Stakeholder Insight: COPD in Emerging Markets (Brazil, India, China, US)

Key differences in treatment despite standardized guidelines

Product Code DAT19564
Publication Date December 2010
Publisher Datamonitor
Product Type Report
Pages n/a
ISBN Number not applicable
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Stakeholder Insight: COPD in Emerging Markets (Brazil, India, China, US)

Key differences in treatment despite standardized guidelines

While general COPD treatment patterns are consistent across the emerging markets compared to the US, some key distinctions between countries have been identified, which impact market potential and growth opportunities. In particular, regulations in the emerging markets play a considerable role in the availability and spectrum of COPD treatments compared to the US.

Scope of this research
  • Insight into COPD in emerging markets based on a survey of 300 physicians in Brazil, India, China, and the US
  • Robust and comparable epidemiology estimates of the current COPD patient population in Brazil, India, China and the US
  • Overview of treatment patterns by severity, and patient segmentation by GOLD guidelines as well as by exacerbation rates, age and smoking status
  • Assessment of commercial attractiveness of the emerging markets based on current COPD drug usage, regulations and intellectual property rights

Research and analysis highlights
  • Survey respondents believe less than half of COPD patients are diagnosed. The perceived diagnosis rate was found to be the highest in the US, 45.5%, and the lowest in Brazil, 29.8%. Low diagnosis was attributed mainly to lack of patient awareness, such that with increased attention to the disease, patient potential could increase considerably.
  • A greater share of physician reported mild and moderate patients was found in the emerging markets versus the US. In Brazil 32.8% of patients are considered mild, over double the rate in the US (15.8%). These results suggest that, with spirometry lacking, subjectivity leads to different classifications, despite claims of GOLD criteria adherence.
  • Emerging markets respondents have a more fragmented choice of preferred COPD products than the US. In India, most respondents prefer products from local company Cipla. Patent laws in the emerging markets have allowed generic availability before the US, but changing regulations are expected to impact the situation in the future.

Key reasons to purchase this research
  • Target physicians more effectively, through an understanding of prescribing behavior and influences
  • Understand treatment outcomes and challenges and their relative importance to prescribing physicians
  • Validate new product forecasting based on diagnosis and treatment rates, and interest in novel products

