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

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

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)

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

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

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

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)

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)

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.

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) =

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.

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

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)

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

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)

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

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

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

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

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

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

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.

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