Post on 20-Jul-2016
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Brand Project-RosulipSwapnil Waichale
Project OutlineSecondary Research Primary Research Findings &
Recommendations
Objective of Secondary Research:1) To find out indications in which the molecule Rosuvastatin is
used2) To find out what other substitute molecules can be used under
same indications3) To find out competitive brands in the market, their shares and
growth rates, size and growth rate of the market4) To Understand the types of doctors involved 5) To understand current Cipla strategy for Rosulip6) To understand the way it is implemented in the fieldSources of Information:1) www.CiplaMed.com 2) Online Journals 3) Rosulip ORG Data4) Vitalis PPT 5) Rosulip PMT, Mr. Vishal Kucheriya 6) SM/BM
Vitalis
Project OutlineSecondary Research Primary Research Findings &
Recommendations
References Used:1) http://ciplamed.com/articles/dyslipidemia-essence-series-0?spec=
12) http://ciplamed.com/slide-library/diabetic-dyslipidemia?spec=13) http://ciplamed.com/articles/atherogenic-dyslipidemia-questions-
and-answers-dr-abhimanyu-garg-usa?spec=14) http://www.apiindia.org/pdf/medicine_update_2010/diabetology_2
5.pdf5) http://www.ijem.in/article.asp?issn=2230-8210;year=2012;volum
e=16;issue=2;spage=240;epage=245;aulast=Dalal6) http://www.who.int/gho/publications/world_health_statistics/EN_
WHS2013_Full.pdf7) http://www.biomedscidirect.com/download/IJBMRF2011208/13/o
besity_and_dyslipidemia
Project OutlineSecondary Research Primary Research Findings &
Recommendations
References Used:1) http://www.ncbi.nlm.nih.gov/pubmed/236445552) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582048/3) http://www.ncbi.nlm.nih.gov/pubmed/223608204) http://www.ncbi.nlm.nih.gov/pubmed/214989065) http://www.mdpi.com/2072-6643/5/7/27086) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656667/7) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681027/
Findings of the Secondary ResearchNCEP Guidelines: All adults over the age 20
should have a 12 hour fasting lipid profile once in 5 years
Overall prevalence of dyslipidemia in India ranges from 10-73% (Dibetology Medicine update 2010, API India)
Prevalence of Hypercholesterolemia: 28% in Urban subjects and 22% in Rural subjects
ADA Guidelines TargetsLipid TargetTriglyceride (TG) < 150 mg/dlLDL Cholesterol < 100 mg/dlHDL Cholesterol > 40 mg/dl
Findings of the Secondary ResearchIn urban New Delhi, Prevalence of Hypertriglyceridemia
was 61% in non-obese subjects, and 73% in obese subjects
24% of urban population of north India had low levels of HDL Cholesterol
Population based studies: High triglycerides in upper SEC due to high fat intakeHigh triglycerides in lower SEC due to high carb intake
Type-2 Diabetes pattern Dyslipdemia (Parikh et al)High LDL, Low HDLHigh LDL in males, Low HDL in females as bigger
threat
Findings of the Secondary ResearchTypes of Dyslipisemia
Manifestations of DyslipidemiaNo SymptomsMay be diagnosed after a myocardial infarction or strokeXanthomas : intra- and extra-cellular deposition of
cholesterol
Type CausesPrimary Several monogenetic disordersSecondary •Non-genetic
•Hypothyroidism, Obstructive Liver Disease, Nephrotic Syndrome, etc. (Hypercholesterolemia)•Obesity, Diabetes, Pregnancy, Chronic Renal failure, Alcohol, etc. (Hypertriglyceridemia)•Type-2 Diabetes mellitus, Rheumatoid arthritis, Malnutrition, Obesity, Cigarette Smoking, etc. (Low HDL)
Findings of the Secondary ResearchConsequences of Lipid Abnormalities• Coronary Heart Disease (CHD)• Stroke• Peripheral Artery Disease (PAD)