Contents

  • OVERVIEW
    • Catalyst
    • Summary
  • EXECUTIVE SUMMARY
    • Scope of the analysis
    • Datamonitor insight into COPD in emerging markets
    • Related reports
  • 1. INTRODUCTION AND SCOPE
    • Coverage of the Stakeholder Insight Survey
      • Epidemiology
      • Access and diagnosis
      • Patient segmentation
      • Treatment patterns and key prescribing influences
      • Treatment outcomes and compliance
      • Treatment challenges
    • Assumptions and caveats
  • 2. COUNTRY TREATMENT TREES
    • Introduction to treatment trees
      • Brazil
      • India
      • China
      • US
  • 3. EPIDEMIOLOGY
    • Key findings
    • Introduction
    • Disease definition, classification and diagnosis criteria
    • Epidemiology risk factors
      • Age
      • Genetics
      • Smoking
      • Biomass fuels
      • Pollution
      • Industry-related exposures
    • Global variation and temporal trends
      • Underdiagnosis is common in all markets
      • Trends are driven by smoking rates
    • Epidemiologic calculations for COPD
      • Sources of epidemiologic data
      • Description of methods
      • Age standardization
    • Results
      • Segmentation by age
      • Segmentation by gender
      • Segmentation by the urban-rural split in China and India
      • Segmentation by stage
    • Discussion
  • 4. ACCESS AND DIAGNOSIS
    • Key findings
    • Healthcare spending and burden of disease
      • Healthcare indicators by country
      • Global burden of COPD on the rise
    • Diagnosis
      • Less than half of patients are diagnosed in each country
      • Low patient awareness of COPD is a consistent barrier to diagnosis
      • Diagnosis by physician type
      • Spirometry is the number one tool for diagnosis
      • Pharmacies distribute the majority of COPD prescriptions
  • 5. PATIENT SEGMENTATION
    • Key findings
    • GOLD classification criteria
    • Patient breakdown by severity
    • Disease control is lower in the emerging markets
    • COPD is a disease of the elderly
      • Most COPD patients are over 40 years old
      • Brazil – age demographics
      • India – age demographics
      • China – age demographics
      • US – age demographics
    • Smoking and COPD remain clearly linked
      • Large variation in smoking rates by country
      • Smoking is more than just cigarettes
    • Novel risk factors in emerging markets
      • Growing recognition of novel risk factors
      • Occupational exposure creates excess risk of COPD
      • Biomass fuels from indoor cooking affect more people than smoking
      • Suggestive evidence of the link between passive smoking and COPD
    • Comorbidities are widespread among COPD patients
      • Comorbidities must be considered in treatment
  • 6. TREATMENT PATTERNS
    • Key findings
    • COPD treatment algorithms
      • Use of guidelines
      • Comparison of guidelines
      • Guidelines followed to a large extent
    • Pharmacological versus non-pharmacological therapy
    • Drug classes target symptoms of COPD
      • Treatment increases with severity
    • Preferred drug treatment varies by country
    • Management of COPD
      • Management by physician type
      • Long-term management tools
  • 7. KEY PRESCRIBING INFLUENCES
    • Key findings
    • Factors influencing physician decision making
      • Treatment attributes
      • Device characteristics
    • The role of generics in treatment
      • High use of similares in Brazil impacts brand sales
      • Insufficient intellectual property rights remain in India
      • Chinese intellectual property protection conforming to international standards
      • Physician’s confidence in generics
    • Comparison with asthma treatment
      • Asthma and COPD overlap
      • Asthma and COPD treatment distinction
  • 8. TREATMENT OUTCOMES AND CHALLENGES
    • Key findings
    • Treatment outcomes
    • Compliance
    • Treatment challenges
      • Disease progression cannot be prevented
      • Exacerbations remain poorly managed
      • High smoking rates must be addressed
    • Future treatment combinations
  • BIBLIOGRAPHY
    • 3. Epidemiology
      • Journal papers
      • Websites
    • 4. Access and Diagnosis
      • Journal papers
      • Websites
      • Datamonitor reports
    • 5. Patient Segmentation
      • Journal papers
      • Websites
    • 6. Treatment Patterns
      • Journal papers
      • Websites
    • 7. Key Prescribing Influences
      • Journal papers
      • Websites
      • Datamonitor reports
    • 8. Treatment Outcomes and Challenges
      • Journal papers
      • Websites
  • APPENDIX A
    • Physician research methodology
    • Physician sample breakdown
    • Contributing experts
    • Contributing authors
    • Conferences attended
  • APPENDIX B
    • The survey questionnaire
      • Screener
      • Introduction
      • Section 1: Access and diagnosis
      • Section 2: Patient segmentation
      • Section 3: Treatment patterns and key prescribing influences
      • Section 4: Treatment outcomes & compliance
      • Section 5: Novel therapies and treatment challenges
      • Demographics
    • Datamonitor consulting
    • Disclaimer
  • TABLES
    • Table: Population-based studies of COPD prevalence used to estimate prevalent cases of COPD in Brazil, China, India, and the US, 2010
    • Table: Age-specific prevalent cases and prevalence rates of COPD in Brazil, India, China, and the US, 2010
    • Table: Crude and age-standardized prevalence rates (%) of COPD in Brazil, India, China, and the US, 2010
    • Table: Gender-specific prevalent cases and prevalence rates of COPD in Brazil, India, China, and the US , 2010
    • Table: Urban/rural-specific prevalent cases and prevalence rates of COPD in India and China, 2010
    • Table: Prevalent cases and prevalence rates of COPD in Brazil, India, China, and the US by stage, 2010
    • Table: Healthcare expenditure indicators in Brazil, India, China and the US, 2008
    • Table: Top 5 causes of mortality by country in Brazil, India, China and the US, 2004
    • Table: Primary reason for COPD patients being undiagnosed (%) in Brazil, India, China and the US, 2010
    • Table: Method of COPD diagnosis (%) in Brazil, India, China and the US, 2010
    • Table: Distribution channel of COPD prescriptions dispensed in Brazil, India, China and the US, 2010
    • Table: Diagnosed COPD patients by severity (%) in Brazil, India, China and the US, 2010
    • Table: Yearly COPD exacerbations by severity (%) in Brazil, India, China and the US, 2010
    • Table: Smoking habits in India, 2005
    • Table: Risk factors for the development of COPD (rating from 1–10) in Brazil, India, China and the US, 2010
    • Table: Physicians with COPD patients suffering comorbidities (%) in Brazil, India, China and the US, 2010
