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April2009
ExecutiveSummary
MedicalDiagnosticaccountsfor10%ofthehealthcareindustryinIndia Diagnosticsmarketcomprisesof
DiagnosticServicesMarket:EstimatedatINR37.9bnin2008 DiagnosticProductsMarket:EstimatedatINR15.8bn2008
Market
Indiahasmorethan40,000laboratories
Drivers& Challenges g
Competition
SomeofthemajorplayersareMetropolisHealthServices,SRLRanbaxy,PiramalDiagnostics,DrLalPathLabs, Thyrocare,ApolloHospitals
Foreign players (like Roche Abbott J&J ) account for 64% share in diagnostic equipment market Foreignplayers(likeRoche,Abbott,J&J )accountfor64%shareindiagnosticequipmentmarket
SomeofthemajordomesticmanufacturersareTransasia,TulipGroupandAgappeDiagnostics
MEDICALDIAGNOSTICS INDIA.PPT
MEDICALDIAGNOSTICS INDIA.PPT
Indiandiagnosticsmarketiswitnessingsignificantgrowthwith majorcontributionfromtheInVitroDiagnostic(IVD)segment
MarketOverview
Indiandiagnosticmarketcomprisesof
Diagnostictestservicesmarket Diagnosticproducts/instrumentsmarket
DiagnosticTestServicesMarket
INRbn
40 30 20 10 0 26.3
+20%
37.9 31.6 31 6
Marketsizeestimationisdifficultasdiagnosticmarketishighlyunorganized
IVDTestSegments(2008)
BioChemistry
5% 6%
IVDInstruments&ReagentMarket
INRbn
20 15 10 5 0 11.4 11 4
4% 3% 37%
+18%
12.8
15.8
7%
14%
24%
Coagulation
2006
2007
2008
MEDICALDIAGNOSTICS INDIA.PPT
Technologicaldevelopmentshasledtothediagnosisofawide spectrumofinfectiousdiseases
Diagnostics
Tuberculosis HIV Malaria HepatitisB HepatitisC Dengue D Syphilis Typhoid
Consumption&trends
InfectiousDisease
Increasing Increasing Increasing Steady Steady Steady S d Steady Steady
Typeoftesting
ELISA90%;Rapid10% ELISA65%;Rapid35% d Immunodiagnosticm ELISA65%;Rapid34%Agglutinationmethods1% ELISA80%;Rapid20% ELISA65%;Rapid35% ELISA 65% R id 35% ELISA65%;Rapid35% ELISA65%;Rapid35%
CAGR%(200408)
11.0 10.6 9.4 7.7 7.7 7.6 76 5.7 5.6
Hormones
Reproductivehormones Thyroid Increasing Increasing ofLH35%,FSHandprolactinkits65% ELISA90%,RIAandChemiluminescence10% 8.6 7.7
Others
BloodGroupingreagents Pregnancydiagnosis CancerMarkers Steady Steady Steady Haemagglutination Immunochromatography/Latex Fluorescence,ELISA,Chemiluminescence 5.7 5.7 5.7
MolecularDiagnostics
Nascentmarket.MaximumpenetrationobservedonlyinPolymeraseChainReaction(PCR)basedtechnologies. Companiesofferingimmunodiagnosticshavebeenlargelyimportingequipments
Thisshowsthatthemarketfordiagnostictestshasbeenrising
MEDICALDIAGNOSTICS INDIA.PPT
MEDICALDIAGNOSTICS INDIA.PPT
Drivers&Challenges
Drivers
Increaseinlifestylerelateddiseases Changingdemographics Growthinmedicaloutsourcing RapidgrowthofIndiaasadestination Rapid growth of India as a destination formedicaltourism Increasingpenetrationofmedical insurance RisingPE/VCinvestments
Challenges
Differenceinimportdutyon diagnostickitsforpublicandprivate sector Lackofaccreditation/certificationof / diagnosticcenters
MEDICALDIAGNOSTICS INDIA.PPT
Mountinginstancesoflifestylediseasesinurbanareasandthe demandforqualitydiagnosis
Growthinlifestylerelateddiseases
Increasinginstancesoflifestylediseasesisanurbanphenomenon,especiallyamongtheyoung andworkingclassinmetropolitanareas Lifestylediseasessuchascardiacailments,diabetesetc.requireexpensivediagnostictests makingthissegmentincreasinglylucrativeforplayers
Impact
PrevalenceofchroniclifestylediseasesinIndia P l f h i lif t l di i I di
% of Population 4.91% 5
4 3 2 1 0
DiagnosticTestsCostComparison Di ti T t C t C i
USD/Treatment
500 400 300 200 150 12 5 100 0 280 418
3.31%
MEDICALDIAGNOSTICS INDIA.PPT
