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yet most neglected public health
problems rise to epidemic proportions on our own doorstep. Obesity. Around
20-25% of the population in the U.K. and the U.S. are clinically obese (i.e.
they have a BMI > 30) and around 50% are overweight. Shocking front page
headlines are appearing in the national press - "Parents may soon outlive obese
children" -and research results are published in the broadsheets . Even in
countries such as Japan, famed for their healthy diet, incidence of obesity is
rising dramatically.
Apart from the obvious strain on the body when
carrying vast amounts of extra weight, more and more research is being
conducted into the physiological effects of an abnormally high proportion of
body fat. Recent studies have proved the link between the most common (Type II)
form of diabetes. Alarmingly, this form of diabetes, previously called
adult-onset diabetes, is rising in children. Shedding as little as 9 lb in
weight on a diet and exercise program was shown to cut the risk of diabetes by
58%.
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Over the last four years, the portfolios
of products available to treat both obesity and diabetes have widely expanded.
Xenical from Roche, launched in September 1998, and Reductil from Abbott
launched in May last year, have transformed the way obesity is treated in the
U.K. Similarly the last three years have seen three new oral products for Type
II diabetes, the glitazones or thiazoldinediones, Avandia (GlaxoSmithKline,
July 2000) and Actos (Takeda, November 2000), and Starlix, a prandial glucose
regulator (Novartis, May 2001).
Considering the cumulative percentage of
GPs aware of these products in the first 24 months post launch - Avandia, the
first glitazone, achieved high awareness immediately post launch, with around
60% of UK GPs aware four months later. After the first 12 months, 80% of GPs
were aware, only increasing slightly in the second year. Actos, launched only
four months later, was slower to gain awareness amongst the GP population, and
plateaued after the first 12 months at 70%. Of the anti-obesity products,
Xenical out performed Reductil (following three years later), consistently
gaining awareness in its first two years and reaching a level of 80%.
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Examining the detailing of the five
products in the first 24 months post launch, similar patterns can be seen, with
Avandia utilising GSK's vast field force resource to outstrip detailing
activity for the other products. It is interesting to note that although
detailing activity for Starlix was higher than that for Actos or Xenical after
month 10, awareness for the product has remained lower.
Given the
increasing demand for effective treatment in both obesity and diabetes, it is
interesting to look at the levels of GP usage of these products for the first
24 months after their launch. Once again, amongst the diabetes products,
Avandia takes the lead, with usage increasing steadily over the two year period
as GPs gain confidence with a novel class of product. Usage for Actos, despite
good awareness and detailing levels was substantially lower than for Avandia.
Starlix, despite a very high level of detailing to GPs , has so far achieved a
low breadth of 5% in the U.K. primary care market.
The data for the
anti-obesity products is interesting. A lower level of both awareness and
detailing for Reductil post launch compared to Xenical, led to a far higher
usage. After 12 months, almost 20% of UK GPs had used Reductil, compared to
around 8% for Xenical. This is the first indication we can see from this data
of the changing attitudes to the treatment of obesity over the last four
years.
Opportunities for GPs to write a script for obesity have
increased dramatically over the three year time period, from around 2000 in a
month to 5000. With the NICE recommendations in March 2001, the main growth
happened before the launch of Reductil. Since the launch of Reductil, Xenical
has maintained a 60% share of the opportunities . However, growth has not been
sustained and opportunities are beginning to flatten off. Is this surprising
considering the size of the potential market? One would think so, but negative
attitudes towards obese people have lead to limited effective obesity
management systems in national health services around the world. The two
products currently on the market, although a great step in the treatment of
obesity, are not ideal due to some of their side effects and contraindications.
In contrast, the diabetes market is dynamic. Opportunities for GPs to
initiate therapy have increased fairly steadily over the last 2 years to around
20,000 in the most recent months. Hopefully the increase in the number of oral
diabetic products available for treating Type II diabetes will mean fewer
patients having to move onto hormonal therapy and greater control of the
disease.
So what do these trends mean for Lantus, the new insulin
launched by Aventis this month. Certainly pre-launch awareness, even amongst
GPs , has been high. With the increased prevalence of obesity, which looks set
only to rise in the coming years, opportunities for a new product in this class
will certainly abound.
Currently obesity costs the NHS at least
£0.5 bn per year in patient care and £2 bn to the wider economy in
for example, sickness absence . Clearly education, both of the general public
and the healthcare professionals, is key in order to improve incomplete and
often confused knowledge of obesity and the surrounding issues. The developing
world must be looking on in wonderment.
About the author
Isis
Research plc is the parent company of Isis Research, Fieldwork International
and Maxis Research. Isis Research has its global and regional headquarters in
London. Working together with our affiliated companies, Fieldwork International
and Maxis Research, we can provide our clients with all their healthcare market
research needs - from early product development through to sales force
effectiveness; fieldwork and data processing in one integrated package.
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click here.
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