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: %
Life expectancy at birth: years (all)
(male: years and women: years)
Literacy rate: %
(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,
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!