CHEMOPREVENTION FOR LIVER CANCER: MARKETING AND ETHICS

1. CHEMOPREVENTION FOR LIVER CANCER: MARKETING AND ETHICS Organization of presentation • Marketing: an overview • Components of marketing • Objective of the section • Market size • Market analysis • Marketing strategy • Ethical issues • Summary

2. Why do we need to care our health? • Complex issue-associated with different factors Figure: Health linkage and dynamics Source: MoPH, 2004

3. Marketing: an overview • A process to introduce products to the consumers • Conducts research and analyzes the consumer needs and demands (Market research) • Caters the needs of consumers by developing products and providing services (Marketing plan)

4. Objective of the section • To introduce and promote the sales of newly manufactured chemopreventive herbal food supplement for prevention of liver cancer

5. Components of marketing Why do we do? • Launching of the product • Advertising and publicity • Sales promotion and distribution What does it require? • Pricing • Naming and labeling • Market research • Marketing plan

6. What do we need to know? “MARKET SIZE” Why? • The ultimate determinant of production and distribution • Determines the economical viability

7. Market size General information • Target population (country): Thailand, 64 million • Age structure: 0-14 years 22% 15-64 years 70% over 65 years 8% • Population growth rate: 0.68% • Life expectancy at birth: 72.25 years (all) (male: 69.95 years and women: 74.68 years) • Literacy rate: 92.6% (CIA, 2006) • GDP growth rate:7.0% (estimated) • GDP per capita income: US $2,221 (NESDB, 2003) (CIA- Central Intelligence Agency; NESDB- Office of National Economic and Social Development Board)

8. Liver cancer incidence • 430,000 new cases worldwide (WHO, 1999). • Three quarters of which is in Southeast Asia alone. • Frequency: Southeast Asia and sub-Saharan countries-30/100,000 population/year; 5/100,000 population/year in Europe and America • Thailand: 11,868 new cases (ASR=37.4/100,000 population in males, ASR=15.5/100,000 in females) in 1993 (Petcharin, et.al., 2004). (ASR= Age-standardized incidence)

9. Existing practices of treatment • Highly sophisticated treatment facilities, not affordable by everyone; • Surgery • Chemotherapy • Radiation therapy • Immune therapy • Vaccine therapy • Liver transplantation Note: options are dependent on the stage and severity of underlying disease.

10. Cost associated with liver cancer treatment • Calculation: Incidence (male+female) = 53/100,000 Incidence in whole population = 33,920 (Total population at present is 64 million) • Treatment cost for 1 patient • Diagnosis cost • Service charge= • Doctor’s fee= • Other associated costs = (Nurse/ Medical officer’s fee) Sub total (A) =

11. Calculation (contd.) • Treatment cost (eg; chemotherapy) • Service charge = • Doctor’s fee = • Other associated cost = • Cost of drug used = dosage x unit price Sub total (B) = Total treatment cost required (C) = No. of chemotherapy cycles x B Cost per 1 incidence of liver cancer (D) = A+C Cost for whole population = D x Estimated incidence in whole population.

12. Risk Factors • Hepatitis B virus infection • Hepatitis C virus infection • Aflatoxin B1 contamination in food • Alcohol consumption • Cirrhosis Best Approach? Prevention!

13. Prevention strategies for Liver cancer • HBV vaccination • Reduction in aflatoxin consumption • Improvement in diets and lifestyle • Chemoprevention: Oltipraz, Chlorophyllin; Natural products (cruciferous vegetables-cabbage, cauliflower, broccoli sprouts, etc.); Products organic-Oxygenze, Alfalfa leaf powder. (Source: John, 2006; Supplementary information)

14. Market analysis • Income status • Huge gap between rich and poor • Highest income group: rising from 49.8% in 1962 to 56.7% in 1996 • Lowest income group: falling from 7.9% in 1962 to 4.2% in 1996 • Expenditure on health • Is in rising trend • Rising from 3.8% of GDP in 1980 to 6.1% (US $124 per capita) in 2002 Figure: Expenditure on drugs and health in relation to GDP, 1980-2002 Source: MoPH, 2004

15. Health insurance policy • 30-Baht health care policy of the government • Implementation of universal health care policy since 2001; The health insurance coverage increased from 71.0% in 2001 to 94.3% in 2004; • 73.5% under the universal health care scheme; 5.7% are uninsured. (Source: MoPH, 2004)

16. Marketing strategy • Market research (shopping habits, lifestyles, potential buyers, wants, price, market barriers & competitors) • Marketing plan (consumers: products, services they want, promotion and advertising strategies) • Factors influencing the market (Govt. policy, distribution channel) • Assessment of accessibility

17. Customers of preference • HBV carriers • Children • General public • Both urban and rural dwellers How do they know? Promotional activities

18. Promotional strategies • Publicity and advertisements prior to the launching • Poster/pamphlet productions • Tele-broadcasting/ radio programming • Dissemination of information through internet and websites • Free distribution upto limited number of customer (first come first serve basis) during launching period • Membership scheme and discount facilities • Counseling • Risk associated with liver cancer • Cost associated with liver cancer treatment • Benefits of using the products

19. Why herbal chemoprevention? • Vaccination- not enough for all, not able to reach to the poor • No vaccine for HCV • Easy availability, easy to use • Psychologically acceptable • No side effects

20. Ethical issues • ‘Prevention is better than cure’ because: • It saves human being from the onset of dreadful disease • Helps provide longer and healthy life • Saves large amount of money- helps entire nation in revenue generation • Early detection is the best approach to control liver cancer as it: • Helps in reduction of incidence and mortality • Makes treatment more effective • Improves life for cancer patient and their families

21. Ethical issues (contd.) • Ethics of chemoprevention clinical trials are much complicated especially when normal human beings are used and for the reasons that: • it lies at the intersection of different approaches to the management of disease and the promotion of health; • several conflicting perspectives are competing in these trials; and • multiple values play a role in determining the nature and magnitude of the risks and benefits. • Products and product quality assurance-approval from National FDA • Consumers will be benefited by getting balanced dosage • Advantage over vaccination-will reach to the poor

22. Summary • Marketing- introduces products, analyzes and caters the consumer needs • Market size- the determinant of production, distribution and economical viability • Thailand- 64 million (total population) with 11,868 new cases of liver cancer (1993 data) • Highly sophisticated treatment facilities • Prevention- the best approach both ethically and economically.

23. THANK YOU!