ChangingdemographicscenarioinIndiaisexpectedtodrive demand
Changingdemographics
Increaseinaveragelifeexpectancyandgrowthinelderlypopulationisexpectedtoboost demand Largescalemovementofruralpopulationtourbancenterswillalsooptfortheseservices AverageLifeExpectancy
years
100 63.3 50 0 65.1 66.0
Impact
Population(Age65yearsandabove)
%
6 4 2 0 4.7 5.3 5.8
2000-04
2005-09
2006-10
2000
2005
2010
MEDICALDIAGNOSTICS INDIA.PPT
Strongoutsourcingopportunitiesduetotechnological enhancementsandcostbenefits
Growthinoutsourcing
Diagnosticsoutsourcinghasbeengrowingduetotechnologicalupgradationofequipmentin Indianlaboratoriesmeetinginternationalstandards Costbenefitshavealsoplayedamajorrole Specializedtestslikemoleculardiagnosticsorhormonerelatedtestscost7080%lessinIndia thaninUS MedicalinstitutionsfromUSandUKhavebeenoutsourcingabulkoftests
OutsourcingopportunityspecificallyfromtheUK,inhealthcaresector,ispeggedataroundUSD800mn
Impact
Indiaprovidescostarbitrage:
Tests Bloodtests,X raysandultrasounds Blood tests, Xrays and ultrasounds Magneticresonanceimaging(MRI)scan Thyroidprofilebloodtest Note:Theratesareindicative CostinUS/UK(USD) 574 700 3050 CostinIndia(USD) 84 60 5 %Difference 583 1067 500900
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Medicaltourismisprovidingsupplementalrevenuesforthe diagnosticmarket
MedicaltourisminIndia
Inadditiontogrowingdomesticdemand,medicaltourismisgeneratingadditionalrevenuefor diagnosticsservices Medicaltourismhasbeengrowingat30%andisexpectedtobecomeatUSD2bnindustryby 2010 Somepartofmedicaltourismmarketisexpectedtoaccruetothediagnosticsmarket,primarily benefitingthehospitalswithdiagnosticcenters M i d i Maindriversandchallengesformedicaltourismare d h ll f di l t i
Drivers Significantsavings Worldclassfacilities Qualityandexperienceofmedicalprofessionals Minimalwaitingtime Largemarketofuninsuredindevelopedcountries Challenges Inadequateairconnectivity Visarequirementsfrommostcountries q Medicolegaljurisdictions Countryspecificrestrictions
Impact
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Growingpenetrationratesofhealthinsurancehasmadequality diagnosticservicesmoreaffordable
Risinghealthinsurancelevels
InIndia,penetrationofhealthinsuranceisverylowbutgrowing:
Morefamiliesfrommiddleclassarenowpurchasinghealthinsurance 20%ofpopulationislikelytohavemedicalinsuranceby2015comparedtocurrent2% Additionally,manycompaniesareprovidinghealthinsurancecoveragetoemployees therebydrivingpenetration
Impact
Increasinginsurancecoverageprovideadditionalrevenuetothediagnosticscentres g g p g
Insurancecompaniestieupwithdiagnosticcentrestoprovidebetterhealthassessment services(medicalscreening,diagnostictesting)tolifeinsurancecandidates
BirlaSunLifeInsuranceCompanyLtdenteredintoapartnershipwithQuestDiagnosticsIndiaPrivateLtd. ICICILombardenteredintoaninsurancepartnershipwithManipal,FortisandApolloGroup
HealthInsurancePremium
INRbn
1,000 500 212 47 0 950
+35%
2008
2013
2018
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LargescaleinvestmentsfromPE/VCfirmstowardscapitalizing onthegrowthprospectsinthemarket
IncreasedfocusofPE/VCfirms
PrivateequityplayersarebullishonthehealthcareindustryinIndia In2008,thehealthcaresectoraccountedfor13%oftotalinvestmentsamountingtoUSD 5570.48mn Apartfromhospitalsandpharma,privateequityplayersarealsoshowinginterestindiagnostic centersinIndia Date D t Nov2007 2007 Jun2006 May2006 2005 Investor I t ePlanetVenturesandHSBC PrivateEquity(Asia)Ltd SequoiaCapitalIndia Sequoia Capital India Bennett,ColemanandCo. ICICIVentures SequoiaCapitalIndia q p Trivitron DrLalPathLabs Dr Lal PathLabs Thyrocare MetropolisHealthServicesLtd DrLalPathLabs Target T t % Stake n.a. n.a. na n.a. n.a. 26 Amount USDmn 11 4 n.a. 8 6