    • Table: Physicians’ use of guidelines by for treating COPD by country (%)in Brazil, India, China and the US, 2010
    • Table: Pharmacological versus non-pharmacological therapy by COPD severity (%) in Brazil, India, China and the US, 2010
    • Table: Drug classes prescribed by COPD severity and country (%) in Brazil, India, China and the US, 2010
    • Table: Preferred drugs for treating COPD (%) in Brazil, India, China and the US, 2010
    • Table: Method of COPD tracking (%)in Brazil, India, China and the US, 2010
    • Table: Average number of points (out of 100) assigned to treatment attributes that influence COPD prescribing behavior in Brazil, India, China, and the US, 2010
    • Table: Average number of points (out of 100) assigned to device attributes in influencing COPD prescribing behavior in Brazil, India, China and the US, 2010
    • Table: Mean rating given to COPD challenges for the pharmaceutical industry to address (rating from 1–10) in Brazil, India, China and the US, 2010
    • Table: COPD survey respondent breakdown, 2010
    • Table: Type of hospital worked in by survey respondents, 2010
    • Table: Survey respondent breakdown, urban versus rural, 2010
    • Table: Survey respondent breakdown by gender and age, 2010
  • FIGURES
    • Figure: Brazil – COPD patient population, split by physician-estimated diagnosis, disease severity, drug-treated population and drug-class usage, 2010
    • Figure: Brazil – COPD patient population, segmented by severity, exacerbation rate, age, and smoking status, 2010
    • Figure: India – COPD patient population, split by physician-estimated diagnosis, disease severity, drug-treated population and drug-class usage, 2010
    • Figure: India – COPD patient population, segmented by severity, exacerbation rate, age, and smoking status, 2010
    • Figure: China – COPD patient population, split by physician-estimated diagnosis, disease severity, drug-treated population and drug-class usage, 2010
    • Figure: China – COPD patient population, segmented by severity, exacerbation rate, age, and smoking status, 2010
    • Figure: US – COPD patient population, split by physician-estimated diagnosis, disease severity, drug-treated population and drug-class usage, 2010
    • Figure: US – COPD patient population, segmented by severity, exacerbation rate, age, and smoking status, 2010
    • Figure: Classification of COPD as measured by airflow limitation
    • Figure: Age-standardized prevalence rates (%) of COPD in Brazil, India, China, and the US, 2010
    • Figure: Prevalent cases of COPD in Brazil, India, China, and the US by gender, 2010
    • Figure: Distribution of the urban-rural split and gender among prevalent cases of COPD in India and China, 2010
    • Figure: Distribution of GOLD stages among prevalent cases of COPD in Brazil, India, China, and the US, 2010
    • Figure: Global projected leading causes of death, 2008–2030
    • Figure: COPD patients who are diagnosed versus undiagnosed (%) in Brazil, India, China and the US, 2010
    • Figure: Primary reason for COPD patients being undiagnosed (%) in Brazil, India, China and the US, 2010
    • Figure: COPD diagnosis by physician type (%) in Brazil, India, China and the US, 2010
    • Figure: Method of COPD diagnosis (%) in Brazil, India, China and the US, 2010
    • Figure: Distribution channel of COPD prescriptions dispensed in Brazil, India, China and the US, 2010
    • Figure: Classification of COPD as measured by airflow limitation
    • Figure: Diagnosed COPD patients by severity (%) in Brazil, India, China and the US, 2010
    • Figure: Yearly COPD exacerbations by country in Brazil, India, China and the US, 2010
    • Figure: Yearly COPD exacerbations by disease severity in Brazil, India, China and the US, 2010
    • Figure: COPD, age, and smoking cessation
    • Figure: Diagnosed COPD patients by age in Brazil, India, China and the US, 2010
    • Figure: Brazil – population spread by age group, 2009 and 2019
    • Figure: India – population spread by age group, 2009 and 2019
    • Figure: China – population spread by age group, 2009 and 2019
    • Figure: US – population spread by age group, 2009 and 2019
    • Figure: COPD patients by smoking status in Brazil, India, China and the US, 2010
    • Figure: Smoking rate by gender and country (%) in Brazil, India, China and the US, 2006
    • Figure: Risk factors for the development of COPD (weighted mean rating from 1–10) in Brazil, China, and India, and the US, 2010
    • Figure: Use of biomass fuel for cooking in an Indian village – a risk factor for COPD
    • Figure: Physicians with COPD patients suffering comorbidities (%) in Brazil, India, China and the US, 2010
    • Figure: Use of guidelines for treating COPD by country (%)in Brazil, India, China and the US, 2010
    • Figure: Comparison of guideline recommendations for the treatment of stable COPD, 2010
    • Figure: Adherence to COPD guidelines (rating from 1–10) in Brazil, India, China and the US, 2010
    • Figure: Pharmacological versus non-pharmacological therapy by COPD severity (%) in Brazil, India, China and the US, 2010
    • Figure: Drug classes prescribed by COPD severity and country (%) in Brazil, India, China and the US, 2010
    • Figure: Use of bronchodilators by country and COPD severity (%) in Brazil, India, China and the US, 2010
    • Figure: Bronchodilators used in the treatment of COPD
    • Figure: Use of corticosteroids by country and COPD severity (%)in Brazil, India, China and the US, 2010
    • Figure: Preferred drugs for treating COPD (%)in Brazil, India, China and the US, 2010
    • Figure: Long-term management of COPD by physician type (%) in Brazil, India, China and the US, 2010
    • Figure: Method of COPD tracking (%)in Brazil, India, China and the US, 2010
    • Figure: Average number of points (out of 100) assigned to treatment attributes that influence COPD prescribing behavior in Brazil, India, and China, and the US, 2010
    • Figure: Average number of points (out of 100) assigned to device attributes in influencing COPD prescribing behavior in Brazil, India , and China, and the US, 2010
    • Figure: Branded versus generic drug use by country (%) in Brazil, India, China and the US, 2010
    • Figure: Confidence in using generics (rating from 1–10) in Brazil, India, China and the US, 2010
    • Figure: Different mechanisms of asthma and COPD , 2010
    • Figure: Level of difference between COPD and asthma treatment (rating from 1–10) in Brazil, India, China and the US, 2010
    • Figure: Treatment outcomes for COPD (ranked 1–5) in Brazil, India, China and the US, 2010
    • Figure: Level of patient compliance by country (%) in Brazil, India, China and the US, 2010
    • Figure: Top 5 challenges in COPD (weighted average for Brazil, China, and India), 2010
    • Figure: Likelihood of prescribing novel combinations (rated 1–5) in Brazil, India, China and the US, 2010