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Chronic Disease Driving Up Costs, Medtech Driving Them Down

[Healthcare costs have two important components — the cost of treating diseases and the costs of not treating them. In the din of discussion of rising healthcare costs, frequently the mantra is heard that medical technology is responsible for the higher costs. Yet, in the case of chronic diseases, the associated, preventable complications, which can run the gamut from heart disease, stroke, wound care, infection control and numerous other complications, reducing the exorbitant costs chronic disease complications is a primary goal of medical technology development.]

Chronic diseases continue to garner much attention due to their blame in rising healthcare costs. Obesity, for one, is gaining more attention by the day, particularly since it can be associated with or directly lead to many other healthcare problems (heart disease, hypertension, end-stage renal disease, vascular disorders, stroke), all of which contribute significantly to rising healthcare costs. Treatments are diverse, with the most effective options — at least in the short term — being those involving bariatric surgery and the use of devices like lap banding and gastric stimulation. The drawbacks are, of course, that these surgical options can be highly invasive, they do not address the root causes of obesity and as effective interventions as they may be for life threatening obesity, they sometimes represent only short term solutions.

Another major contributor to chronic disease is Type 2 diabetes, particularly for its high prevalence worldwide and its correlation with growth in the incidence of obesity. If left unchecked, its associated complications are enormously costly both in human and financial terms, yet the number of options for its effective management make it a high profile target of healthcare industry attention..

By no means representing all chronic disease and certainly recognizing the overlapping involvement of obesity and diabetes, obesity and diabetes are nonetheless among the most salient examples in which chronic disease creates enormous potential for medical technology.

Considering these two chronic conditions, we provide additional data on each that bear on the size of the opportunity to make an impact on chronic disease.

Diabetes

The most common form of diabetes, Type 2, which manifests itself more frequently in adults, represents a huge and growing segment of the global population, all the more for the fact that upwards of 80% of all cases of Type 2 diabetes are undiagnosed yet insidiously lead to a myriad of health problems like hypertension, heart disease, diabetic retinopathy, diabetic nephrophathy, stroke and other circulatory disorders.

In the chart below is shown the prevalence of diabetes (all types) by region in 2003 and forecast for 2025, illustrating dramatic regional and overall growth.

Source: International Diabetes Federation; MedMarket Diligence, LLC, report #D500, “Diabetes Management, Worldwide, 2005-2015: Products, Technologies and Markets in the U.S., Europe, Japan & Rest of World.”

The presentation of type 2 diabetes has a high correlation with cardiovascular disease and obesity; overweight middle-aged people age are much likelier to develop the condition than individuals of normal weight. The associated costs of treating the condition and its complications are vast compared with the cost of the drugs that are currently available. This explains why diabetes has become a prime candidate for disease management programs; pharmacy benefit managers see a good opportunity to reduce the overall cost of the disease through better and earlier intervention with medicines.

The size of the patient population, its steady growth – especially rapid in developing world countries enjoying new prosperity – and the limitations of current treatments mean that diabetes has become a major R&D focus for many of the world’s largest drug companies. These include Bayer, Pfizer and Servier, as well as Eli Lilly, Novo Nordisk and Sanofi-Aventis, and biotechnology companies such as Amylin.

Unlike Type 1 diabetes (juvenile onset), which is characterized by lack of insulin production, Type 2 diabetes is variably characterized as being associated with either with patients’ inadequate insulin production or production of ineffective forms of insulin. This requires different therapeutic regimens to either provide insulin or other drugs that can moderate the patient’s sensitivity to insulin in order to effectively regulate blood glucose levels.

While drugs and devices for the monitoring and treatment of type 2 diabetes are well established, this does not equate with lack of opportunity in the market, given the trend in prevalence, untapped patient population, accelerating healthcare costs and other drivers. In fact, tremendous opportunities exist for better drugs (e.g., considering recent questions about Avandia), less invasive glucose measurement (e.g., painless lancing, near-infrared or similar non-invasive approaches), less invasive delivery of insulin (although Exubera, the inhalable insulin from Pfizer was approved in early 2006, questions about respiratory effects and other questions have dampened the — one might say — overly “exuberant” potential for this drug), and other treatments to improve clinical outcomes and further penetrate the undiagnosed type 2 population.

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