With 229 ESRD patients per million, India’s incidence rate is higher than Brazil, Russia and most other developing countries. About 2,90,000 new ESRD cases occur in India each year, of which only a moderate proportion is diagnosed and prescribed renal replacement therapies (RRT). The total number of patients undergoing hemodialysis (HD) in India is expected to grow at about 15-20% each year till 2018. With the dialysis patients being spread disproportionately across metropolitan and tier 2/3 towns, the need for new dialysis centers is on the rise. While developing countries such as Mexico and Thailand have employed a “PD First” policy to promote peritoneal dialysis, India doesn’t support PD (peritoneal dialysis) as a first line of RRT. The number of patients undergoing PD in India has increased very moderately in the past three years. However in India, PD as a first line modality for RRT is not accepted as yet. This can be attributed to less favorable government policies towards PD and lack of awareness among patients as well as doctors.
The market for dialysis machine and accessories in India is expected to be valued over $287 Million in 2018. HD machines represent the largest product category, followed by dialyzers. While global companies such as Fresenius, Baxter and B.Braun are market leaders in India, there is a gradual influx of Chinese and local manufacturers in the Indian market. Driven by the need for cost-effective dialysis sessions, the number of public-private partnerships (PPPs) is on the rise. New corporate dialysis centers are looking to capitalize on this opportunity and expanding through inorganic growth through acquisitions of in-hospital dialysis centers
Of the total dialysis centers operational in India, 29% are concentrated in the metropolitan cities. There exists a stark contrast in the services offered and the mode of operation of dialysis centers in non-metro towns as compared to metropolitan cities. These centers are typically characterized by major cost cutting measures, and operational streamlining efforts to offer cost-effective dialysis. Corporate chain dialysis centers position themselves as facilities with high-end infrastructure and value-added services for its dialysis patients. Such corporate groups are looking for expansion to non-metro cities by acquiring in-hospital dialysis centers that may be typically running to moderate to low profits. In-hospital dialysis centers possess some innate strengths including ability to serve critical renal failure patients due to the availability of ICUs. However, there may be compromised infection control protocol in such centers due to budget restrictions.
In- hospital dialysis centers are most prevalent types of dialysis centers in non-metro towns catering to middle and lower middle socio-economic class. Optimizing operational cost and reducing additional frills in order to pass on cost benefit to the patients continues to take precedence. Owing to scarcity of nephrologists in non-metro towns and absence of clinical guidance at most in-hospital dialysis centers, nephrologist-owned in-hospital dialysis centers are being established.
Frequent niggles with the machine and absence of prompt servicing protocols are the most common challenges faced by dialysis technician. As indicated by the technicians, manual wash of dialyzers and blood tubing sets often increase their workload, hampering them from providing personal assistance to the patient and updating knowledge and capability. Inadequate training and clinical knowledge of the technician has been a key challenge voiced by many nephrologists and patients in non-metro towns. In addition to the high cost of dialysis, many patients believe that the quality of dialysis provided is sub-standard. Moreover, technical knowledge of the technician, lack of empathy and compassion, delay in appointments and absence of clinical support during dialysis is indicated to be few major concerns by many patients.
The report has been authored with the objective to help medical device manufacturers, dialysis chain owners and investors take better informed decisions while keeping voice-of-customer at the center of their strategy. While taking a deep-dive into the dialysis equipment and accessories market in India, the report indicates the need-gap of dialysis centers, infrastructure etc. across various city tiers in India.
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