Ten percent of India’s 1.2 billion people have chronic kidney disease (CKD), a condition in which the kidney gradually loses function and fails. According to one 2013 survey, 17% of urban Indians have CKD. Rates were as high as 47% in some cities.
As the number of Indians with CKD increases, so has the size of India’s dialysis market. It grew to a value of $155 million in 2012, up from $97 million in 2007. Demand for dialysis in India is increasing at an annual rate of 30 percent, compared to 5% in the U.S. and 7% in the rest of the world.
Diabetes is the leading cause of CKD in India. It accounts for one third of all CKD cases, while high blood pressure accounts for one fifth. India is home to 63 million diabetics. If current rates hold, that number will double by 2040. Doctors estimate that 30% to 40% of these people will eventually develop CKD.
Indian CKD patients are on average much younger than patients in other countries. Those with Stage V CKD (also known as end stage renal disease) fall within the 40-55 age range, compared to age 60 and above in the West. Therefore, Indian CKD patients often need longer and more comprehensive care regimens than patients in the West.
CKD prevalence also varies by region in India. Rates are much higher in urban areas and in the country’s north. New Delhi, for example, had a CKD rate of 41% in 2013. But rates in India’s south are much lower – 4.2% in Mysore and just 4% in Bangalore.
Treatment for CKD ranges from drug therapy and dieting to regular dialysis. However, most Indians with CKD are unaware that they have the disease. To raise awareness, India’s public and private healthcare providers have set up a number of national outreach programs. In addition, they are working to rapidly expand the number of stand alone dialysis centers across the country.
In 2012, India’s Ministry of Health (MOH) reported plans to offer subsidized dialysis treatment in more than 600 public centers throughout India. In 2012, private healthcare provider the Apollo Hospital Group expanded its SUGAR initiative to 150 diabetes management clinics across the country. These clinics offer tailored diabetes management to thousands of Indians, and warn them of the dangers of untreated diabetes and CKD.
But access to CKD treatment is still an issue. India has more than 52,000 patients receiving long-term dialysis, but has only 1,000 kidney specialists in the whole country.
Furthermore, treatment is expensive. A year of dialysis can range from $1,000 at government subsidized clinics to more than $12,000 for home based treatment. This is only a small fraction of the $30,000 price tag in the U.S. But in a country where the average annual per capita income (in PPP) is only $3,650, it is a significant cost.
One of the biggest challenges for international device manufacturers is the low reimbursement rates and low per capita incomes of most Indian patients. In addition, the already low budgets of most public hospitals are subject to uncertain funding decisions by the central government. Recently, for example, plans for a public dialysis center in Madurai had to be dropped, due to the withdraw of central government funding.
India’s CKD problem has already reached epidemic proportions, and disease rates will only go up in the future. Foreign medical companies that understand the Indian dialysis market will be able to take advantage of multiple sales opportunities. Companies that can bring down the average price point of advanced dialysis equipment (by manufacturing a product with fewer bells and whistles), will have an even greater advantage when selling to private Indian patients and public dialysis centers.
Ames Gross is president and founder of Pacific Bridge Medical, a consulting firm that helps medical companies doing business in the Asian market (www.pacificbridgemedical.com). A recognized national and international leader in the Asian medical markets, he founded Pacific Bridge Medical in 1988, which has helped hundreds of medical companies with business development and regulatory issues in Asia.
Published: July 1, 2013 – Medical Device Daily