ブランドと戦略：不安定狭心症/非ST上昇型心筋梗塞（UA/NSTEMI）

Abstract

Introduction

In 2006, the unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) market, valued at more than $820 million in the United States, Europe, and Japan, was dominated by a handful of premium-priced therapies, including Schering-Plough' s gpIIb/IIIa inhibitor Integrilin and Sanofi-Aventis' low-molecular weight heparin Lovenox. Nine existing drug classes and complicated treatment regimens make for a crowded and competitive market; nonetheless, huge unmet clinical need provides an attractive commercial opportunity for new treatments that demonstrate efficacy and safety superior to that of currently available treatments. Several new agents are set to enter the market before 2011, including Eli Lilly' s ADP receptor antagonist prasugrel, GlaxoSmithKline' s Factor Xa inhibitor Arixtra, Schering-Plough' s thrombin receptor antagonist SCH-530348, and The Medicines Company' s cangrelor. The launch of these drugs will impact currently available therapies and contribute to revenue growth, driving the UA/NSTEMI market to more than $1 billion in 2011.

Questions Answered in This Report

• Schering-Plough dominated the UA/NSTEMI market in 2006, with a market share in excess of 40%, almost double that of the next leading competitor. How has Schering-Plough secured such a dominant market share? What strategies will the company employ to sustain a leading position over the forecast period?
• Cardiologists and interventional cardiologists have been cautious in their uptake of expensive new agents because of the need for cost containment and the lack of perceived improvement over existing agents. What do physicians identify as the key attributes of currently marketed agents? What are the perceived advantages and/or disadvantages of emerging therapies versus available therapies?
• Plavix is currently the gold standard for antiplatelet therapy; however, Eli Lilly' s highly anticipated prasugrel and The Medicines Company' s cangrelor have the potential to radically change the ADP receptor antagonist drug class dynamic. Other agents in development also have the potential to compete directly with Plavix. What products are being developed in the major competitors' pipelines? How will emerging drugs perform if approved for UA/NSTEMI treatment?
• UA/NSTEMI is part of a broader set of cardiovascular conditions that includes acute coronary syndrome (ACS) and thrombosis-related disorders, and it is distinct from primary care cardiovascular conditions such as dyslipidemia and hypertension. How does UA/NSTEMI fit into the wider cardiovascular therapeutic area? What strategies are being pursued to achieve success in this treatment area?

Scope

• Markets Covered: United States, France, Germany, Italy, Spain, United Kingdom, and Japan.
• Competitive Analysis: Detailed discussion of major competitors, including Schering-Plough, Sanofi-Aventis, Bristol-Myers Squibb, Eli Lilly, Merck, and The Medicines Company, as well as the emerging competitor GlaxoSmithKline. Included is an analysis of each company' s cardiovascular product portfolio, strategic positioning, and development pipeline in UA/NSTEMI. The report features an in-depth discussion of leading brands including approval history, sales and market position, SWOT analysis, and strategy initiatives.
• Physician Perception of Key Brands: Analysis of physician perceptions of the UA/NSTEMI market based on a custom survey of 50 U.S. cardiologists and interventional cardiologists. The survey is brand-focused and examines physician perceptions of key competitors, brand attributes, and uptake of emerging agents.
• Epidemiology: Total prevalent and diagnosed cases for each of the major markets are presented in an annualized forecast from 2006 to 2011.
• Market Forecast: Annualized sales forecasts for branded agents presented by region, drug class, molecule, and brand for 2006 to 2011, including the uptake of new agents.

Table of Contents

Table of Contents

Table of Exhibits

Executive Summary

Section 1: Disease Dynamics

• Background
• Patient Population
• Prevalence and Diagnosis
• Prescribers
• Treatment Dynamics
  • Existing Treatments
  • Emerging Treatments
• Reimbursement Issues
• Market Summary

Section 2: Competitive Analysis

• Overview of Competitive Landscape
  • Promotional Spending
  • Physician Perceptions of UA/NSTEMI Competitors

Schering-Plough

• Cardiovascular Product Portfolio
• Goals and Vision in Cardiology
• Current Positioning
• Market Strategy
• Future Positioning
• Integrilin
  • History
  • Current Positioning
  • Competitive Analysis
  • Key Brand Strategies
  • Future Positioning
• SCH-530348
  • History
  • Competitive Analysis
  • Future Positioning