Impact
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Biasedgovernmentregulationandthelackofaccreditation affectingtheofqualityservicesarethemajorbarriers
Differenceinimportdutyondiagnostickitsforpublicandprivatesector
Theimportstructurehasbeensoformulatedthatitfavorsthepublicsector Privatesectorisfacedwiththeissueofprovidingservicesatcompetitivepricesacrossincome groupsandareoftenreducedtoprovidingservicesonlytoanichemarket
Public Inordertoimportequipmentsandreagents Government hospitals do not require a an import Governmenthospitalsdonotrequireaanimport license;adutyof5%islevied Equipmentandsuppliesareprocuredthrough tenderswithpricebeingtheforemostbasisof decisionmaking Private Forimportingdiagnosticequipmentsadutyof19.8 21.7%islevied Equipmentsandsuppliesareprocuredbasedon qualityandprice,leadingtocostescalations
Impact
Lackofaccreditation/certificationofdiagnosticcenters
Lackofaccreditationorcertificationhasledtoalargepoolofmedicalcenterswithminimal g p focusonthequality,whichisincontrasttomandatoryrequirementsforotheraspectsof
Impact
healthcaresuchashospitals,doctors,nursesandevenpharmacies
Lessthan1%ofthetotallaboratoriesareaccredited
14haveCollegeofAmericanPathologists(CAP)accreditation 45haveNationalAccreditationBoardofLaboratories(NABL)accreditation
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Diagnosticequipmentmanufacturersarehighlyregulatedbythe centralandstategovernmentbodies
Majorgoverningbodies
GovernmentAuthorities
TheDirectorateGeneralofHealthServices FDAandCDSCO DrugControllerGeneralofIndia Drug Controller General of India Statedrugoffices/StateFDAs
Operation
OverseesactivitiesoftheIndianFoodandDrugAdministration(FDA)andCentralDrugs Oversees activities of the Indian Food and Drug Administration (FDA) and Central Drugs StandardControlOrganization(CDSCO) Regulatesthemanufactureofalldiagnostickitsandreagentsasitbelongstothe categoryofdrugs Responsibleforapprovaloflicensesofspecifiedcategoriesofdrugsanddiagnostics products Theymonitorthequalityofdrugsanddiagnosticsproductsthataremanufacturedby respectiveStateunitsandthosemarketedintheState
Segmentationofproducts
CriticalDevices DiagnosticProducts Diagnostic Products Productsusedforthe diagnosisofHIV,HBsAg, HCV,Bloodgrouping reagents,malariatests
NonCriticalDevices
Otherdiagnosticsproducts
AlldiagnosticsproductsmanufacturedorsoldinIndiarequiresalicense
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Thedifferenceinregulationsforcriticalandnoncritical diagnosticsdeviceshasledtolackofqualitycontrol
Regulatoryprocessfordiagnosticsequipments
Applicationis A li ti i submittedtothe DrugsController GeneralofIndia Quality checksare conducted by y National Institute of Communica ble 36months disease Manufact uring license li granted afteran auditof manufact uringunit
CriticalDevices
NonCriticalDevices
Testmanufacturinglicenseortestbatchevaluationisnotrequired Noinspectionsneedstobecarriedoutbythecentralauthorities The application is to be filed only with the State drug offices TheapplicationistobefiledonlywiththeStatedrugoffices
Lackofsufficientqualitycontrolmeasureshasledtosubstantialnumberofquestionableproductsinthemarket
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Manufacturersneedanimportlicenseandproductregistration certificatefromtheCentralDrugsStandardControl
RegulationsRelatedtoImports
