. CD BCD Having regular contact with my physician is the best way for me to avoid illness D D I prefer to treat myself with an OTC than to depend on a doctor to give me a prescription. D I like to see what my friends and family think of a medication before I try it. BCD CD 0% 10% 20% 30% 40% 50% 60% 70% Total Brazilian Population Group A Group B Group C Groups D and E Source: Kantar Health. September National Health and Wellness Survey, 2011 [Brazil]. Princeton, NJ. Letters indicate statistically significant difference at 95% confidence level between subgroups. 11

13 Kantar Health s Multiclient Resources in Latin America Kantar Health s National Health and Wellness Survey (NHWS) is the largest international selfreported patient database in the healthcare industry. NHWS provides disease-specific measures that help healthcare clients size market opportunities, measure direct and indirect costs, gain insight into disease-specific segments, and develop marketing and publication strategies directed at specific consumer or patient segments. The NHWS began collecting survey responses in Brazil in 2011 utilizing a mixed recruiting methodology (Internet/CAWI) to ensure representativeness of the sample. The database offers a holistic view of the patient in each emerging market, from the patient s point of view, and reports metrics that can only be captured from the patient. This real-world patient-level information covers more than 160 therapeutic conditions and has the advantage of being able to compare data to key established markets: the US, Europe (France, Germany, Italy, Spain and the UK) and Japan. Kantar Health s Epi Database is the gold standard of epidemiology data, providing reliable, rigorous research and documentation in the G7 and key emerging countries, including Brazil and Mexico. In-depth analysis with projections to All epidemiologies are thoroughly researched in scientific literature, including public and private data sources. Data are broken out by country, indication, and year as well as gender, race, and age if applicable. Fully documented sources provide complete transparency. Epidemiologies are reviewed quarterly, with additional reviews completed more frequently on a situational basis. Click here to download Kantar Health s podcast, Understanding Patients in the Emerging Market of Brazil. 12

14 About Kantar Health Contact Linda VerPlanck Senior Vice President, LatAm Tel: Dave Pomerantz Senior Vice President, Health Sciences Tel: Kantar Health ( is a global, evidence-based decision support partner to the world s leading pharmaceutical, biotech, device and diagnostic companies. Our 700+ staff act as catalysts, working closely with customers to drive distinctive decision-making that helps them prioritize product development and portfolios, differentiate their brands and ensure product profitability after launch. We are unique in that we bring together clinical, medical and methodological expertise, commercial/marketing know-how and proprietary data. It is this rare combination, together with our unparalleled stakeholder reach, that enables us to mobilize incisive, imaginative and timely ROI-driven solutions, empowering clients to deliver better healthcare options to their customers. With offices in over 30 countries, we excel at solving technically or logistically challenging projects around the world and across the product lifecycle, combining on-the-ground know-how and global and national proprietary data to quickly identify value drivers. As part of WPP, we can also incorporate highly innovative thinking from outside the industry into our solutions. 13