Sanofi-Aventis

• Cardiovascular Product Portfolio
• Goals and Vision in Cardiology
• Current Positioning
• Market Strategy
• Future Positioning
• Lovenox
  • History
  • Current Positioning
  • Competitive Analysis
  • Key Brand Strategies
  • Future Positioning

Eli Lilly

• Cardiovascular Product Portfolio
• Goals and Vision in Cardiology
• Current Positioning
• Market Strategy
• Future Positioning
• ReoPro
  • History
  • Current Positioning
  • Competitive Analysis
  • Key Brand Strategies
  • Future Positioning
• Prasugrel
  • History
  • Competitive Analysis
  • Future Positioning

The Medicines Company

• Cardiovascular Product Portfolio
• Goals and Vision in Cardiology
• Current Positioning
• Market Strategy
• Future Positioning
• Angiomax
  • History
  • Current Positioning
  • Competitive Analysis
  • Key Brand Strategies
  • Future Positioning
• Cangrelor
  • History
  • Competitive Analysis
  • Future Positioning

Merck

• Cardiovascular Product Portfolio
• Goals and Vision in Cardiology
• Current Positioning
• Market Strategy
• Future Positioning
• Aggrastat
  • History
  • Current Positioning
  • Competitive Analysis
  • Key Brand Strategies
  • Future Positioning

Bristol-Myers Squibb

• Cardiovascular Product Portfolio
• Goals and Vision in Cardiology
• Current Positioning
• Market Strategy
• Future Positioning
• Plavix
  • History
  • Current Positioning
  • Competitive Analysis
  • Key Brand Strategies
  • Future Positioning

Emerging Competitor: GlaxoSmithKline

• Cardiovascular Product Portfolio
• Goals and Vision in UA/NSTEMI
• Arixtra
  • History
  • Competitive Analysis
  • Future Positioning

Section 3: Market Forecast

• Market Overview
  • Drug Sales by Region
  • Drug Sales by Class
• Market Forecast
  • GpIIb/IIIa Inhibitor Market
  • Heparin Market
  • Hirudin Market
  • ADP Receptor Antagonist Market
  • FXa Inhibitors
  • Thrombin Inhibitors

Section 4: Appendix

• Acronyms and Initialisms
• Methodology
  • Epidemiological Forecast Methodology
  • Market Forecast Methodology
  • Competitive Analysis Methodology
  • Survey Methodology

Table of Exhibits

Executive Summary

• Exhibit ES-1: Key Parameters of the UA/NSTEMI Market
• Exhibit ES-2: UA/NSTEMI Market ($US), Major Markets, 2006-2011
• Exhibit ES-3: UA/NSTEMI Market Competitive Position, 2006 and 2011
• Exhibit ES-4: UA/NSTEMI Brand Sales ($US), by Brand, 2006 and 2011
• Exhibit ES-5: UA/NSTEMI Market Shares, by Brand, 2006 and 2011
• Exhibit ES-6: Physician Perceptions of UA/NSTEMI Market Competitors

Section 1: Disease Dynamics

• Exhibit 1-1: Platelet Activation Pathways
• Exhibit 1-2: Prevalent and Diagnosed UA/NSTEMI Cases, Major Markets
• Exhibit 1-3: UA/NSTEMI Rate of Events, by Country, 2006
• Exhibit 1-4: UA/NSTEMI Prevalence, by Indication, Major Markets, 2006
• Exhibit 1-5: UA/NSTEMI Cases, US
• Exhibit 1-6: UA/NSTEMI Cases, Europe
• Exhibit 1-7: UA/NSTEMI Cases, Europe, Continued
• Exhibit 1-8: UA/NSTEMI Cases, Japan
• Exhibit 1-9: Unmet Needs in UA/NSTEMI Treatment
• Exhibit 1-10: Physician Perceptions of Unmet Needs in UA/NSTEMI Treatment
• Exhibit 1-11: Impact of Information Sources in UA/NSTEMI
• Exhibit 1-12: Leading UA/NSTEMI Drugs, by Drug Class
• Exhibit 1-13: Emerging UA/NSTEMI Drugs, by Drug Class
• Exhibit 1-14: UA/NSTEMI Sales ($US), by Country, 2006
• Exhibit 1-15: UA/NSTEMI Sales ($US), by Drug Class, 2006
• Exhibit 1-16: Average UA/NSTEMI Patient Shares, by Brand, 2006
• Exhibit 1-17: UA/NSTEMI Brand Sales ($US), by Brand, as a Percent of Total, 2006

