India Parenteral Nutrition Market

Market Opportunity Assessment

June 21, 2020

Table of Contents

Overview of the Parenteral Nutrition (PN) market in India

 Market overview

 Market Dynamics

 Unmet needs

 Competitive positioning matrix for India parenteral nutrition market & Key stakeholders involved

 e-Pharmacy, Hospital Pharmacy and Brick-and-Mortar Pharmacy Market in India

Key Substance
 Key Macro and Micro Factors Governing India Parenteral Nutrition Market

 Assumptions and Backup for Market Size Estimation

© 2018 Grail Insights

OVERVIEW & INDIA PN MARKET
 Parenteral Nutrition Market: Overview

Global Parenteral Nutrition Market Size was US$4.3 billion in 2018. Owing to growing gastrointestinal surgeries and intolerance
towards the EN are the key factors contributing towards the growing Parenteral Nutrition Market in India

• Presence of malnourished children, high natality rate, increasing premature births,

India’s Parenteral Nutrition Market in US$ million (2018 – 2019)
rising cancer disorder and adoption by healthcare settings for administration of

nutrients in chronically ill geriatric patients are driving the market 161.25
Y-o-Y: ~7.5%
• APAC accounts for 21% of the global market and account for ~ US$1 billion in 2019

and excepted to grow at the rate of 4-5%

• In 2019, Indian Parenteral Nutrition Market size was US$225 million and expected

to grow at the rate of 5-6% during forecasted years

150

• In India, gastrointestinal surgeries were the most common indication for PN use , for

instance, major gastrointestinal surgeries and intolerance to EN were the most

common indications for PN

2018 2019
• Single dose amino acid solutions is accounted for major market share in 2019 and is Note: Since the exact market for India is not available, estimated market size based on

expected to dominate throughout the forecast period. assumptions mentioned on slide number 10

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Sources’: Baxter Clinical Nutrition (PDF), Medind, Indian Journal of Critical Care Medicine
© 2018 Grail Insights
Parenteral Nutrition Market: Market Dynamics

Malnutrition is one of the major drivers in the PN market, It was the predominant risk factor for death in children younger than five
in every state of India in 2017, accounting for 68.2 per cent of the total under-5 deaths, translating into 706,000 deaths
Trends
• Rising instances of preterm birth, which prompts unhealthiness, is a key reason fuelling the utilization of parenteral sustenance in India. For instance, As per
statistics, India accounts for nearly 3 million preterm births annually. Hence, it will augment the growth of the market.
• Low birth weight, the largest contributor to the malnutrition DALYs in India, had a prevalence of 21 per cent in 2017, which showed a modest declining trend. However,
the prevalence has remained very high in India at 39 per cent and 33 per cent respectively, in 2017
• Improvement in social insurance framework, increment in access to medicinal services offices and ascend in per capita human services use in the area are probably
going to fuel the market in India.

Drivers
• Malnutrition is one of the major drivers in the parenteral nutrition market . As per the Cuddles Foundation (India), In India over 50,000 children are diagnosed with
cancer every year and 40 per cent of them are malnourished at diagnosis.

• In addition, deficiency of protein diet is common in critically ill patients, that leads to occurrence of protein-energy malnutrition diseases and fat loss. In such cases
patients are treated with amino acid rich parenteral products thus, augmenting the growth of parenteral nutrition products.

• The market is slated to witness a considerable growth, owing to increase in cases of hepatic insufficiency and renal insufficiency

Challenges
• Lack of awareness among people causes the major hindrance , followed by the poor healthcare setting and minimal availability of the product across the India and in
the less developed area

• High cost associated with the Parenteral nutrition, suppress the growth in the under developed areas

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Sources: Clinical Nutrition - AWS; Investor Presentation ,  Indian Council of Medical Research (ICMR)
© 2018 Grail Insights
PN Market: Unmet needs, Gap Analysis and Factors demanding more advancement in India

Gap Analysis: Unmet need for this therapy – Particularly in certain acute and critical care settings in India supported by the lack
of awareness among the patient

Access to curative treatment is limited and poor survival rates have been reported due to lack of PN in healthcare setting. Knowledge about cancer-related malnutrition
1 and the use of parenteral nutrition (PN) in the clinical setting are lacking. The reported diagnosis and treatment frequency of malnutrition in a multinational survey to in
cancer patients’ care was found to be extremely low

Poor nutritional status, both under-and over-nutrition, range from 5% to 50% in pediatric cancer patients at diagnosis, with a higher prevalence of under nutrition in in
2 low- and middle-income countries like India

Life-sustaining option to patients who cannot get adequate oral or enteral nutrition. However, many patients, despite the advances in enteral and parenteral nutrition
3 are still not getting the therapy they need, especially those in the acute and critical care settings

4 Infectious complications associated with parenteral nutrition in intensive care unit and non-intensive care unit patients is causing the hindrance in the market growth.
PN has been associated with more infectious complications according to multiple meta-analyses, However, caloric targets are more easily reached using this method

Source: Therapeutic Advances in Medical Oncology © 2018 Grail Insights

 Parenteral Nutrition Market: Competitor and Key Stakeholder Analysis

Market is highly concentrated & Competitive, Owing to the presence of key players like Baxter India, continuous product
launch, ongoing research and development activities and supported by the launch of PN Tools to boost Nutrition