CDSCOisresponsibleforqualitycontrolofimportedproductsaswellasthelicensingofnewproducts
RegistrationCertificate
RegistrationCertificate:Applicationinrespectofthe premisesandthedevicestobeimported Submission: TheapplicationisreviewedbytheDrugs ControllerGeneral Registrationfee:USD1000perproducttoberegistered OtherDocuments:Bankslipsshowingrequisitefeepaid,Form 40PowerofAttorneytotheIndianAgent/Officeanddossiers Duration:Theregistrationprocesstakes9months Forwardedbythemanufacturer,importerortheagentin India
ImportLicense
Documentation Form9istobeforwardedbythemanufacturerandshouldbe attestedbytheIndianEmbassyinthemanufacturerscountry GMP(GoodManufacturingPractices)certificate CompanyRegistrationcertificate FreeSalesCertificateinthecountryofmanufacture Manufacturing License ManufacturingLicense CountryofOriginCertificate Listofcountrieswheretheproductisalreadybeingexported ISO/TUV/CEcertificate BatchReleaseCertificate(foranyonebatch) QCcertificates(foranyonebatch)
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Customdutyisleviedonthediagnosticequipmentsimported
Importdutystructure
TheGovernmenthasbeenfocusingonenhancingprivatesectorparticipationbyreducingthe customsdutyleviedonimportsofdiagnostickitandreagentsimportedbytheprivateplayers
%
40 30 20 10 0 34.4 34.5 21.7 19.8
Pregnancy confirmation reagents/Reagents for diagnosing AIDS/Others Diagnostic reagents designed to be administered to the patient/Blood grouping reagents
Jan 2008
Feb 2009
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Organizedpathlabsarerapidlyexpandingusingthehuband spokemodel,includingsmall,independentlabsinthenetwork
DiagnosticTestingMarketStructure
Highlyfragmentedwith~40,000laboratories:
Hospitals:43% Independentlabs:52% CC Reference Lab Satellite Satellite Lab CC Satellite S t llit Lab
HubandSpokeModel
CC CC CC
AmongthelabsinIndia
Automated 5% Semi Automated 38% Manual 58% Manual 58%
Organizedplayersaccountfor10%ofmarketand expandingwithhubandspokemodel:
Referencelabsactasregionalhubsandareusuallylocated inlargemetros Collectioncentresarelocatedinhospitals,nursinghomes, pathologylabs,doctorsclinicsetc. Satellitelabsandcollectioncentresareeitherownedor franchised
CC
CC
CC
Referencelabs:Hubwithcomprehensiveorspecializedtesting capability Satellite labs: Limited testing capability; feedreferencelabs Satellitelabs:Limitedtestingcapability; feed reference labs Collectioncentres(CC):Collectsamplesforforwardingto eitherasatellitelaborreferencelab Avariationinthismodelistheabsenceofsatellitelabsand theexistenceofonlyreferencelabsandcollectioncentres
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MajorPlayers DiagnosticTestServicesMarket(1/2)
Company ApolloHospitals Overview
Startedin1983 DiagnosticfacilitiesintheirsubsidiaryApolloClinics Facilities allow for investigation in Biochemistry Haematology FacilitiesallowforinvestigationinBiochemistry,Haematology, ClinicalPathology,Microbiology,Xray,UltrasoundwithColor Doppler,ECG,EchoCardiographyandTreadmill Startedin1977 40labsand500samplecollectioncenters Accreditation:NABL,CAP
BusinessOutlook
EnteredintoaJVwithAmcareLabs,an affiliateofJohnsHopkinsInternationalof theUS,tosetupadiagnosticlaboratoryin HyderabadataninvestmentofUSD2.2mn Establishedaninternationalalliancewith QuestDiagnosticsNicholasInstitutefor testing Planningtosetup50labsand1000 collectioncentersby2012 Expandoperationsinsouthernandwestern regionsinvestingINR600mn PlanningtoinvestINR100mninbrand l b d building Growinginorganically Itislookingatoverseasexpansionaswellas outsourcingopportunities g pp Plansonincreasingtheirportfolioto9more labs TargetedrevenueofINR5bnby2010 In2008,acquiredtwolabsinNorthIndia andamajoritystakeinBangalorebasedRV and a majority stake in Bangalore based RV DiagnosticLaboratory