Management of Dyslipidemia• Therapeutic Lifestyle Changes (TLC)
• Reduced intake of saturated fats (<7% of total calories) and cholesterol (<200 mg/day)
• Therapeutic options for enhancing LDL lowering such as plant stanols sterols and increased viscous fiber
• Weight reduction• Increased physical activity
• Drug Therapy
Findings of Secondary researchDrugs affecting Lipoprotein Metabolism
Fibric Acid Brand: FenolipCombinations: Atorlip-F, Rosulip-F
Drug Class EffectsHMG-CoA Reductase Inhibitors (Statins)
LDL Lower 18-55%HDL Rise 5-15%TG Lower 7-30%
Fibric acids (Fibrates) LDL Lower 5-20%HDL Rise 10-20%TG Lower 20-50 %
Nicotinic Acid (Niacin) LDL Lower 5-25%HDL Rise 15-35%TG Lower 20-50%
Cholesterol Absorption Inhibitors (CAL)
LDL Lower 17%HDL Minimal ChangeTG Minimal Change
Bile Acid Sequestrants LDL Lower 15-30%HDL Rise 3-5%TG No change or Rise
Statins Cipla Brands
Simvastatin Simcard
Atorvastatin Atorlip
Rosuvastanin
Rosulip
Lovastatin
Pravastatin
Fluvastatin
Secondary Research on StatinsRosuvastatin is more effective compared to
Atorvastatin in reduction of sdLDL levels.Most Effective LDL-C Reduction Doses
All three safe in muscular and hepatic functionsRenal Safety: Atorvastatin > Rosuvastatin > PravastatinRosuvastatin is most effective statin at reducing
LDL-C, Triglycerides, and total cholesterol at lowest dose of 10 mg.
Moreover, it reduces HDL-C the least, compared to other statins
Rosuvastatin 10
Atorvastatin 40
Pravastatin 20
29.03% 22.8% 20.3%
Secondary Research on Statins Patients with Acute Coronary Syndrome are recommended for early
aggressive low-density lipoprotein (LDL) cholesterol-lowering therapy.
LUNAR study: RSV40 more effectively decreased LDL cholesterol, increased HDL cholesterol, and improved other blood lipid parameters than ATV80 in patients with acute coronary syndrome.
Patrol Trial: The safety and efficacy of these 3 strong statins are equal. It is suggested that the use of these 3 statins be completely dependent on physician discretion based on patient background.
In patients with the metabolic syndrome, despite attainment of LDL cholesterol goals, these patients may retain considerable residual coronary heart disease risk.
Patients with the metabolic syndrome may have relatively normal LDL cholesterol when LDL particle concentration is elevated because these patients have a preponderance of small, cholesterol-poor LDL particles.
Thus, LDL cholesterol may underestimate risk in patients with the metabolic syndrome.
RSV was more effective than ATV in reducing LDL cholesterol (P < 0.001), LDL particle concentration (P < 0.05), and non-HDL cholesterol (P < 0.01) after 6 and 12 weeks.
Secondary Research: Stroke & StatinsLarge clinical trials have shown that statins reduce the incidence of
cerebrovascular events. In addition to their cholesterol lowering properties, statins exert a
number of pleiotropic, vasculoprotective actions that include improvement of endothelial function, increased nitric oxide (NO) bioavailability, antioxidant properties, inhibition of inflammatory responses, immunomodulatory actions, regulation of progenitor cells, and stabilization of atherosclerotic plaques.
long-term statin treatment reduces stroke riskCombined data from 9 trials including 70 070 patients indicated
relative and absolute risk reductions for stroke of 21% and 0.9%, respectively, with statins
Rosuvastatin reduces by more than half (51%) the incidence of ischemic stroke among men and women with low levels of LDL-C levels who are at risk because of elevated levels of high-sensitivity C-reactive protein.
