This article was also published on Medical Device Daily
Nearly ten percent of India’s 1.24 billion people suffer from chronic kidney disease (CKD), a disease in which the kidney slowly loses function and fails. One 2013 survey found that more than 15 percent of urban Indians have the disease, with rates almost 50 percent in some cities.
As the number of CKD patients goes up, so has the size of the Indian dialysis market. It increased in value to more than $150 million in 2012, from $100 million in 2007. India’s demand for dialysis is growing at a rate of 31 percent, compared to 6 percent in the US and 8 percent in the rest of the world.
CAUSES AND PREVALENCE
Diabetes is the primary cause of CKD in India. The condition accounts for 30 percent of all CKD cases, as opposed to high blood pressure, which accounts for 20 percent of all cases. India is home to more than 60 million diabetics. Should current rates hold, the number of diabetics in India will more than double by 2040. According to doctors, about one third of these patients will go on to develop CKD.
CKD patients in India tend to be much younger on average than in other countries. Patients with end stage renal disease (also known as Stage V CKD) are usually 45 – 50 years old, as opposed to older than 60 in the West. As a result, CKD patients in India typically need more comprehensive and longer care regimens than their counterparts in other countries.
Prevalence of the disease also varies by region in India. Urban areas have much higher rates than rural areas, and Northern India has higher rates than Southern India. For example, New Delhi had a CKD rate of more than 40 percent in 2013, while Mysore and Bangalore had rates of about 4 percent.
CKD treatment ranges from dieting and drug therapy to regular dialysis. Since most Indians with CKD do not realize they have the disease, public and private healthcare providers have set up several national outreach programs across India. In addition, the number of dialysis centers in India are rapidly increasing.
India’s Ministry of Health (MOH) in 2012 announced plans to provide subsidized dialysis treatment in more than 550 public centers throughout India. That same year, private healthcare provider Apollo Hospital Group increased its number of diabetes management clinics to more than 155. These SUGAR clinics offer patients tailored diabetes management and warn patients of the dangers of CKD.
Nevertheless, access to CKD treatments is limited. Although India has more than 50,000 patients who receive long term dialysis, it has only a thousand kidney specialists in the entire country. Furthermore, treatment can be expensive. One year of dialysis costs anywhere from $1,000 at government subsidized clinics to $10,000 for home based treatment. While this is far less than the average $25,000 cost in the US, it is significant in a country where the average annual per capita income (in PPP) is less than $4,000.
DISEASE MANAGEMENT EQUIPMENT
The management of CKD requires a host of medical devices, from glucose monitoring systems and insulin pumps to dialysis equipment. Other products with strong demand include dialyzers, dialysis solutions, concentrates and home dialysis equipment.
India’s market for home based care has until recently been quite small, but it is growing. More and more middle class Indians are able to afford automated peritoneal dialysis machines, which filter a patient’s blood during their sleep. Foreign medical device companies such as Fresenius and Baxter sell this kind of home care equipment in India, usually at substantial discounts to patients. These companies also offer rental options and graduated payment plans to finance the initial cost of home care equipment.
In spite of the recent growth in home care, all but 10 percent of dialysis in India still takes place in public hospitals and clinics. Hospitals in large Indian cities purchase more than 90 percent of all hemodialysis machines. This purchasing takes place at the central level, as opposed to a hospital by hospital basis.
Indian healthcare providers such as Apollo and Fortis Healthcare are increasing their number of dialysis centers and expanding their range of dialysis services. In 2011, for example, Fortis announced plans to establish 50 standalone dialysis centers by 2014. The new chain of centers shall feature state-of-the-art technology, from specialized chairs to advanced water testing. Unclean water has forced dialysis centers across India to suspend treatment in the past. Additionally, the Fortis centers will hold educational sessions to help CKD patients better manage their conditions.
There are few local manufacturers in India with the ability to make sophisticated dialysis equipment. In 2012, most advanced dialysis machines were imports. Medical equipment like catheters, needles, blood tubing and dialysis treatment chairs are often made by local manufacturers, however. These companies are starting to expand their product lines into dialyzers and even hemodialysis machines. Nevertheless, it will likely take years for locally produced equipment to reach the performance and quality standards of imported medical devices.
FOREIGN COMPANIES IN INDIA
The rapid rise of CKD has meant many opportunities for foreign dialysis equipment manufacturers doing business in India. Fresenius, for example, has seen its dialysis equipment sales in India increase by 30 percent per year since 2006. The German firm controls one third of the dialysis market in India, followed by Baxter. Smaller foreign medical device companies, like Nipro Diagnostics, are experiencing double digit growth in their Indian medical equipment sales, as well.
Perhaps the biggest challenge for foreign medical device companies is the low per capita income of most patients, coupled with low government reimbursement rates. Additionally, the already small budgets of many public hospitals are subject to sudden changes in funding by the central government. In May 2013, for example, local plans for a public dialysis center in the southern city of Madurai had to be scrapped after the central government withdrew its funding.
India’s CKD problems have reached epidemic proportions, and it is likely that disease rates will continue to go up in the future. Those foreign medical device companies that understand India’s dialysis market should be able to take advantage of numerous sales opportunities. For example, companies that can bring down the average price of advanced dialysis equipment will be at an even greater advantage when they sell their products to public dialysis centers and private Indian patients.