Indonesian prices of branded drugs to treat non-small cell lung cancer (NSCLC) are rising 10% a year and cost almost three times as much as generics, in a market that is set to soar in value from $16 million in 2010 to $26 million in 2015, says a new report.

The high prices of branded drugs are expected to compensate manufacturers for the decline in sales volumes, as generics are the first line and often the only form of drug treatment for NSCLC in Indonesia, says the study, from Frost & Sullivan.

Branded drugs are sold at price-per-cycle and their volumes drop when this price crosses $850. As the price-per-cycle of generics has not yet reached the $850 mark, their volume is expected to continue rising, it says.

F&S suggests that the prices of both generic and branded NSCLC drugs could see a spurt, along with an increase in transportation and oil costs, since active pharmaceutical ingredients (APIs) are generally imported. However, it adds, the market will be sustained by the increasing incidence of NSCLC caused by Indonesia's high numbers of smokers.

The percentage of adult male smokers increased from 53% of the population in 1995 to 66% in 2010, and while only 4.2% of adult Indonesian women smoke, their numbers have also increased from 1.7% in 1995, comments F&S research analyst Poornima Srinivasan.

"Furthermore, approximately 97 million non-smokers are routinely exposed to secondhand smoke (SHS), and 70% of children under the age of 15 are regularly exposed to SHS, expanding the market for NSCLC drugs," she says.

Indonesia also has one of the world’s highest numbers of child smokers, with 25% of children over the age of three having tried cigarettes. This is likely to cause the onset of tobacco-related illnesses including NSCLC to occur at earlier ages, says Eugene van de Weerd, country director at F&S.

"In addition, cigarettes are relatively cheap and taxes levied by the government, at 37% of the sales price, are low in comparison to the global standard of 70%. Without higher cigarette sales taxes and comprehensive cigarette cessation programmes, smoking rates will remain high in Indonesia and increase the likelihood of cancer,” he says.

Both patent expiries and the introduction of novel NSCLC drugs will widen the treatment options for patients, even though the standard first line of therapy will continue to be a platinum-based generic chemotherapy combination. The study authors expect the NSCLC market in Indonesia to remain loyal to generic drugs, due to the low level of patient affordability, and point out that while rising incomes will make private insurance affordable to the public in due course, only 48% of the population currently has health insurance.

The nation's healthcare expenditures have increased gradually, from $6.80 billion in 2006 to an estimated $19.80 million in 2010, and are projected to rise to $33.80 billion in 2015, at a compound annual growth rate (CAGR) of 11.3%, says F&S. Currently, only 13% of private-sector workers have health insurance, but this is expected to improve with robust growth in Gross Domestic Product (GDP).

So far, pharmaceutical companies have been unable to tap the market's potential, as inadequate screening programmes and often innocuous early signs of NSCLC impede the likelihood of an early diagnosis. As most patients are in the advanced stages of the disease, only a small percentage are benefitting from drug therapy, the study finds.

Greater healthcare for patients and quality healthcare infrastructure will be necessary to persuade patients to seek therapy and make it unnecessary for wealthy Indonesians to travel abroad for treatment, it notes, adding that public/private partnerships, along with private investments, will be crucial for the market to upgrade its facilities and expand.

"Sponsoring disease awareness programmes that identify the risk factors and early warnings signs of NSCLC is one way to encourage the undiagnosed to detect the disease early," Ms Srinivasan suggests. "Also, developing strong relations with hospitals and clinics, along with a solid market presence, is essential to capture market shares in the Indonesian marketplace," she adds.