Sources: Stroke, Journal of the American Heart Association 2004, 2010, 2103.
Project OutlineSecondary Research Primary Research Findings &
Recommendations
Objectives of Primary Research:1) To understand the level of awareness in public regarding
Dyslipidemia2) To understand the therapy choice of doctors 3) To understand affinity of doctors towards brands, and reasons
behind them4) To understand how Cipla can partner with Doctors, in order to
enhance timely detection of Dyslipidemia5) To understand the purchasing and compliance behavior of
patientsMethodologies to be used:1) Public awareness survey 2) Patient Survey 3) Discussions with Doctors 4) Lipid Profile Check-up Camp Observation 5) Retail Survey
Interaction with Doctors in EASD WebcastDr. Mahendra Wawhal, Asst. Professor, MGM
After 3 months, repeat lipid profiles are checked, and doses are adjusted/titrated according to lipid levels and patient compatibility (Side effects, etc.)
Percentage ratio in Practice: Atorvastatin : Rosuvastatin :: 60 : 40
Atorvastatin: Good ResultsRosuvastatin: Less Dose, better resultsConcern area for Rosuvastatin: Safety in Elderly Patients
Indication DrugChronic Stable Angina Rosuvastatin 40 mgUnstable Angina Rosuvastatin 40 mgTriple Vessel Disease Rosuvastatin 40 mgAfter Heart Operative Procedures
Rosuvastatin 40 mg
Interaction with Doctors in EASD WebcastDr. Amit Choradiya, Sr. Resident, MGMAcute Coronary Syndrome: Rosuvastatin 40 mg or
Atorvastatin 80 mgSurgical Intervention: In Clinic (7-15 days) & 1 month,
Rosuvastatin 40 mg or Atorvastatin 80 mg is prescribed.After one month, lipid profiles are rechecked, and depending
on results and patient compatibility, further doses are decided.
Transient Ischemic Attack (TIA) & Cerebrovascular Accident (CVA): 10mg & 5 mg are preferred (Lower Doses)
Depending on TG levels, Fenofibrate Combination is prescribed.
When asked on selection between Atorvastatin and Rosuvastatin, he says, “It’s like choosing between Maruti 800 and Swift. Both serve the purpose.”
Interaction with Doctors in EASD WebcastDr. M. B. Pisolkar, Sr. Physican (Old Doctor)Atorvastatin is molecule of choice, Rosuvastatin has
more side effectsStarting Dose he prescribes is Atorvastatin 80 mg. Lipid Tests every monthWithin 3-4 month, Patient comes to maintenance dose
of 10 mg.Conducted study on 200 patients, in which he started
statins. Statins he continued for 15 years. 90% of patients did not suffer any problems, and he found their angiography to be perfectly normal.
Interaction with Doctors in EASD WebcastDr. R. Kharkar, Sr. Physician (Old Doctor)Individualized Treatment plan for every patient,
according to lipid profiles3 Month Repeat check-ups for further titrationAtorvastatin as molecule of choiceRosuvastatin is unsafe due to renal and other
Side-effectsOther Doctors:
Young Doctors preferred Rosuvastatin more compared to old doctors, who preferred Atorvastatin
Interaction with Cardiologists during callsDr. Magarkar Dr. Shirish
DeshmukhDr. Deodhar Dr. Kalbande
• After procedures (Peripheral Coronary Intervention, Angioplasty, etc.), A high dose of Atorvastatin 80 mg is used for a period of 7-30 days.
• After further lipid tests, dosages are lowered to 20/40 mg as per patient needs.
• Lifelong maintenance dose: Atorvastatin/Rosuvastatin are used in small dosages.
• No one preferred Rosuvastatin 40 mg.• Dr. Magarkar, however mentioned that he is on shift to
Rosuvastatin.
