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Chronic kidney disease (CKD) and its underlying conditions (diabetes and hypertension) are among the top causes of disability-adjusted life years in the Latin American region. Complications arising from CKD include renal anemia and mineral disorders such as hyperphosphatemia and secondary hyperparathyroidism that significantly increase the costs of treating CKD as the disease progresses. Hence, new, cost-effective drug treatments that can delay the progression of CKD are in high demand. Although several erythropoiesis-stimulating agents (ESAs) have been approved in Brazil and Mexico to treat renal anemia, access barriers to more recent and effective ESAs limit the majority of patients in the public sector to domestically produced ESA products. In addition, public CKD patients must meet strict requirements to be eligible for ESAs and other CKD therapies that are managed by nephrologists. In the private sector, a different access environment develops, but barriers still exist in both countries. All of these access barriers have created a need for oral drugs with new mechanisms of action, such as hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors (for example, roxadustat by AstraZeneca/FibroGen) and iron-based phosphate binders such as Velphoro and Auryxia.
This Emerging Physician & Payer Forum report, entitled Market Access Challenges Facing Chronic Kidney Disease Treatments in Brazil and Mexico, surveys 104 nephrologists and interviews six payers in Brazil and Mexico. We assess how these stakeholders currently shape the renal space and how it will evolve in the next 2-3 years as disease burden increases, budgets tighten, and new products penetrate the market.
Markets covered: Brazil and Mexico.
Primary research: 104 nephrologists complete an online quantitative survey designed by therapeutic and country experts. Six payers/payer-advising thought leaders who have influence on patient access to CKD drugs at a regional or national level were interviewed and include:
- Medical auditor responsible for the disease and portfolio management in a major insurance company, member of the drug standardization committee of the institution.
- Head of pharmaceutical assistance programs at São Paulo State (reference to the MoH and CONITEC for development of protocols).
- Nephrologist KOL, professor at a university hospital, member of the drug standardization committee of the institution.
- Nephrologist at an ISSSTE hospital; prior Chief of Nephrology CMN "20 November" and General Hospital "Dr. Darío Fernández Fierro”; active member of the Mexican Institute of Nephrology Research.
- Nephrologist KOL, active member of the Mexican Institute of Nephrology Research.
- Chief of Nephrology in an IMSS’s hospital, director of a hemodialysis unit, member of the Board of Nephrologists of Mexico.
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