DrLalPathLabs
MetropolisHealth Services
Startedin1981 10000laboratoriesacross125citiesglobally,13laboratoriesin India,350collectioncenters , Capabilitytocarryover3600routineinvestigationswithover 100technologies e.g.biochip,DNAsequencing,pathology, radiology ICICIVenturesowns18%ofthecompany Accreditation: CAP NABL Accreditation:CAP,NABL
Note:Thislistisnotexhaustive
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MajorPlayers DiagnosticTestServicesMarket(2/2)
Company Overview BusinessOutlook
PlanningtoinvestINR2.5bntoexpandits diagnosticchainin75urbancentersby2010 AcquiredMinradInternationalIncforUSD q 40mn TieupswithUKbasedorganizationsfor outsourcing Plansondeveloping23reference laboratoriesin2009 ExpansionbudgetispeggedatINR1.5bn In2008,acquiredDubaibasedMena HealthcareforUSD20mn Centralizedoperationsthroughasingle laboratorymodel,locatedinNaviMumabi Onlyplayerexpandingthrougha100% franchiseemodel
Startedin1996 35labs,800collectioncentersdistributedin400townsacross thecountryand7franchiseelab Catersto25000doctors,650hospitalsand~1000smaller pathologylabsandcarriesout34000tests/daybasedon95 technologies Accreditation:CAP,NABL,CLSI,GCLP ReportedtotalrevenuesofINR804mninFY2007 p Startedin1995 Carriesout30000test/day,over600franchisedcollection centers Accreditation:CAP,NABL
Thyrocare
Note:Thislistisnotexhaustive
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Manufacturers IVDProducts/InstrumentsMarket
Playersinthemarket
TheIVDproductsmarketinIndiaisprimarily y g p dominatedbyforeigncompanies GlobalIVDcompanieslikeRocheDiagnostics, Abbott,J&J,SiemensHealthcareDiagnostics, BeckmanCoulterhavestrongpresenceinthe Indianmarket I di k t Domesticplayershaveforayedintothemarket andareestablishingthemselvesbyproducing q yg costeffectiveandqualitygoods 60%ofdiagnosticmedicalequipmentand suppliesisimported Lowcostreagentkitsarebeingimportedfrom China,Taiwan,andKorea
36%
IVDProductsMarketShare(2008)
64%
ForeignPlayers DomesticPlayers
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BusinessOutlook
Focusingontheexportmarketswithplans ofestablishingasubsidiaryinDubaiunder AgappeMiddleEastLLC AlsoplanstoexpandoperationstoAfrica andEurope LaunchedBiolis12i,afullyautomatic analyseraswellasCystatinC,amore sensitiveinstrumentfortheestimationof GlomurularFiltrationRate FocusesonPointofCare(POC)for infectiousdiseaseslikeHIVandmalaria Massproductionataffordableprices Partnered with WHO for product sales PartneredwithWHOforproductsales MarketleaderinHIVdiagnosisequipment FocusesonPOCsforinfectiousdiseases Massproductionataffordableprices Partnered with WHO for product sales PartneredwithWHOforproductsales
J.Mitra
Rapidtestkits:HIVrange,HCVrange,HBVrange,Malaria range ELISAtestkits:HIVrange,HCVrange,HBVrange,Dengue range,LEPTOrange,TBrange range LEPTO range TB range ConfirmatoryTests,BloodGroupingRange Fertilityrange,Infectiousdiseasesrange, Parasitologyrange
Note:Thislistisnotexhaustive
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BusinessOutlook
Adoptedaninorganicgrowthpath
InApril2008,acquiredBremerPharma InSeptember2008,acquiredUSbased MallinckrodtBakerforUSD340mn InJanuary2008,acquiredGodrejMedical DiagnosticsandAlvedPharma&Foods InJuly,2007acquiredWiproBiomedical
TargetedrevenueofINR5bnby2010
SpanDiagnostics Ltd.