Section 2: Competitive Analysis

• Exhibit 2-1: UA/NSTEMI Market Competitive Position, 2006 and 2011
• Exhibit 2-2: UA/NSTEMI Market ($US), by Company, 2006-2011
• Exhibit 2-3: Promotional Spend for UA/NSTEMI Therapies, by Company, 2006
• Exhibit 2-4: Promotional Spending for UA/NSTEMI Therapies, by Brand, 2006
• Exhibit 2-5: Importance of Factors on Physician Perception of a Cardiovascular Company
• Exhibit 2-6: Physician Ranking of UA/NSTEMI Competitors as Overall Cardiovascular Companies
• Exhibit 2-7: Physician Ratings of Factors Influencing Perception of a UA/NSTEMI Company
• Exhibit 2-8: Physician Ranking of UA/NSTEMI Competitors
• Exhibit 2-9: Physician Ranked "Best" UA/NSTEMI Market Competitors
• Exhibit 2-10: Summary of Schering-Plough' s Cardiovascular Product Portfolio
• Exhibit 2-11: Physician Perceptions of Schering-Plough in UA/NSTEMI
• Exhibit 2-12: Timeline of Integrilin' s Development
• Exhibit 2-13: GpIIb/IIIa Physician Prescribing, by Patient Group
• Exhibit 2-14: Physician Perceptions of Integrilin
• Exhibit 2-15: Ongoing Clinical Trials for Integrilin
• Exhibit 2-16: Ongoing Clinical Trials for Integrilin, Continued
• Exhibit 2-17: Integrilin Market ($US), 2006-2011
• Exhibit 2-18: Integrilin Market ($US), by Country, 2006-2011
• Exhibit 2-19: Price to Treat per Day ($US), Integrilin, by Country, 2006
• Exhibit 2-20: SCH-530348 Market ($US), 2006-2011
• Exhibit 2-21: SCH-530348 Market ($US), by Country, 2006-2011
• Exhibit 2-22: Expected Price to Treat per Day ($US), SCH-530348, by Country
• Exhibit 2-23: Summary of Sanofi-Aventis' Cardiovascular Product Portfolio
• Exhibit 2-24: Physician Perceptions of Sanofi-Aventis in UA/NSTEMI
• Exhibit 2-25: Timeline of Lovenox' Development
• Exhibit 2-26: Physician Perceptions of Lovenox and UFH
• Exhibit 2-27: Physician' s Key Drivers of Choice for Lovenox versus UFH
• Exhibit 2-28: Clinical Trials for Lovenox versus UFH
• Exhibit 2-29: Additional Ongoing Clinical Trials for Lovenox
• Exhibit 2-30: Lovenox Market ($US), 2006-2011
• Exhibit 2-31: Lovenox Market ($US), by Country, 2006-2011
• Exhibit 2-32: Price to Treat per Day ($US), Lovenox, by Country, 2006
• Exhibit 2-33: Summary of Eli Lilly' s Cardiovascular Product Portfolio
• Exhibit 2-34: Physician Perceptions of Eli Lilly in UA/NSTEMI
• Exhibit 2-35: Timeline of ReoPro' s Development
• Exhibit 2-36: Physician Perceptions of ReoPro
• Exhibit 2-37: Ongoing Clinical Trials for ReoPro
• Exhibit 2-38: Ongoing Clinical Trials for ReoPro, Continued
• Exhibit 2-39: ReoPro Market ($US), 2006-2011
• Exhibit 2-40: ReoPro Market ($US), by Country, 2006-2011
• Exhibit 2-41: Price to Treat per Day ($US), ReoPro, by Country, 2006
• Exhibit 2-42: Physician Perceptions of Prasugrel' s Impact on ACS Treatment
• Exhibit 2-43: Prasugrel Market ($US), 2006-2011
• Exhibit 2-44: Prasugrel Market ($US), by Country, 2006-2011
• Exhibit 2-45: Expected Price to Treat per Day ($US), Prasugrel, by Country
• Exhibit 2-46: Summary of The Medicines Company' s Cardiovascular Product Portfolio
• Exhibit 2-47: Physician Perceptions of The Medicines Company in UA/NSTEMI
• Exhibit 2-48: Timeline of Angiomax' Development
• Exhibit 2-49: Physician Perceptions of Angiomax
• Exhibit 2-50: Ongoing Clinical Trials for Angiomax
• Exhibit 2-51: Angiomax Market ($US), 2006-2011
• Exhibit 2-52: Angiomax Market ($US), by Country, 2006-2011
• Exhibit 2-53: Price to Treat per Day ($US), Angiomax, by Country
• Exhibit 2-54: Cangrelor Market ($US), 2006-2011
• Exhibit 2-55: Expected Cangrelor Revenue ($US), by Country, 2006-2011
• Exhibit 2-56: Expected Price to Treat per Day ($US), Cangrelor, by Country
• Exhibit 2-57: Summary of Merck' s Cardiovascular Product Portfolio
• Exhibit 2-58: Physician Perceptions of Merck in UA/NSTEMI
• Exhibit 2-59: Timeline of Aggrastat' s Development
• Exhibit 2-60: Physician Perceptions of Aggrastat
• Exhibit 2-61: Ongoing Clinical Trials for Aggrastat
• Exhibit 2-62: Aggrastat Market ($US), 2006-2011
• Exhibit 2-63: Aggrastat Market ($US), by Country, 2006-2011
• Exhibit 2-64: Price to Treat per Day ($US), Aggrastat, by Country
• Exhibit 2-65: Summary of BMS' Cardiovascular Product Portfolio
• Exhibit 2-66: Physician Perceptions of BMS in UA/NSTEMI
• Exhibit 2-67: Timeline of Plavix' Development
• Exhibit 2-68: Physician Perceptions of Plavix
• Exhibit 2-69: Key Drivers of Choice for Plavix Use
• Exhibit 2-70: Ongoing Clinical Trials for Plavix
• Exhibit 2-71: Plavix Market ($US), 2006-2011
• Exhibit 2-72: Plavix Revenue ($US), by Country, 2006-2011
• Exhibit 2-73: Price to Treat per Day ($US), Plavix, by Country, 2006-2011
• Exhibit 2-74: Summary of GSK' s Cardiovascular Product Portfolio
• Exhibit 2-75: Physican Perceptions of Arixtra
• Exhibit 2-76: Arixtra Market ($US), 2006-2011
• Exhibit 2-77: Arixtra Market ($US), by Country, 2006-2011
• Exhibit 2-78: Expected Price to Treat per Day ($US), Arixtra, by Country

