India, which has a population of 1.2 billion, is the third largest medical device market in Asia. The total market for diagnostic and medical equipment in India is worth about $3.5 billion and is expanding at an annual rate of 18 percent. However, India is forecast to suffer substantial human and economic costs from increasing rates of cancer. More than 1 million cancer cases are diagnosed annually in India, and this number may reach 5 million over the next decade.
Western medical companies that want to take advantage of the many opportunities in the Indian cancer sector should focus on clearly developing a strategy for the Indian market. While some “top of the line” Western device companies can sell their triple A products to private Indian hospitals, most public hospitals will require simpler, portable, easy-to-use and more affordable versions of Western diagnostic and cancer treatment products.
Cancer treatment and diagnosis
The number of hospitals, clinics and research centers that provide cancer treatment is growing quickly in India. These healthcare facilities are buying basic and advanced medical devices for cancer therapy, sometimes offering care (primarily at private hospitals) similar to levels found in the West. Demand is also high for portable cancer equipment that can be used in mobile medical units to reach patients in India’s rural areas.
Over the past decade, ultrasound equipment, X-ray scanners, CAT scanners, mammography equipment, MRI machines, CT simulators, CT scanners, PET-CT scanners and tomotherapy have become widely used in Indian oncology units for those who can afford it.
In addition to imaging equipment, other types of diagnostic tests for cancer have become common in India such as cytological sampling, dermoscopy, biopsies, endoscopies and blood tests to detect tumor markers. Hospitals are procuring more sophisticated cancer diagnostic equipment, such as vacuum-assisted and computer-guided biopsy devices.
Radiation, chemotherapy and surgery are common, as are treatments that combine chemotherapy and radiotherapy. 3-D conformal radiotherapy is now routine in India, and the advanced technique of Intensity Modulated Radiation Therapy (IMRT) has been growing in popularity. Brachytherapy is used in India to treat many types of cancers. Minimally invasive radiofrequency ablation is used sometimes for liver and kidney tumors.
Radiosurgery technology, such as Gamma Knife radiosurgery, is available, as is laser therapy. India also has one of the most advanced CyberKnife surgery systems in Asia. Other new cancer treatment technologies, such as proton therapy, are spreading quickly throughout India.
Device companies with cancer devices
In cancer diagnostics and equipment, Western companies have a majority of the market share. GE, Siemens, Philips and Toshiba are particularly strong players in this sector. These companies are introducing modified cancer diagnostic and monitoring equipment designed for the Indian market. Again, medical equipment that will be most successful in the Indian market should be easy-to-use, portable, durable, less expensive, with fewer bells and whistles.
For example, in early 2014, GE launched a PET/CT scanner in India, priced 40 percent less than competing scanners. GE and Nuclear Healthcare have partnered to establish 120 molecular imaging centers in India by 2015. Every center will have an advanced PET/CT scanner, while some will also have PET Trace Medical Cyclotrons. Toshiba has been successfully selling radiology equipment to hospitals in second tier cities — who are buying more advanced oncology equipment in a rush to compete for patients.
Siemens and Philips are also market leaders in the Indian cancer imaging market. Since 2011, Philips has been selling its MRI-guided HIFU system to major Indian hospital chains like Apollo and Fortis. In addition, Philips has been promoting its TruFlight Select PET/CT system that aids in early detection of cancer. Siemens’ CT simulators/scanners have also been popular in India.
GE has a particularly strong presence in the Indian cancer treatment market. At GE’s Indian development center, the company is working on 100 new cancer treatment products. GE has already launched half a dozen such products, and plans to launch 10 to 15 more products throughout 2014. GE has also partnered with local Indian companies to develop cancer related services and products. GE and the Indian Institute of Technology-Madras’ Healthcare Technology Innovation Center (HTIC) announced a three-year research and development agreement in January 2014. GE and India’s Max Healthcare announced a partnership in March 2014 to develop cancer treatment protocols and pathways, a training institute and a virtual expert consultation program.
Advanced treatment options for cancer are increasingly spreading to India. For instance, last year Apollo Hospitals announced a partnership with Belgium’s Ion Beam Applications to build India’s first proton therapy center, which will be operational in 2016. Western manufacturers of diagnostic tests for cancer are also succeeding in the Indian medical market. Mobile cancer screening laboratory units and portable equipment are in high demand. In February 2014, Qiagen launched a HPV test that was designed for areas with limited healthcare infrastructure and resources. The careHPV Test is portable, durable, easy to use and cost effective. The system utilizes self-contained reagents and easily understandable color-coded menus. It can withstand temperature variations and operate in situations of limited water or electricity.
Healthcare providers in India
The growing number of cancer cases is increasing the demand for cancer treatment and equipment. Many Indian hospital and healthcare companies – such as Apollo, Manipal, Healthcare Global and Max Healthcare – are key players in cancer treatment. Max Healthcare is increasing its cancer care investment by 40 percent annually. Healthcare Global has built 27 cancer care centers in the past eight years and plans to invest almost $120 million over the next three years.
Some Indian home healthcare companies are starting to offer in-home chemotherapy assistance. This increasingly popular type of service is more affordable and allows more Indians to access cancer care without having to travel long distances to a specialized hospital.
Western cancer product companies are also entering the Indian cancer treatment market. For instance, in March 2014, GE announced a partnership in India with U.S. based Cancer Treatment Services International (CTSI). The two companies will invest $120 million to develop a network of 25 cancer care centers throughout India over the next five years.
As India’s cancer burden grows, the Indian cancer diagnostic and treatment market offers many opportunities for Western medical device companies that make such products. To succeed, Western companies need to develop their strategies in India carefully. Less sophisticated versions of Western device companies’ products that are easy to operate, portable, durable and more affordable will do very well in the Indian medical equipment market. Simpler and lower cost options for diagnostic screening tests, surgery, radiotherapy, immunotherapy, chemotherapy, targeted therapies and other cancer treatments should be very successful in India.
About the Author:
Ames Gross is president and founder of Pacific Bridge Medical, a Bethesda, Md.-based consulting firm that helps medical companies doing business in the Asia market. A recognized national and international leader in the Asian medical markets, he founded Pacific Bridge Medical in 1988, which has helped hundreds of medical companies with business development and regulatory issues in Asia.