Interaction with Nephrologists during callsDr. Borkar S. S., Kamal Nayan Bajaj HospitalLow doses of Atorvastatin are prescribed in patients with
CKDPrefers monotherapy to combinationsShifting focus on Rosuvastatin (Low dosages)Does not need Atorvastatin 80 mg or Rosuvastatin 40 mgDr. Sudhir Kulkarni, MGMCustomized treatment according to lipid profilesAtorvastatin 10/20/40 are used mostly. Concerned about renal safety in Rosuvastatin usage
Synopsis of Insights from doctorsPhysicians & Diabetologis
ts
• Low shares of 40 mg Rosuvastatin• More shares of 5/10/20 mg• Young Doctors preferring Rosuvastatin
Cardiologists
• Interventions: 40 mg rosuvastatin• Also 5/10/20 mg• Young Doctors preferring Rosuvastatin
Nephrologists
• 5/10 mg most common• Concerned about renal side effects
Competition is huge, and every company is offering Lipid Profile Test Coupons, Expensive Gifts, Conferences Invitations, etc.
Doctors are not brand loyal. They prescribe as per the activities/expenditures by companies on them.
Retail Survey of Chemists with Neurologists and Neuro-SurgeonsSM Vitalis noticed potential for statins at a
neurologist, Dr. UkadgaonkarHe has added him in MSLHowever there is no focus on other
neurologists and neurosurgeonsIn order to assess neuro-potential of statins
and competitive status, we are carrying out this Retail survey
Results: Refer Next Slide
Neurologist Retailing FindingsChemist Statin Monotherapy CombinationShree Medical, Dr. Majid
70 strips-Atorvastatin (10/20/40)10 strips-Stator 80 mg200 Strips-Coltro (Rosuvastatin)30 Strips-Novastat 10
150 strips-Atorfit CV
Max Medical, Dr. Devdatt Deshmukh
40 strips-Rosuvas 90 strips-Ecosprin 75/150
Bajaj Medical 30 strips-Tonact 10/2030 strips-Tonact 80 mg30 strips-Rosuvas
40 strips-Ecosprin 75/150
Dr. kanjalkar, Manik Hospital
40 strips-Atorva 10/2010 strips-Stator 1040 strips-Rozavel 10/20
Sachin Medical, Dr. Panse
20 strips-Atorvastatin 10/2010 strips-Rosuvas 10
Dr, Anand Soni, MGM Hospital
10 strips-Tonact 10/20 20 strips-Ecosprin 75
Brain Medical, Dr. Ukadgaonkar
180 strips-Atorvastatin 10/20/4020 strips-Rosuvas 10
Patient Awareness Survey Conducted a survey among 50 OPD patients in Hedgevar Hospital All patients more than 40 yrs age selected (Range: 40-72 yrs)Findings: 29 people with no Lipid Profile Test (LPT) so far 12 people with Associated Risk factors (Family History, Obesity, etc.) Among 21 who did LPT, 16 cases were recommended LPT by doctor when
they approached Doctor for 10 cases with Diabetes & Hypertention 6 cases with Unrelated ailments (Allergy, Foot Ache, Stone Operation, etc.)
Patient Age (Some Cases) First LPT72 (Diabetes, Hypertention) After Angioplasty (At age of 56)
66 (Diabetes, Hypertention) Last Week! (At age of 66)
63 (Diabetes, Hypertention) 2 months back (At age of 63)
51 (Diabetes, Hypertention) 3 months back (At age of 51)
55 (Hypertention) 3 yrs back (At age of 52) Regular Since then
50 (Hypertention) 4 yrs back (At age of 46) Regular Since then
50 Female (Foot ache Visit: => LPT)
At the age of 50
What is the need to do LPT? When I am absolutely fine?
We do not know such things
Patient
Patient Segmentation
Urban• More Awareness in higher Income groups• Access to healthcare
Rural
• Unaware mostly• Lack access to Healthcare, need to visit cities• Try to avoid Dr. visits due to economic troubles,
unawareness, etc.