Section 3: Market Forecast

• Exhibit 3-1: UA/NSTEMI Market ($US), Major Markets, 2006-2011 (Tabular Format)
• Exhibit 3-2: UA/NSTEMI Market ($US), Major Markets, 2006-2011 (Graphical Format)
• Exhibit 3-3: Key Events , UA/NSTEMI Market, 2006-2011
• Exhibit 3-4: UA/NSTEMI Market ($US), by Country, 2006-2011
• Exhibit 3-5: UA/NSTEMI Market ($US), by Drug Class, 2006-2011
• Exhibit 3-6: UA/NSTEMI Market, by Drug Class, as a % of Total, 2006 and 2011
• Exhibit 3-7: GpIIb/IIIa Inhibitor Market ($US), by Drug, 2006-2011
• Exhibit 3-8: GpIIb/IIIa Inhibitor Market ($US), by Country, 2006-2011
• Exhibit 3-9: GpIIb/IIIa Inhibitor Market ($US), by Brand, 2006-2011
• Exhibit 3-10: Heparin Market ($US), by Drug, 2006-2011
• Exhibit 3-11: Heparin Market ($US), by Country, 2006-2011
• Exhibit 3-12: Heparin Market ($US), by Brand, 2006-2011
• Exhibit 3-13: Hirudin Market ($US), by Drug, 2006-2011
• Exhibit 3-14: Hirudin Market ($US), by Country, 2006-2011
• Exhibit 3-15: ADP Receptor Antagonist Market ($US), by Drug, 2006-2011
• Exhibit 3-16: ADP Receptor Antagonist Market ($US), by Country, 2006-2011
• Exhibit 3-17: ADP Receptor Antagonist Market ($US), by Brand, 2006-2011

Section 4: Appendix

• Exhibit 4-1: Adjusted Price of Lovenox, 2006-2011
• Exhibit 4-2: Adjusted Price of Angiomax, 2006-2011
• Exhibit 4-3: Adjusted Price of Arixtra, 2006-2011
• Exhibit 4-4: Surveyed Physicians' Years of Practice
• Exhibit 4-5: Surveyed Physicians' Patients per Month
• Exhibit 4-6: Surveyed Physicians' Geographic Distribution