Injectable Cosmetic Treatments

injectable cosmetic treatments syringe

The two most popular types of minimally-invasive cosmetic treatments in the United States are botulinum toxin type A and soft tissue filler injections. Both are used to temporarily reduce or eliminate wrinkles. Botulinum toxin type A — commonly known as Botox, but other brand names include Dysport and Xeomin — is a neurotoxin derived from bacteria. It blocks nerve signals to the muscle in which it’s injected. The muscle is unable to contract thereby eliminating wrinkles. It’s most commonly used to smooth frown lines, forehead creases, and crows feet. Soft tissue fillers, also known as dermal fillers, are gel-like substances injected under the skin to smooth out wrinkles. They’re also used to enhance lips and improve symmetry among facial features. The U.S. Food and Drug Administration has approved several types of fillers: hyaluronic acid, calcium hydroxylapatite, poly-l-lactic acid, and polymethylmethacrylate. Hyaluronic acid and calcium hydroxylapatite are naturally found in skin and bones, respectively. Poly-l-lactic acid and polymethylmethacrylate are synthetic, biocompatible substances. Some brand names include Juvéderm, Radiesse, Sculptura, and Bellafill.

Today’s market size shows the amount spent on injectable cosmetic treatments in 2016 and forecast for 2025 worldwide. In the United States, more than 10 million injectable cosmetic treatments were performed in 2018. Botulinum toxin type A procedures were the most popular; 7.4 million were performed, up 5.4% from 2016. Nearly 2.7 million soft tissue filler procedures were performed in 2018, a 2.9% increase from 2016. While women still comprise the vast majority of patients, globally an estimated 15% of injectable cosmetic treatments are performed on men.

Geographic reference: World
Year: 2016 and 2025
Market size: $6.5 billion and $17.2 billion, respectively
Sources: “Facial Injectables Market Analysis by Product (Collagen, Hyaluronic Acid, Botulinum Toxin Type A, Calcium Hydroxylapatite, Polymer Fillers), by Application (Aesthetics, Therapeutics), by Region, and Segment Forecasts, 2018 – 2025,” Grand View Research Press Release, May 2017 available online here; “Global Facial Injectables Market Size Worth $17.2 Billion By 2025,” Grand View Research Press Release, May 2017 available online here; 2018 National Plastic Surgery Statistics, American Society of Plastic Surgeons, March 2019 available online here; 2017 Plastic Surgery Statistics Report, American Society of Plastic Surgeons, 2018 available online here; “What Is Botulinum Toxin Type A?” American Society of Plastic Surgeons available online here; “Hold Still,” The Economist, February 9, 2019, page 22; “Injectable Fillers Guide,” American Board of Cosmetic Surgery available online here.
Image source: qimono, “syringe-shot-medicine-bottle-1884758,” Pixabay, December 6, 2016 available online here.

Radiopharmaceuticals

radiopharmaceuticals technetium injection

Radiopharmaceuticals are medicinal products containing radioactive isotopes. Radiopharmaceuticals can be swallowed, injected or inhaled and are selected based on the type of tissue or organ that will be scanned or treated. In the manufacturing process, radioactive isotopes and organic molecules bond. It is the organic molecules that transport the radioisotopes to specific tissue or organs. Of the more than 10 million nuclear medicine procedures performed in the United States every year, 85% use the radioisotope technetium-99m.

For diagnostics, after the radiopharmaceutical is administered, the patient’s tissue or organ is scanned using a SPECT or PET scanner,1 allowing the doctor to detect changes at the cellular level. Radiopharmaceuticals are helpful in diagnosing various diseases of the blood vessels, bones, brain, kidney and liver as well as detecting heart disease, heart muscle damage and cancer.

Radioisotopes for diagnosis emit radiation that can be detected outside the body by scanners. Radioisotopes for treatment emit all their energy in a small area; therefore, they’re used for localized destruction of cancer cells. They are also used to treat hyperthyroidism and pain as a result of bone cancer and severe arthritis.

Today’s market size shows the amount spent on radiopharmaceuticals globally in 2018 and forecast for 2023. More than 100 radiopharmaceuticals have been developed using radioisotopes produced by nuclear research reactors or cyclotrons. As of the end of 2018, fifty FDA-approved radiopharmaceuticals were used for the diagnosis and treatment of medical ailments in the United States. GE Healthcare, Curium, Lantheus Medical Imaging, DRAXIMAGE, and Pharmalucence are 5 of the 18 manufacturers of these approved products.2

1 SPECT stands for single photon emission computed tomography. PET stands for positron emission tomography. Often these scans are combined with CT or MRI scans to provide more detailed images.
2 Top 5 based on the number of different FDA-approved radiopharmaceuticals the company manufactures.