Unaware
At risk
• In spite of family history, diagnosed diabetes/hypertention, obesity, etc.
• Lack of knowledge, Lack of access, etc.
Competitive Price Analysis
Strategic Pricing of DRL:• The 40 mg and 80 mg Doses are priced minimum
• These are the doses, given first time to the patient• Atocor 80 mg comes in pack of 30 tablets, while Atorlip 80
comes in 3 strips of 7 tablets (21 tablets)(less value/Converted prescription)
• The patient are then titrated to lower doses, which are priced higher
• 5 mg and 10 mg are lifelong maintenance doses• Acquire Patient at cheap price, maintain at higher
price!Low Pricing of Abbott• Showing great growth as compared to market
Atorvastatin 5 10 20 40 80 Share Growt Value Units STORVAS Ranbaxy 6.29 9.792 18 24.7 29.4 17.31 2.95 1,15,64,70,155 1,05,84,511 ATORVA Zydus 3.652 10.45 19.85 25.35 36.95 11.35 11.99 75,82,51,099 80,36,016 AZTOR Sun 4.011 6.206 15.9 22.9 28.39 9.61 15.99 64,24,07,473 74,44,298 TONACT LUPIN. 6.615 12.9 21.51 17.64 27.37 9.01 14.69 60,18,91,549 52,48,818 LIPICURE Intas 4.4 7 17.33 21.4 27 6.57 -3.58 43,91,18,320 32,72,262 ATOCOR DRL 6.35 9.2 10.77 16.28 16 4.88 6.71 32,62,95,220 41,52,502 ATORLIP CPL 5.2 9.4 17.3 19.96 23 4.35 -0.91 29,08,10,923 31,95,744 STATOR Abbott 4.22 7.7 16.8 3.65 17 24,36,16,861 59,13,855 Lipikind Mankind 1.9 3.8 1.45 5.84 21,38,45,018 24,95,872Atorvastatin Market 100 6.66 6,68,24,12,146 9,30,39,715
Share Eaters• Zydus
Cadilla• Sun• Lupin• Dr. Reddy’s
Competitive Price Analysis
Strategic Pricing of DRL & USV• Both showing above market growth•Great Pricing strategy for foray into Rural market, which is as good as White Field, due to very less competition•Converting City Doctors Vs. Acquiring Rural Doctors/ young PGs•Cipla CEO Vision: To develop a Reach as good as Hindustan Unilever, to make avaiable medicines to everyone who needs them•Cipla’s Differentiation: Field Force, Portfolio, Pipeline
Rosuvastatin 5 10 20 40 Share Growth Value Units ROSUVAS RBY 6.83 9.50 26.54 39.90 22.64 18.65 65,40,79,646 63,05,564 ROZAVEL SPI 6.19 11.20 20.64 30.20 12.48 38.03 36,05,70,954 43,59,098 CRESTOR AZN 13.09 18.10 32.47 52.75 8.17 17.22 23,58,52,043 15,57,212 ROZUCOR TNT 5.95 11.80 22.40 30.00 7.71 47.34 22,26,60,512 24,60,918 ROSEDAY USV 3.59 5.99 11.99 7.38 54.39 21,32,60,165 51,01,614 NOVASTAT LU. 5.84 10.61 18.59 38.00 5.67 36.46 16,36,74,989 17,11,201 RAZEL GMK 6.60 13.20 23.70 35.00 5.08 46.73 14,67,77,754 16,16,897 ROZAT DRL 3.99 5.85 10.80 18.00 3.64 53.08 10,51,05,181 22,30,254 CREVAST ELS 5.50 10.00 21.60 32.50 2.84 36.02 8,20,99,063 10,94,525 ARVAST IN9 7.20 10.50 23.00 35.00 2.79 16.91 8,04,85,207 7,51,029 ROSULIP CPL 5.60 9.90 15.00 28.00 2.73 29.90 7,87,93,701 10,54,545 ROSAVE AMB 6.10 11.70 22.50 2.37 43.30 6,85,76,723 9,10,412Rosuvastatin 100 31.23 2,88,84,77,298 3,68,30,682
MRP/Tablet
Share Eaters• Sun• Torrent• USV• Lupin• Glenmark• Dr. Reddy’s• Alembic
Competitive Strategies from FieldUSV: Doctor’s Choice Program: 5 top prescribing Doctors are chosen per TM,
and they are given a choice to choose from a list of 5 Gifts/Medical equipment etc.
