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Potential Addressable Market (PAM) for TB

Introduction

The use of DAT in TB treatment has steadily expanded in the past few years, reaching a high of  70 countries reporting some level of use in 2019. Currently, use within countries remain small in scale relevant to actual TB burden and market trends indicate the market for DAT in TB treatment is emerging, with high potential for future growth. Where is this future growth likely to occur? How much demand for DAT products may eventually arise from global TB control efforts?

Finding the answers to these and other similar questions by estimating and visualizing the potential addressable market can aid DAT manufacturers and global health stakeholders in developing long-term strategies to navigate and influence this emerging market.

Understanding the PAM for TB

The potential addressable market for TB is the total theoretical need for TB treatment adherence support globally that could be met through use of DAT. Epidemiological models of annual TB incidence indicate that, in 2019, ~9 million people experienced a case of active TB and had need for TB treatment. This is the maximum market size for DAT in TB treatment.

The potential addressable market is visualized below. Use the interactive diagrams to explore the distribution of the global PAM for TB by DAT across countries and WHO regions. Select WHO region(s) in the bar chart to apply filters on the map. Hover over elements to review data in detail.

Analysis of PAM Distribution and Trends

Geography

The demand for DAT in TB treatment is highest in Asia, specifically the South-East Asia and Western Pacific regions (as defined by the WHO), and is expected to grow dramatically. In close proximity here is clustered 4 of the top 5 countries by annual TB incidence (India, China, Indonesia, and the Philippines) of which India is the global epicenter for TB infections worldwide, accounting for over 35% of the world’s share. Many of these countries are pioneers in using DAT for TB treatment, contributing greatly to DAT implementation research and bringing homegrown DAT products to market (see Market Landscape to learn more).

Most other countries in the region are also early adopter of DAT for TB treatment.

In total, S.E. Asia and W. Pacific account for over 5 million cases annually. The high intensity and geographic proximity of demand in this area is beneficial for the emerging DAT market, yielding a wealth of opportunities and efficiencies for local manufacturers and distributors. Strong market growth across a number of countries, and relatively low cost to expand products to multiple countries, could incentivize competition, driving down cost of products and innovation to meet the needs of all segments in the TB market.

In Africa, while potential aggregate demand is also high, underlying indicators point to slower potential growth than in Asia. Firstly, potential demand is more widely dispersed both at the regional and national level. No African country rank in the top 5 globally in terms of annual TB incidence (compared to 4 in Asia). Furthermore, the level of urbanization and development is generally lower. This means it is comparatively less efficient to expand DAT products to multiple markets and within any given market.

To date, few African countries have begun to adopt DAT for use in TB control. The above trends may partially explain this trend, as may epidemiology and economics. On average, health systems in Africa have smaller budgets and must address a larger public health portfolio (including other priority infectious diseases such HIV and malaria). As such, there may insufficient capacity to be early adopters in the DAT for TB market.

Other contributing factors, such as generally lower diagnostic capability and internet and communication technology (ICT) access will be explored in subsequent sections.

Overall Size

Compared to other health areas potentially addressable by DAT, the market opportunity afforded by the TB market is relatively small. HIV, for example, also requires lengthy and complicated treatment, and is much more prevalent.  In 2020, ~38 million people were estimated to be living with HIV. The potential addressable market in using DAT for non-communicable diseases (NCDs) is even bigger.

One way to frame these comparisons is to consider other use cases as “competition” for the TB market. Certain manufacturers may see the DAT market for NCDs as a higher priority given the larger market opportunity there, and may decline to specifically address the needs of the TB market. This “competition” already shapes the DAT market in HIC settings where most current products are geared towards use for NCDs, reproductive health, and clinical trial applications. While many of these products could be adapted to fit the needs of the TB market (read more in ASCENT’s DAT Market Landscape analysis), manufacturers in HICs may lack incentive to do so.

The picture looks different in LMIC and MIC settings, particularly in high burden Asian countries, where the demands of the TB market is a major driving force in adopting DAT. While there are currently few DAT manufacturers in these countries, products are more specifically designed for the TB market. With most HIC manufacturers focused on other use cases, there is opportunity for LMIC manufacturers to corner the TB market and grow.

In the end, the largest market opportunity in the DAT space lies in designing products and platforms which can flexibly meet the needs of multiple health areas, and manufacturers which succeed in doing so will likely see long-term sustainable growth.

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