Geographic reference: World
Year: 2018 and 2023
Market size: $3.95 billion and $5.26 billion, respectively
Sources: “Radiopharmaceuticals/Nuclear Medicine Market by Type (Diagnostic (SPECT (Technetium), PET (F-18)), Therapeutic (Beta Emitters (I-131), Alpha Emitters, Brachytherapy(Y-90))), Application (Oncology, Thyroid, Cardiology) – Global Forecasts to 2023,” MarketsandMarkets Press Release, Accessed February 18, 2019 available online here; “FDA-Approved Radiopharmaceuticals,” Cardinal Health, December 28, 2018 available online here; Phillippe van Put, “What Is Nuclear Medicine?” available online here; “Radiopharmaceutical (Oral Route),” Mayo Clinic available online here; “Radiopharmaceutical Production,” International Atomic Energy Agency available online here; “Nuclear Medicine,” National Institute of Biomedical Imaging and Bioengineering, July 2016 available online here; Haley Hansen, “Niowave Enters $4 Billion Medical Isotope Market,” Lansing State Journal, February 18, 2019, pages 1A and 4A; Dr. Craig Hacking and Dr. Ayush Goel, et. al., “SPECT vs. PET,” Radiopaedia available online here.
Image source: Bionerd [CC BY-SA 3.0], via Wikimedia Commons. No alterations were made to image.

Medical Marketing

Does it seem like you’re seeing more ads for prescription medications and medical services? You’re not imagining it. In 2016, the last year for which data were available, pharmaceutical companies alone bought 4.6 million direct-to-consumer ads, up from 79,000 ads in 1997. Spending increased nearly six-fold, from $1.3 billion to $6.0 billion during this time period. Total medical services advertising expenditures grew at a similar rate, led by cancer centers, mental health and addiction services, and cosmetic surgery services.

According to PhRMA, the largest pharmaceutical trade group in the U.S., direct-to-consumer advertising provides “scientifically accurate information to patients so that they are better informed about their health care and treatment options.”1 Around half of the consumers in a 2015 analysis by the U.S. Food and Drug Administration believed these ads did not contain enough information about the medications’ risks and benefits to be of use. That year, the American Medical Association (AMA) called for a ban on pharmaceutical and medical device advertising, saying that ads such as these encourage consumers to seek out more expensive treatments when less expensive, more appropriate, effective alternatives may be available. In addition, the AMA was concerned that increased spending on advertising led to higher prescription drug prices. Banning such advertising would not be easy, even if Federal lawmakers agreed that such a ban should take place. Several court cases throughout the years determined that this type of advertising is protected by the United States Constitution.

Today’s market sizes show total medical marketing spending and spending on a subset of that, direct-to-consumer advertising, in 1997 and 2016. Medical marketing includes advertising of prescription drugs, health services, and laboratory testing. It also includes disease awareness campaigns. Marketing to health care professionals by pharmaceutical companies accounted for most of the spending during this time period. However, as a percentage of total spending, this has been dropping. In 1997, 88.1% of medical marketing dollars were spent on free samples, direct physician payments for such things as speaking engagements and meals, and prescriber detailing, in which pharmaceutical sales representatives educate physicians about their products. In 2016, 67.9% of marketing dollars were spent this way. Direct-to-consumer marketing comprised the balance.

1 PhRMA spokesperson Tina Stow. Source: Susan Kelly, “U.S. Doctor Group Calls for Ban on Drug Advertising to Consumers,” Reuters, November 17, 2015, available online here

Geographic reference: United States
Year: 1997 and 2016
Market size: (Total) $17.7 billion and $29.9 billion, respectively
Market size: (Direct-to-consumer advertising) $2.1 billion and $9.6 billion, respectively
Sources: Lisa M. Schwartz, MD, MS and Steven Woloshin, MD, MS, “Medical Marketing in the United States, 1997-2016,” JAMA, Special Communication, January 1-8, 2019 available online here; Susan Kelly, “U.S. Doctor Group Calls for Ban on Drug Advertising to Consumers,” Reuters, November 17, 2015, available online here; Alison Kanski, “7 Things to Know from Dartmouth’s Medical Marketing Study,” MM&M, January 14, 2019 available online here; Margaret Rouse, “Pharmaceutical Detailing,” TechTarget, February 2011 available online here.
Image source: Martin Brosy, “Doctor with a Stethoscope,” Unsplash, July 30, 2018 available online here.