Conferences: Either Travelling or Stay Costs of Doctors are born Lipid Profile Camp CouponsPiramal: (Old Strategy from Ex-Piramal Cipla person) Their per tablet price was Rs. 3. So they created a buzz around the number
3. They gifted Doctors everything that came in Rs. 3, like balms, pens, etc. 25%, 50%, 100% Lipid profile Test Coupons given to Doctors, depending on
Doctor profiling Conferences, Expensive Gifts to select Doctors LBLs, patient education materials, campsRanbaxy: Lipid profile camps, Diabetic Camps, Multi-Speciality Camps Talk about Legacy Conferences, Expensive Gifts to select Doctors, CMEs, etc.
Everyone is doing the same things!
SWOT Analysis of RosulipStrengths• Descent Prices• Cipla Equity: Quality, Several
Firsts• Camps, Activities: RED4U• Academic Inputs: CMEs,
Conferences• Distribution & Field Force Reach
Weaknesses• Late Market Entry• Less Focus on Rural patients• Me too Brand Strategy: Camps,
Academics, Gifts• Neurologists: Neglected
Segment• So far less focus on Patient
AwarenessOpportunities• Patient Awareness: To enable &
drive patients for regular check-ups
• Rural India: Awareness & Diagnosis
• Pricing Tactics
Threats• Already established competitors• Threat from brand substitution• Highly competitive Market in
Cities• Brand Shifting among Doctors
Strategy RecommendationUrban: Fight It! Rural: Win It!
• Current Strategy is Recommended
• Additionally, More Focus required on getting New patient Share through Diagnosis Camps, & Direct Patient Awareness
• Know Number of new Cipla patients, Number of old patients, their purchasing frequency. Refer to Next slide to know how!
• More focus required on generating relationships with new PGs (0-5 years of practice)
• More focus on Neurologists and Neurosurgeons Segment required
• Urban India: Highly competitive Market! Fight It!
• Align with Mr. Subhanu Saxena’s Vision: To have distribution reach as good as Hindustan Unilever!
• Really make the drugs required by them, affordable! Reduce Prices if needed! (Ref. DRL Pricing Strategy in previous Slide)
• Create awareness in public regarding health check-ups, healthy life-style
• Attach with young PGs to do Diagnosis Camps, Mobile Clinics in rural areas: Provide access to Healthcare
• Rural India: White Field Business Opportunity! Win It!
Patient Loyalty: How to Measure Chemist will handover Discount coupons for repurchase to the
patients, in every New Prescription. These coupons will have a code written over them, which will tell us the
number of New patients. To avail discount, the patient will give one coupon at every repurchase to
the chemist. Company will reimburse the discounted money to the chemist, when the chemist gives these coupons to company. This will tell us number of times of their repurchases.
Business Sense: Discounts will keep people stuck to Cipla brand. In fact they will insist Doctor, that some of my coupons are remaining, kindly do not change my brand!
Connect to patients through Coupons: Take their Contact numbers or ask them to register online on a website, provide them information, services, advice. Biocon provides 24 hrs facility and Diabetic Advisor reach to patient
at home within 2 hours of complaint from patient, especially for Insulin
Chemist Relation: Advice Chemist on getting these patients back to their counters (Their contact numbers, home delivery options, etc.) Develop relationship with the chemist, and enjoy it in Acute therapies’ OTC Sales!
Acquire & Retain your patients!
Thank You