Industry Trend Analysis - Access To Oncology Market Will Remain Challenging - JAN 2018

BMI View : Access to cancer treatments will remain a key public health concern throughout Sub-Saharan Africa. Low affordability levels, a lack of technical support, and limited funding continue to dictate a tailored multinational company strategy. Indeed, the rising cancer incidence, combined with government incentives to improve access to treatment, will support a greater drugmaker presence over a longer timeframe, although exploiting these opportunities will remain highly challenging.

The demand for oncology treatments in Sub-Saharan Africa (SSA)'s pharmaceutical markets will continue to engage multinational drugmaker interest. In November 2017, Swiss multinational Novartis announced a partnership with the American Society for Clinical Pathology (ASCP) and the American Cancer Society (ACS) to improve access to cancer treatments and diagnostics in select SSA markets. As part of Novartis's commitment to reducing the cancer burden in the region, Ethiopia, Uganda, and Tanzania are set to benefit from improved cancer diagnosis tools, namely immunohistochemistry, as well as greater technical support and training for healthcare professionals. If successful, this latest initiative will improve targeted cancer treatments in few national hospitals, albeit limited in its scope to support the wider population. The project will also serve as a pilot for the future roll-out of similar activities within other SSA countries.

Rapidly Increasing Burden

Supporting Novartis's decision to target these three markets first, almost one-fifth (19.9%) all new cancer cases diagnosed in SSA annually occur in Ethiopia, Uganda, and Tanzania according to Globocan. Cancer survival rates are very low in the region due to funding shortages and the poor basic healthcare infrastructure. As such, Globocan ascribes a 12.5% chance of developing cancer before the age of 75 and a 9.5% chance of dying. Moreover, the number of new cancer cases is expected to increase significantly in each of these markets by 2030, and while subtle regional differences exist, the leading four cancer subtypes in terms of incidence and mortality are cervical, breast, prostate and liver cancers. This aligns well with Novartis' oncology portfolio, which remains the firm's largest therapeutic area by global revenue (as of Q317).

Rising Cancer Incidence To Boost Long-Term Demand
Number Of New Cancer Cases In Select African Markets
Source: Globocan, BMI

Novartis's interest in SSA's oncology market follows a similar development in October 2017, where US multinational Pfizer and Indian generic firm Cipla committed to price reductions for sixteen essential cancer medicines in Nigeria, Ethiopia, Kenya, Uganda, Rwanda and Tanzania. According to the ACS, Pfizer's agreement includes a price reduction for the following cancer medicines: carboplatin, cisplatin, docetaxel, doxorubicin, epirubicin, fluorouracil, gemcitabine, leucovorin, methotrexate, oxaliplatin, and paclitaxel. For Cipla: anastrazole, bleomycin, capecitabine, carboplatin, cisplatin, cytarabine, oxaliplatin, and vinblastine have been listed. The fastest growing cancer subtypes in SSA are well suited to Pfizer and Cipla's product portfolio, with a significant number of the chosen medicines to be reduced in price falling under these categories.

Public Sector Engagement

We highlight that many governments in SSA are becoming more engaged in the process of supporting the uptake of cancer treatments, alongside their primary focus which remains on communicable diseases. To give a few examples, Angola now includes cancer vaccinations in its government-funded immunisation programme and Ghana now includes numerous cancer medicines in its state-subsidised National Health Insurance Scheme. Healthcare infrastructure is also being improved with Ethiopia announcing the construction of a state-of-the art cancer treatment centre in April 2017. Over the long-term, as governments in SSA will improve cancer provision, either through state-subsidised treatments or the development of specialised treatment facilities, this should support foreign drugmakers' pricing-and-market access efforts in a greater number of SSA markets. While this holds potential to improve cancer-related healthcare outcomes over the long-term, the contribution to pharmaceutical sales will not rise in a linear fashion, as a large proportion of the SSA population still reside in rural areas, and so a significant number of cancer cases will remain undiagnosed.