Pharmacy Benefit Managers

The cost of prescription drugs in the United States is a subject about which there is much controversy. As the Affordable Care Act—or, Obamacare—gets off to a rocky start across the nation, we decided to look at just one small part of the prescription drug distribution network, about which most people are not particularly conscious. That is the segment made up of Pharmacy Benefit Managers (PBMs), middlemen who stand in a central position in the prescription drug supply chain and who, it turns out, have carved out for themselves a rather lucrative business. The three largest PBMs—Express Scripts, CVS Caremark, and OptumRx—together control about 70% of all prescriptions filled in the United States.

PBMs are firms that provide an administrative service to insurance companies, large self-insured employers, and government benefit providers. They develop and maintain drug formularies—lists of specific drugs to be covered and the prices for each—for their insurance providing customers. They also negotiate with pharmaceutical companies for preferred pricing on the drugs covered in those formularies and they negotiate with retailers to accept those terms and participate in the PBM’s network of preferred pharmacies.

According to an article in Fortune magazine, “PBMs started as paper pushers: They began hand-processing medical claims in the 1970s and evolved into middlemen who touted their ability to use corporate customers’ combined purchasing power to negotiate huge discounts from pharmaceutical companies. Today the top PBMs are as big as or bigger than their clients.” The United States has a unique health care delivery system, one which is significantly fuller of lucrative middleman-businesses than the systems present in other industrialized nations.

Today’s market size is the total estimated revenue earned by Pharmacy Benefit Managers in the United States in 2012.

Geographic reference: United States
Year: 2012
Market size: $250 billion
Source: Katherine Eban, “Painful Prescription,” Fortune, October 28, 2013, pages 202-207.
Original source: J.P. Morgan analysts
Posted on November 4, 2013

The Sleep Business

In 2012, approximately three-fourths of internet users searched online for health information. Half of them searched specifically for sleep remedies. According to the National Sleep Foundation, only 56% of Americans report getting a “good night’s sleep” on a typical night. Some sleep studies have found a link between insufficient sleep and hypertension, depression, diabetes, and other illnesses. Spending related to sleep has increased 8.8% yearly since 2008. Spending on over-the-counter sleep aids increased 31% from 2006 to 2011, with the biggest increase being spending on natural and homeopathic products.

Today’s market size is the estimated amount spent in the United States, in 2012, on things designed to aid sleep, from pills and medical devices to sleep consultants who work with hospitals and deluxe mattresses made with tension-relieving foams.

Wishing all our readers a sound night’s sleep!

Geographic reference: United States
Year: 2012
Market size: $32 billion
Source: Kit Yarrow, “The Sleep Industry: Why We’re Paying Big Bucks for Something That’s Free,” Time, January 28, 2013, available online here.
Posted on March 1, 2013

Cuban Imports

On the whole the United States has been a supporter and booster of free trade and globalization since the end of the second World War and with increased energy since the 1990s. Yet with one neighboring country, Cuba, trade relations have been unusual. The frictions in trade between the United States and Cuba date back to the 1950s and the Cuban Revolution, followed by a forty-year trade embargo imposed by the United States. In 2000, President Clinton signed the Trade Sanctions Reform and Export Enhancement Act which opened the door for some restrictive trade with Cuba, specifically, U.S. exports of farm and forestry products and some medicines. The act did not open the door for any imports from Cuba.

Today’s market size is the total value of products exported from the United States to Cuba in 2000, 2008, and 2011. The drop in exports from 2008 to 2011 is largely the result of the fact that under the restrictions imposed on this trade, Cuba is required to pay in advance for all U.S. imports in cash, something that became much harder as the financial crisis of 2008 took hold. By way of placing this level of international trade into perspective, according to CIA estimates, Cuba’s imports in 2011, from all over the world, totaled $14 billion.

Geographic reference: United States and Cuba
Year: 2000, 2008, 2011
Market size: $1.3, $711.5, and $363.3 million
Source: “2011 Exports of NAICS Total All Merchandise,” and interactive, online data resource published by the International Trade Administration and available online here. “The World Factbook,” entry on Cuba, published by the U.S. Central Intelligence Agency and make available online here.
Original source: ITA (U.S. Department of Commerce, International Trade Administration) and the CIA
Posted on January 11, 2013

Bioinformatics

Over the last decade bioinformatics has been characterized by the mapping of many genomes. This has fueled explosive growth in the field generally, growth which is anticipated to continue into the future.

Bioinformatics, in the most basic sense, is the application of information technology to the life sciences to increase the understanding of biological and chemical processes. It is the study of the methods for storing, retrieving and analyzing biological data, a wealth of which is growing rapidly and thus feeding demand for more bioinformatics. Fields that benefit from the output of bioinformatics are many, including especially agricultural biotechnology, pharmaceutical research and development, and medical and clinical diagnostics.