Diagnosticreagents&kits:Bloodbankingproducts,clinical chemicalreagents,hematology,infectiousdiseasesserology, histopathology,antibioticdiscs Instruments:Biochemistry,ELISA,Hematology, Chemiluminescence Relatedtobiochemistry,hematology,urineanalysis, coagulation,ESR,immunology,liquidhandlingsystem ImmunologyReagents,CardiacMarkers,CancerMarkers, Parasitology&InfectiousDiseaseRange Parasitology & Infectious Disease Range Instruments Coagulometers,ELISAreader&washer
ItisaleaderinSphilisandthyroiddiagnosis equipment
Planstoexpanditsexistingproductrange andventureintomicrobiologyand veterinaryscience Itisoneoftheleadersinsyphilis,typhoid, malaria,reproductivehormones,blood malaria reproductive hormones blood groupingreagents,cancermarkersand tuberculosisdiagnosticequipment
Note:Thislistisnotexhaustive
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BusinessOutlook
StrategicpartnershipwithQualigensfine chemicalsinordertomarkettheirHIV andhepatitisdiagnostickits p g
YashrajBiotech
Antigens:Customizedmonoclonalandpolyclonalantibodies
OtherPlayer: AccurexBiomedical,BhatBiotech,MedsourceOzoneBiomedicalsPvt.Ltd.,Trivitron
Note:Thislistisnotexhaustive
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MarketOverview Drivers & Challenges Drivers&Challenges Rules&Regulationsfor Manufacturers/Suppliers Competition Ke De elopments KeyDevelopments
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KeyDevelopments
Date
17Mar09
Development
RocheDiagnostics,aswissbasedcompany,plansonconsolidatingtheirpositionintheIndianmarketin2009.Theyplanon expandingtheirreachthroughinnovativediagnostictestssuchastheNTproBNPandKRASmutationtestsrelatedto colorectalcancer. AlokaTrivitronMedicalTechnologies,amedicalequipmentmanufacturingJVofAloka,JapanandTrivitronhealthcarebegan productionofAlokaSSD500,portableultrasoundscannerfromitsfacilityatPoonamalleeinChennai.Itplansondeveloping highqualityproductsonacosteffectivebasiscateringprimarilytothedevelopingnations. WiproanITgianthasenteredthemedicaldiagnosticsmarketthroughitssubsidiaryWiproBiomed.Theyhavetiedupwith GEtodevelopcuttingedgetechnologyinordertogenerateauniquesellingprice.Wiproisplanningtofocuson GE to develop cuttingedge technology in order to generate a unique selling price Wipro is planning to focus on telemedicine,especiallyinthediagnosticradiology. SnehaDiagnosticsplansondeveloping10stateoftheartmedicaldiagnosticscentresacrossAndhraPradeshby2009.A capitalinvestmentofINR50mnisexpectedtowardsthisexpansionventure. RFCLLimited,anICICIventurecompanyacquiredGodrejMedicalDiagnostics.ThisledtopartnershipswithQBCDiagnostics, USA,AsiaGenCorporation,TaiwanandUritestMedicalElectronicCoLtd,Chinaallowingthemtoexpandtheirreach. USA Asia Gen Corporation Taiwan and Uritest Medical Electronic Co Ltd China allowing them to expand their reach
10Feb09
06Oct08
10Mar08 09Jan08
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