Anticoagulant market analysis
DEW, outstanding work on your analysis and you amaze me with your memory that this thread warranted follow up.
I agree with your analysis and assumptions, except for two points, one of which is trivial, and the other perhaps more substantive.
First: A) Primary VTE prevention following hip/knee surgery.
I predict that the orthopedist mind set will prefer to stick with one drug for both inpt and outpt setting. Since most of the post op care and risk of DVT occurs post discharge, I predict we will see an oral drug (i.e. Xarelto) with reasonable safety profile and comparable efficacy to either warfarin or enoxaparin take the lion's share of the prophylaxis market. To make a guess, I would estimate enoxaparin could lose 50% of the inpatient post op prophylaxis market share (vs. 20% in your model).
Second: D) Acute VTE treatment
I disagree with your assertion:
acute DVT treatment is exclusively a hospital-based indication, and hence the advantages of Lovenox cited in A) — its longstanding safety record, lower cost, and injected formulation — should enable Lovenox to compete effectively against the oral competition in this indication.
Already we are seeing many leg DVTs diagnosed in the ED and discharged on enoxaparin that is administered by the patient, family member, or a visiting nurse. Even pulmonary embolus has some data indicating some patients can be managed as an outpatient similarly. In these cases, the plan is usually to use enoxaparin as a bridge to warfarin. Even though I think we could be seeing an increasing trend to outpt treatment of DVT, I don't this as strongly bullish for the newer anticoagulants or strongly bearish for enoxaprin, because I think clinicians and patients are going to have a tough time giving up the comfort of a drug such as time-tested warfarin that can be monitored by blood tests. Especially for a disease that is considered acute and life threatening, this is going to to be the gold standard until we have more head-to-head trials that convince clinicians that the newer drugs are the wave of the future.
So, in summary, I don't see my views affecting your model figures for acute VTE treatment substantively.
Thanks for your good work,
Urche
AI