Today’s market size is the estimated value of this hybrid industry in 2012 and a projected value for 2018.

Geographic reference: World
Year: 2012 and 2018
Market size: $2.3 billion and $9.1 billion respectively
Source: “Global Bioinformatics Market is Expected to Reach USD 9.1 Billion in 2018: Transparency Market Research,” The Herald, November 28, 2012, a link to which is here.
Original source: Transparency Market Research, whose study on this industry may be purchased on their website here.
Posted on November 28, 2012

Growing Market for Epinephrine

Anyone with a child in school these days is likely to be very aware of the growing concerns related to food allergies. In many elementary schools in the United States, special tables in the lunch room are set aside for children whose lunches contain any nuts, like the traditional peanut butter and jelly sandwich. In some schools, foods containing nuts of any kind are banned entirely. This is because of a rising number of children who suffer from food allergies, particularly nut allergies, and the rising severity of their allergic reactions.

Nut allergies have been the fastest growing food allergies in recent years. In 1997, approximately 278,000 children under the age of 18 in the United States (0.04% of the age group) suffered from an allergy to peanuts. In 2008, that number had risen to over a million (1.5% of children in the age group).

Today’s market size is the estimated number of children (under the age of 18 years) in the United States who suffer severe food allergies. It is a calculation based on a study that showed that one in thirteen children suffer food allergies and that nearly 40 percent of those children suffer severe allergic reactions, severe enough to require the use of a drug like epinephrine to combat the reaction and save their lives.

Geographic reference: United States
Year: 2010
Market size: 2.28 million
Source: Katie Thomas, “Tiny Lifesavers for a Growing Worry,” The New York Times, September 8, 2012, page B1. Population data used to calculate today’s market size are from “Table 1. Population by Sex and Selected Age Groups: 2000 and 2010,” Age and Sex Composition: 2010, May 2011, one of the Census Bureau’s reports on the 2010 Census of the United States, available here.
Original source: A study published in the journal Pediatrics and referenced in the source article listed above.
Posted on September 12, 2012

Pharmacy & Drug Stores

Drug Retailing

The sale of drugs, whether over-the-counter or prescription drugs, has been a healthy, growing business for a long time in the United States. The sale of these products through pharmacies and drug stores is the subject of our post today. The graph presents sales of these retailers over the period 1992–2010. The annual growth rate in sales over this period was 10.3%, a third faster than the economy as a whole, which grew at 7.2% annually.

Worth noting is the fact that over this same time period, the number of retail outlets selling drugs has increased as Big Box stores, grocery stores and others have gotten into the business of selling drugs with enthusiasm. Consequently, the role of pharmacies and drug stores in total drug sales has actually declined over this period.

Geographic reference: United States
Year: 2000 and 2010
Market size: $130.87 billion and $222.26 billion respectively
Source: Annual Retail Trade Survey 2009, and updates from the Monthly Retail Trade Reports from the same reporting series, U.S. Census Bureau, available online here.
Original source: U.S. Department of Commerce, Bureau of the Census
Posted on April 4, 2012

DTC Drug Advertising

Ad Spending

Direct-to-consumer (DTC) advertising of prescription drugs is a big business in the United States, as it is in New Zealand, the only other country in which this activity is legal. Anyone who watches TV for more than an hour or two a week will be more than familiar with the sorts of ads we are talking about, those that invariably end with an ominous list of potential side effects of the very drugs being pushed.

Until the late 1990s this advertising was quite limited by FDA regulations but in 1997 the FDA announced changes to those regulations (implemented in 1999) that freed up the pharmaceutical industry to start producing stylish ad campaigns for its most popular prescription drugs. The industry took full advantage, as the graph above clearly shows. Industry analysts suggest that the slowdown in spending starting in 2007 had more to do with the expiration of important brand name drugs (and their replacement with generics for which such spending is not done) than with the beginning of the recession.

Today’s market size is the amount spent by pharmaceutical companies on DTC prescription drug advertising in 2008.

Geographic reference: United States
Year: 2008
Market size: $4.57 billion
Source: For the data from 1989 through 2001: Francis B. Palumbo and C. Daniel Mullins, “The Development of Direct-to-Consumer Prescription Drug Advertising Regulations, Food and Drug Law Journal, Volume 57, Number 2, 2002. For the data from 2002 through 2005: Donahue Ph.D., Julie M., Marisa Cevasco, B.A. and Meredith B. Rosenthan, