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ACE INHIBITOR U.S. MARKET COULD GROW 10-FOLD TO $12 BIL.

Executive Summary

ACE INHIBITOR U.S. MARKET COULD GROW 10-FOLD TO $12 BIL. by the year 2000, Menlo Biomedical Associates, Inc. forecasts in a report on the world-wide cardiovascular market entitled "Cardiovascular Medicine in the 1990s: Trends Strategies and Opportunities." The report projects that U.S. sales of angiotensin-converting enzyme (ACE) inhibitors will increase at an average annual rate of 25% from $1.3 bil. in 1990 to $12 bil. in 2000. MBA expects the growth to be evenly spread across current therapeutic uses of ACE inhibitors, predominantly mild, moderate and severe hypertension and congestive heart failure. MBA projects faster growth in the 1990-1995 period: 30% annually versus 20% annually in 1995-2000. Bristol-Myers Squibb's Capoten (captopril) patent expires in 1995. The report, however, maintains that patent expirations will not have a great influence on the market until the end of the decade. MBA's aggressive growth projections for ACE inhibitors are typical of the report's bullish outlook: "The future of the cardiovascular market is not as bleak as some are predicting," MBA declared in an Oct. 30 press release. The report forecasts 20% annual growth in the total U.S. cardiovascular market from $8.6 bil. to $53.9 bil. over the decade. Study Project Director John George contends that "based on what medical practitioners are telling us, CV market forecasts that call for little or slow growth over the next 10 years are way off the mark." The report justifies its growth projections through a combination of "often overlooked" positive factors and a belief that negative factors will not play as great a role as expected. The report emphasizes "replacement of older, cheaper, products by newer more expensive ones" as well as "out-of-indication use by physicians." MBA added that "improved detection, treatment, and life style changes...are causing a drop in mortality and a build-up of the treatable patient base." While demographic changes have been cited by others, "it is often overlooked that older people are frequently well off and able to pay for the greater share of costs," MBA maintained. "Negative developments, mainly pricing pressures and patent expirations, are indeed present but their impact is not projected to be as great either in degree or in timing as some in the industry expect," MBA maintained. The report is skeptical about political efforts at health care reform. "Governmental strategies are trending toward having the consumer pay more out-of-pocket costs rather than lowering prices," the report says. MBA believes "that it would be very unlikely that a new administration in Washington would be able to drastically revamp the U.S. health care financing system to the significant detriment of the markets addressed in our report." A second antihypertensive class, calcium channel blockers, will almost keep pace with ACE inhibitors over the decade, MBA projects. CCBs are forecast to grow at 22% annually, from $1.9 bil. in 1990 to $14.4 bil. in 2000. ACE inhibitor and calcium channel blocker growth will come at the expense of the three other antihypertensive classes included in the report: beta blockers, diuretics and vasodilators, the MBA report asserts. Beta blockers are forecast to grow at 10% per year, from $1.2 bil. to $3.1 bil. MBA, however, projects that use for angina, myocardial infarction and arrhythmias will increase more quickly than antihypertensive use. In fact, MBA forecasts that angina and MI use, at $621 mil. in sales for each indication, will equal the mild hypertension market in 2000. Antiarrhythmic use of beta blockers will total $466 mil., MBA projects, the same as the forecast market for moderate hypertension. Diuretic use is projected by MBA to grow at 5% per year, from $726 mil. to $1.2 bil. Vasodilator use is forecast to decline at an average rate of 2% annually, from $161 mil. in 1990 to $130 mil. in 2000. A new report by the National High Blood Pressure Education Program runs counter to some of MBA's projections. The report places diuretics and beta blockers as first-line therapies for hypertension,while dropping ACE inhibitors and calcium channel blockers to second-line treatments (see related item, below). The last revision of the report, released in 1988, had added ACEs and CCBs to the first-line armamentarium. The MBA report projects the fastest growth rate for platelet inhibitors, at an average of 54% per year from $10 mil. in 1990 to $743 mil. by 2000. Lipid regulating agents are projected to grow at 27% per year, from $950 mil. in 1990 to $10.6 bil. in 2000. "Cardiovascular Medicine in the 1990s" is the first report by Capitola, Calif.-based Menlo Biomedical Associates. More information on the report is available from Frank von Richter (617/482-0552) in the U.S. and George von Haunalter (41-1-261- 3679) in Europe.
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