Keep it simple: Driving growth for inhalers in emerging markets

‘Advanced simplicity’ will drive growth for inhalers in emerging markets, Peter Schmelzer, CEO of H&T Presspart tells us more.

The number of blockbuster respiratory products going off-patent has opened up opportunities for generic inhalers, and demand for asthma and chronic obstructive pulmonary disease (COPD) treatments is on the rise in the developing world, not just the mature markets.

Indeed, emerging markets clearly represent an area of unmet need when it comes to respiratory care. In Latin America, COPD deaths have risen by 65% in the last decade,¹ while in India, a recent study collecting data without spirometry assessment suggested that 12 million people were affected by the disease¹ — in China, chronic respiratory diseases are the second leading cause of death.¹

More and more people in emerging markets are entering the middle classes with new money and new demands. Also, as access to medication improves in developing countries, citizens and their doctors are demanding better treatments.

Growth opportunity

We have seen that the generic capsule-based dry powder inhaler (DPI) segment in developing markets shows a lot of promise and demand is rising. However, when it comes to these products, patients in developing markets have not been best served by strategies employed by major pharmaceutical companies in the US and Europe, which have developed DPIs customised exclusively for one specific active pharmaceutical ingredient (API).

Global generic players also have customised devices for specific DPIs and have spent heavily in leading emerging markets. However, the healthcare markets in most of the fastest-growing economies in the developing world are highly fragmented.

Local players make up a sizeable chunk of the market in developing countries, with well-established channels of generic production and distribution. We have also seen a number of new entrants coming into the inhaler field.

As such, there is a growing demand in the emerging markets for a DPI which can be used with a variety of API but is easy to use and affordable.

Companies who aspire to capture these growth opportunities must therefore ensure that they have functional excellence in place. Quality is critical when it comes to manufacturing not only APIs but also the components and delivery systems.

As well as manufacturing excellence, the firms that will succeed will be those that can accelerate the development, global scale-up and commercialisation of products for respiratory patients in the developing world. They will need to come up with designs that minimise manufacturing assembly and production costs, whilst maximising ease of use.

To address this challenge, H&T Presspart moved into the DPI space through a pact with Portugal’s Hovione. Through this partnership, we have launched PowdAir Plus, primarily designed as a ‘generically available’, customisable device for the developing world. It features an all-plastic, four-component design to keep costs low. It automatically opens the capsule once the tray is closed, removing the need for patients to pierce the capsule and reducing operational steps. By enhancing ease of use, the design also removes the risk of errors that may affect treatment efficacy.

Design features that help tackle the persistent issue of poor adherence are extremely important for asthma and COPD treatment. Despite significant advances in inhalers, many patients continue to experience poor disease control, with adherence being a key factor. According to WHO, patient adherence for those on long-term therapies for chronic diseases is only at 50%, with rates in asthma and COPD varying from 22–78%. As well as impacting patient quality of life and outcomes, non-adherence is associated with higher healthcare utilisation and costs — pertinent in emerging markets.

Aspirational design

While cost and functionality are crucial, companies that fail to recognise the growing aspirations of consumers in emerging markets are missing a trick. Consumers in these markets are not prepared to accept cheap, but inferior products, and the desire for higher-end, high-quality products is growing. So, alongside quality and functionality, companies need to consider aesthetics.

In the same way that we have seen a move towards more stylish insulin pens, inhalers are part of daily life and patients are looking for sleek and compact designs that are both attractive and highly portable, as well as being robust.

Specific emerging market needs

As for specific regions, players looking to benefit from the coming growth in the emerging markets should consider opportunities in India, Pakistan and Bangladesh but also take into account the needs of patients when designing their inhalers. For example, humidity can affect the performance of the device, while patients expect to use their capsule-based DPI for up to six months, not one month as in the West.

Latin America, the Middle East and Africa are also seeing increased usage of asthma inhalers and while the volume sold in China is currently low, the country is expected to become one of the highest consumers of generic inhalers, driven by rapid urbanisation and industrialisation, as well as improved access to healthcare.

The potential for DPIs in emerging markets is clear. The winners will be the companies who can offer aspirational devices driven by advanced simplicity, ease of use and affordability.

References

1. WHO. Chronic Respiratory Diseases. Available at: http://www.who.int/gard/publications/chronic_respiratory_diseases.pdf