Competitor Analysis Stakeholder Analysis

• Hospital and pharmacy are the two main key stakeholders involved in India
• PN market is highly concentrated with the presence of companies such as
PN market.
Baxter India, B. Braun India, Fresenius Kabi India Pvt. Ltd and Amanta
Healthcare Ltd. • Hospitals include the multi specialty hospital, corporate hospitals
followed by the government/district hospital
• These companies are actively involved in improving the current product
portfolio of parenteral nutrition to sustain their position in the market. • Among the type of hospital, Corporate hospital/multispecialty
Moreover, development of new drugs and their entry in the untapped hospitals acquired the largest share, As these of hospitals have their
regions are estimated to boost the market growth. own well established pharmacies and having higher demand of the
PN products across their oncology, Pediatric and
• Market is highly competitive with the presence of the top five players in India
Department of Gastroenterology & Hepatology unit respectively
and acquired the majority of the share in the Indian PM market

• Major organized players operating in brick-and-mortar pharmacy

• Baxter India acquired the highest share in India , followed by B. Braun India
market in India are Apollo Pharmacy, MedPlus Health Services Pvt.
and others. Currently Baxter India offered the complete solutions across
Ltd., Zydus Wellness Limited, 98.4 Degree (Global Healthline Pvt.
the PN portfolio . In 2019, Baxter International Inc commercially launched
Ltd.), Trust Chemists & Druggists Ltd and Emami Frank Ross Ltd.
its patented olive oil-based lipid injectable emulsion, Clinolipid in 2019

Source: ASPEN Conference © 2018 Grail Insights

e-Pharmacy, Hospital Pharmacy and Brick-and-Mortar Pharmacy Market in India

Hospital and pharmacy market in India are the two pillars supporting the access of PN products to full fill the unmet needs
across the healthcare setting

• Brick-and-Mortar pharmacy in India currently has the largest market share in Indian pharmacy Hospital & Pharmacy Market
market.

• In 2017, the report suggested, Indian spend 64.21% of their health expenditure from out-of-pocket of
2%
which pharmaceuticals spend accounts for 51.67%
18%
• In 2018, Government of India launched largest public healthcare scheme Ayushman Bharat Yojana
or Pradhan Mantri Jan Arogya Yojana (PMJAY) under National Health Protection Scheme (NHPS)
which aims to provide free healthcare coverage of up to INR 0.5 million to around 100 million people.

• Also, under the aegis of Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana the Government of India
as set up Jan Aushadhi Kendra (pharmacy stores) which provide quality medicines at affordable
prices.  80%

• Major organized players operating in brick-and-mortar pharmacy market in India are Apollo
Pharmacy, MedPlus Health Services Pvt. Ltd., Zydus Wellness Limited, 98.4 Degree (Global
Healthline Pvt. Ltd.), Trust Chemists & Druggists Ltd and Emami Frank Ross Ltd. Online / e-Pharmacy Hospital Pharmacy
Brick-and-Mortar Pharmacy

Source: pharmacies in India. - World Wide Journals © 2018 Grail Insights

Substance

Multispecialty/corporate hospital will strongly assist the PN market manufacturer in formulating various business
strategies for improving products, improved clinical settings, business expansion, and profitability

1 Hospital with pharmacy 2 Awareness 3 Decision makers 4 Campaign

• Leverage the hospital pharmacy to
provide direct access to products. It will
help manufacturer to understand the
end user (Physician)  and patient
unmet needs
• Gaining physician and patients
observation in clinical setting will
give the chance to improve current
products and research and
development activities
• Awareness among the physician and
key decision makers of the hospital
system about the current PN
offerings and gain access to the
larger patient population across India
• List of the key stake holders and their
email and phone contact
• Direct access to healthcare system
requires the involvement with the key
decision makers of Corporate
/Multispecialty hospital
• Sales through brick motor
pharmacy stores will provide direct
access to larger pool of patient across
the heath system
• To penetrate the Indian market,
Brand Awareness through campaign
will help in invading greater
geographic access
• Campaign across the hospitals will
help in getting the direct key contacts
of the stakeholders to facilitate the
access

• Allow manufacture to provide PN

products in the pharmacy store, and will
be easily available across the healthcare
setting for usage and thus building
physician trust and improving brand
image

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Sources’: Analysis © 2018 Grail Insights

Assumptions and Backup for Market Size Estimation

• Global PN market was 4.3 billion in 2018 and expected to grow at the rate of 3-4%

– Asia pacific accounts for 15% of the global market (Based on Figure 1 and 2)

­ In APAC, market is concentrated with the presence of China, Japan, India, Thailand and
followed by South Korea
– India acquired the third position, with 24% of the overall APAC region
Forecast: Considering the current uncertainty of the Indian healthcare setting its difficult to
project the growth rate for 2020

– Considering COVID-19 situation, we have projected the lesser penetration rate of the market
in 2020-2021

– The major penetration factor taken in the account: In 2018, Government of India launched
largest public healthcare scheme Ayushman Bharat Yojana or Pradhan Mantri Jan Arogya
Yojana (PMJAY) under National Health Protection Scheme (NHPS) which aims to provide free
healthcare coverage of up to INR 0.5 million to around 100 million people.

– Ayushman Bharat Yojana has fueled the market growth through covering larger cancer
patient population under this scheme

– As on 15 December, 2019 a total of 470,133 cancer cases have been treated under AB-
PMJAY, according to the latest data available with National Health Authority (NHA), nodal
agency for implementing the scheme.

– The number of cases treated under the medical oncology was 3,59,327, pediatric oncology
was 17,421, radiation oncology was 76,444 and surgical oncology was 16,941, as per the NHA
data

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Sources’: Analysis © 2018

© 2018 Grail Insights
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© 2018 Grail Insights
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