NSCLC in China and South Korea presents a huge challenge for healthcare providers and a considerable opportunity for drug manufacturers. Incidence in China is the second highest of the major emerging markets and is expected to reach levels comparable to the West in the next decade.
As the molecular pathogenesis of NSCLC is further elucidated, treatment of advanced disease in China and South Korea is increasingly influenced by tumor molecular characteristics predictive of response to premium-priced targeted agents. In both markets, EGFR tyrosine kinase inhibitors (TKIs) Iressa (AstraZeneca; gefitinib) and Tarceva (Roche; erlotinib) are approved for EGFR mutation-positive NSCLC, while in China, Zhejiang Beta Pharma’s Conmana (icotinib) is also available. Recently published meta-analyses suggest that this disease subtype occurs in as many as 47% of Chinese patients, although the incidence in South Korea appears to be closer to the levels seen in Western nations. More recently, Pfizer’s Xalkori (crizotinib) has been approved in both countries for the treatment of the small proportion of patients whose tumors express the EML4-ALK fusion protein; this agent launched in South Korea in January 2012, with rollout in China taking place from mid-2013. While biomarker-driven prescribing enables treatment with these expensive drugs to be channeled toward the patients most likely to respond, the associated cost of molecular testing (borne largely by patients in both countries) adds to the market access challenges for each agent.
Furthermore, the costly targeted treatment options approved for NSCLC also include VEGF inhibitors Avastin (bevacizumab) and Endostar (SD. Simcere Medgenn's endostatinin) in South Korea and China, respectively. With novel agents such as irreversible EGFR inhibitors Gilotrif (Boehringer Ingelheim; afatinib) and dacomitinib (Pfizer; PF-00299804) and c-Met inhibitor MetMab (Roche/Genentech; onartuzumab) waiting in the wings, NSCLC undoubtedly represents an increasingly costly healthcare challenge for payers and prescribers in these markets.
This report covers the prescribing and coverage/reimbursement environment for these drugs and drug classes in China and South Korea and assesses how the NSCLC market access landscape will evolve in the next several years as new therapies expand the treatment armamentarium.
This Emerging Markets Physician & Payer Forum report explores the market access hurdles and levers that affect NSCLC market dynamics in China and South Korea. The report is based on a survey of 100 prescribers (oncologists) mostly located in tier III hospitals in China and in both public and private general and high-level general hospitals in South Korea, plus interviews with 7 payers who have an influence at a national or regional level and include the following:
- China: Senior officials at the Qingdao and Zhejiang Provinces Human Resources and Social Security Bureaus; Researcher at the National Institute of Human Social Security Research, Beijing.
- South Korea: Section Chief, Healthcare Benefit Standard Team, HIRA; Head of Department, DRG Management Department, HIRA; Section Chief, Department of Insurance Benefits, NHI; Head, Health Care Policy Institute, Private Sector.