德银-中国-医疗保健行业-中国的血栓治疗-20180102-88页_12mb

Thrombosis Therapeutics in China: Summary

Core Content

The report analyzes the thrombosis therapeutics market in China, focusing on its growth drivers, competitive landscape, and valuation prospects for key players. Thrombosis is a significant contributor to cardiovascular disease (CVD), which is the largest therapeutic class in China with a market size of RMB124bn in 2017. The thrombosis market alone reached RMB44bn in 2017, growing at a CAGR of 13% from 2013 to 2017, outperforming the CVD and overall drug markets. The market is projected to grow at a CAGR of 10% from 2017 to 2022, reaching RMB72bn by 2022.

Main Points

Market Growth Drivers

• Increasing Prevalence of Thrombosis: The incidence of thrombosis in China is growing, with a notable rise in conditions like stroke and acute coronary syndrome (ACS). The prevalence of stroke is particularly high, while myocardial infarction (MI) and deep vein thrombosis (DVT)/pulmonary embolism (PE) are relatively lower.
• Reimbursement Expansion: The new National Reimbursement Drug List (NRDL) includes four out of six major thrombosis drugs, creating opportunities for domestic generics.
• Limited Therapeutic Options: The market has limited therapeutic options, especially for novel oral anticoagulants (NOACs), which leaves room for domestic players to fill the gap.

Competitive Landscape

• Market Share: MNCs hold a 31% share in the thrombosis market, compared to 25% in the overall drug market. Domestic companies are expected to capture significant market share with the entry of generics.
• Key Players: Sino Biopharm (SBP), CSPC Pharma, and Hengrui Medicine are highlighted as leading domestic players with robust pipelines and strong market positioning.
• Therapeutic Breakdown: Antiplatelets and anticoagulants constitute the majority of the thrombosis market in China, with antiplatelets at 40% and anticoagulants at 20% in 2017. This contrasts with the US, where anticoagulants make up 71% of the market.

Regulatory and Market Status

• Generic Approvals: While all but Effient of the FDA-approved drugs were approved in China, only two domestic generics of Plavix were approved among the six branded drugs.
• NOACs Adoption: NOACs are still in early stages of adoption in China due to limited physician education and approved indications, but they are expected to grow as domestic generics enter the market.
• Warfarin Usage: Warfarin, the standard therapy for venous thrombosis, is used less frequently in China than globally due to its complexity and risk of bleeding.

Key Companies and Valuation

Sino Biopharm (1177.HK)

• Market Exposure: SBP has five generics under late-stage development/regulatory review, including apixaban, rivaroxaban, dabigatran, clopidogrel, and ticagrelor.
• Revenue Projections: Estimated to generate RMB4.0bn from its thrombosis franchise by 2022.
• Valuation Metrics:
  • P/E (2017E): 36.0
  • EV/EBITDA (2017E): 18.5
  • Price/book (2017E): 8.1
• Recommendation: Buy

CSPC Pharma (1093.HK)

• Market Exposure: CSPC has two generics under late-stage development, including clopidogrel and rivaroxaban.
• Revenue Projections: Estimated to generate RMB1.8bn from its thrombosis franchise by 2022.
• Valuation Metrics:
  • P/E (2017E): 33.3
  • EV/EBITDA (2017E): 21.2
  • Price/book (2017E): 7.88
• Recommendation: Buy

Hengrui Medicine (600276.SS)

• Market Exposure: Hengrui has three generics under late-stage development, including clopidogrel, fondaparinux, and edoxaban.
• Revenue Projections: Estimated to generate RMB2.0bn from its thrombosis franchise by 2022.
• Valuation Metrics:
  • P/E (2017E): 60.1
  • EV/EBITDA (2017E): 47.6
  • Price/book (2017E): 12.42
• Recommendation: Buy

Physician Feedback

• Disease Prevalence: Physicians noted that the lower incidence of thrombosis in China compared to the US is due to lifestyle and epigenetic factors. However, the trend is deteriorating, with younger patients developing ACS.
• Guideline Influence: Physicians in tier 1/2 hospitals generally follow ESC guidelines rather than ACC/AHA, which are more US-focused.
• Therapeutic Preferences: Domestic drugs are preferred for cost-effectiveness and physician incentives. However, some domestic therapies like BVS face challenges due to high costs and limited data.
• NOACs Adoption: NOACs are not widely used due to price, physician education, and limited approved indications. Domestic generic approvals are expected to increase usage.

Valuation Table Highlights

Conclusion

The thrombosis market in China is expected to grow significantly due to increasing patient prevalence, reimbursement expansion, and limited therapeutic options. Domestic companies like Sino Biopharm, CSPC Pharma, and Hengrui Medicine are well-positioned to capture this growth with their extensive pipelines of generics and branded drugs. The report highlights the potential for substantial market expansion and the importance of physician education and regulatory approvals in driving the adoption of new therapies.