June 2015

Advanced Technology: The Winning Leap

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With rising cancer cases in the country, oncology will be a key area of growth in India’s healthcare sector, says Manikandan Bala, Managing Director, Elekta Medical Systems India Private Limited in conversation with Romiya Das of Elets News Network (ENN)

What are your views on radiation oncology equipment market in India vis-à-vis the global market?

As the incidence cases of cancer diseases continue to rise, along with increasing trends in accurate diagnosis and precise treatment planning system, the radiation therapy devices market for treating these diseases continue to show significant growth. Radiation therapy is one of the main modes of treatment for cancer globally. On an average about 50 per cent of cancer patients need radiation therapy apart from other treatments like chemotherapy and surgery. However, globally for 33 million cancer patients we have a huge gap on the available linear accelerators (LINAC) at present which is almost a gap of 10,000 linear accelerators. In India, this gap is a lot more pronounced, where for

Manikandan Bala, Managing Director, Elekta Medical Systems India Private Limited

Manikandan Bala, Managing Director, Elekta Medical Systems India Private Limited

about 3 million cancer patients we have a gap of more than 1,200 linear accelerators. For instance, while US has about 12 LINAC per million of the population, India has about 0.3 LINAC per million of the population. Even countries like China and Brazil are way ahead and have a larger concentration of LINAC compared to India. With cancer incidents on the rise because of improved life expectancy, diagnosis and survival rates, this gap is getting wider. Even within India, analyzing the distribution of LINAC, almost 56 per cent are installed in metros and tier I cities whereas 70 per cent of cancer incidences are reported in rural areas. Nowadays, patients in tier III cities and rural areas have to travel long distances to get the radiation treatments involving huge financial burden and tremendous inconvenience. They need to stay in these cities to get treated as radiation therapy is a long term treatment typically spreading over four to five weeks. So, if one has look at the comparative cost, radiation therapy is still affordable compared to other modes. Hence, there is a huge demand for new linear accelerators as well as the replacement of the ageing cobalt Systems in India and we strongly feel that the growth will be driven by the demand coming in from the tier II and III cities. At present, only about 50 new linear accelerators are added every year in the Indian market.

What are your views on market price sensitivity in terms of radiation oncology equipment industry?

Indian market is a very price sensitive one as most healthcare spends is out of pocket. The ability to pay in India is not the same as in other markets. Reimbursement levels of treatment are almost one tenth of that of developed countries like US, even in corporate hospitals. As a result, the end-users are under pressure to reduce the expenditure on capital equipment purchases as well as maintenance costs to ensure decent return on investment (RoI) – the operation cost also needs to be minimum. Therefore, there is a huge pressure exerted on the vendors to reduce the cost of the equipment as well as the maintenance cost. In simple words, customers want the best equipment at lower prices. The average price realization is one of the lowest when we compare with other countries in Asia-Pacific.

What according to you are the emerging trends in technology in this particular sector?

The radiation therapy market is growing at a rapid pace over the past few years on account of rising cancer cases and increase in sophistication of new treatment processes. This in turn is driving the technology innovation on the therapy side. If we talk about emerging trends in radiation therapy, one segment is innovations and advancement towards image-guided radiation therapy. With improved diagnostic options, we expect more and more patients to get diagnosed at early stages of cancer where curative and aggressive radiation therapy treatment can be administered. As radiation therapy treatment gets more aggressive with higher dose rate, hypofractionation and stereotactic radiation therapy treatments, image guidance will be highly important enabling the clinicians to gain that added confidence of removing the tumour with better sparring of the healthy tissues and organs near to the tumour.

How beneficial is the ‘Make in India’ concept in terms of the radiation oncology equipment market?

‘Make in India’ is an excellent concept, which should result in many benefits for Indian healthcare industry as well as the patients. We already see positive trends across industry especially in healthcare. Software plays a significant role in radiation therapy – be it record verification, treatment planning, and oncology information management systems. We see a great potential of tapping software development talent in India. To further enhance our software solutions, we are keen to actively engage with few of the key customers to make major investment in the sector. We are keen to leverage the talent and skill set in India as we move forward

What are your challenges and expectations from the radiation oncology equipment industry?

As the India cancer burden continues to grow at an alarming rate, we continue to see very low expenditure on healthcare spend in the government sector. As a percentage of GDP we have been hearing about some optimistic figures, but are still waiting for these initiatives. As a result, the investment, specifically in the cancer facility, which is a capital intensive, is slow in the government sector. From the industry’s pov Complex RoI for high-end solutions remains a significant market restraint. One of the other major concerns is the shortfall in availability of skills and talent – namely the Radiation Oncologists and the Medical Physicists

What would you like to suggest the buyers of radiation oncology equipment industry?

The demand for radiation therapy is growing in tier II and III cities. We anticipate the healthcare providers, mainly the corporate and the government, to spread and penetrate more into tier II and III cities. The hub-and-spoke model where the centre of excellence can be in a major city with tier II and III cities feeding the technology centers will be the key focus. We also expect the buyers to use more Information Technology (IT) and Clinical Information Management System to ensure the standardized Quality and protocol driven care is provided to patients at all the centres in the network. At the same time, all patient-related data generated electronically can be used for improving the care further. With our strength on oncology Information Management systems, we are poised to provide superior solutions for these ventures. With the objective of penetrating patient care to the tier II & III cities, we also are motivated to encourage and facilitate investment in radiation therapy facility in smaller towns by individual or group of oncologists.

What are Elekta’s present operations in India and future expansion plans?

We are present in India for last 20 years, and have a large operation with very large install based of Linear accelerators, brachytherapy, after-loaders, and neurosciences specialty equipment such as gamma knife and Leksell stereotactic frames. With our highly trained and passionate staff, we have always provided high quality service and application support to our customers. We facilitate multiple trainings to all our customers, both at our dedicated training centers and at the customer locations, augmenting the skill development on the new and innovative technologies. We have invested on a service workforce ahead of the curve which helps in maintaining high up-time of all the equipment, thereby resulting in unhindered and quality treatment to the patients who deserve nothing but the best.

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