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CHEMOPREVENTION FOR LIVER CANCER: MARKETING AND ETHICS

Organization of presentation Marketing: an overview Components of marketing Objective of the section Market size Market analysis Marketing strategy Ethical issues Summary

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Why do we need to care our health?

Complex issue-associated with different factors

Figure: Health linkage and dynamics Source: MoPH, 2004

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Marketing: an overview

A process to introduce products to the consumers

Conducts research and analyzes the consumer needs and demands (Market research)

Caters the needs of consumers by developing products and providing services (Marketing plan)

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Objective of the section

To introduce and promote the sales of newly manufactured chemopreventive herbal food supplement for prevention of liver cancer

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Components of marketing

Why do we do? Launching of the product Advertising and publicity Sales promotion and distribution

What does it require? Pricing Naming and labeling Market research Marketing plan

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What do we need to know?

“MARKET SIZE”

Why?

The ultimate determinant of production and distribution

Determines the economical viability

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Market size

General information Target population (country): Thailand, 64 million Age structure:

0-14 years 22% 15-64 years 70% over 65 years 8%

Population growth rate: 0.68% Life expectancy at birth: 72.25 years (all)

(male: 69.95 years and women: 74.68 years) Literacy rate: 92.6%

(CIA, 2006)

GDP growth rate:7.0% (estimated) GDP per capita income: US $2,221

(NESDB, 2003)(CIA- Central Intelligence Agency; NESDB- Office of National Economic and Social Development Board)

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Liver cancer incidence

430,000 new cases worldwide (WHO, 1999). Three quarters of which is in Southeast Asia alone. Frequency: Southeast Asia and sub-Saharan

countries-30/100,000 population/year; 5/100,000 population/year in Europe and America

Thailand: 11,868 new cases (ASR=37.4/100,000 population in males, ASR=15.5/100,000 in females) in 1993 (Petcharin, et.al., 2004).

(ASR= Age-standardized incidence)

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Existing practices of treatment

Highly sophisticated treatment facilities, not affordable by everyone; Surgery Chemotherapy Radiation therapy Immune therapy Vaccine therapy Liver transplantation

Note: options are dependent on the stage and severity of underlying disease.

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Cost associated with liver cancer treatment

Calculation:Incidence (male+female) = 53/100,000 Incidence in whole population = 33,920 (Total

population at present is 64 million)

Treatment cost for 1 patient Diagnosis cost

Service charge= Doctor’s fee=

Other associated costs = (Nurse/ Medical officer’s fee)

Sub total (A) =

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Calculation (contd.)

Treatment cost

(eg; chemotherapy) Service charge = Doctor’s fee = Other associated cost = Cost of drug used = dosage x unit price

Sub total (B) =

Total treatment cost required (C) = No. of chemotherapy cycles x B

Cost per 1 incidence of liver cancer (D) = A+C

Cost for whole population = D x Estimated incidence in whole population.

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Risk Factors

Hepatitis B virus infection Hepatitis C virus infection Aflatoxin B1 contamination in food Alcohol consumption Cirrhosis

Best Approach?

Prevention!

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Prevention strategies for Liver cancer

HBV vaccination Reduction in aflatoxin consumption Improvement in diets and lifestyle Chemoprevention: Oltipraz, Chlorophyllin; Natural

products (cruciferous vegetables-cabbage, cauliflower, broccoli sprouts, etc.); Products organic-Oxygenze, Alfalfa leaf powder.

(Source: John, 2006; Supplementary information)

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Market analysis

Income status Huge gap between rich and poor Highest income group: rising from 49.8% in 1962 to 56.7% in 1996 Lowest income group: falling from 7.9% in 1962 to 4.2% in 1996

Expenditure on health Is in rising trend Rising from 3.8% of GDP

in 1980 to 6.1% (US $124

per capita) in 2002

Figure: Expenditure on drugs and health in relation to GDP, 1980-2002

Source: MoPH, 2004

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Health insurance policy

30-Baht health care policy of the government Implementation of universal health care policy

since 2001;The health insurance coverage increased from 71.0% in 2001 to 94.3% in 2004;

73.5% under the universal health care scheme; 5.7% are uninsured.

(Source: MoPH, 2004)

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Marketing strategy

Market research (shopping habits, lifestyles, potential buyers, wants, price, market barriers & competitors)

Marketing plan (consumers: products, services they want, promotion and advertising strategies)

Factors influencing the market (Govt. policy, distribution channel)

Assessment of accessibility

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Customers of preference

HBV carriers Children General public Both urban and rural dwellers

How do they know?

Promotional activities

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Promotional strategies

Publicity and advertisements prior to the launching Poster/pamphlet productions Tele-broadcasting/ radio programming Dissemination of information through internet and

websites Free distribution upto limited number of customer

(first come first serve basis) during launching period Membership scheme and discount facilities Counseling

Risk associated with liver cancer Cost associated with liver cancer treatment Benefits of using the products

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Why herbal chemoprevention?

Vaccination- not enough for all, not able to reach to the poor

No vaccine for HCV Easy availability, easy to use Psychologically acceptable No side effects

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Ethical issues

‘Prevention is better than cure’ because: It saves human being from the onset of dreadful

disease Helps provide longer and healthy life Saves large amount of money- helps entire nation in

revenue generation Early detection is the best approach to control liver

cancer as it: Helps in reduction of incidence and mortality Makes treatment more effective Improves life for cancer patient and their families

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Ethical issues (contd.)

Ethics of chemoprevention clinical trials are much complicated especially when normal human beings are used and for the reasons that: it lies at the intersection of different approaches to the

management of disease and the promotion of health; several conflicting perspectives are competing in these

trials; and multiple values play a role in determining the nature and

magnitude of the risks and benefits. Products and product quality assurance-approval from National

FDA Consumers will be benefited by getting balanced dosage Advantage over vaccination-will reach to the poor

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Summary

Marketing- introduces products, analyzes and caters the consumer needs

Market size- the determinant of production, distribution and economical viability Thailand- 64 million (total population) with 11,868

new cases of liver cancer (1993 data) Highly sophisticated treatment facilities Prevention- the best approach both ethically and

economically.

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THANK YOU!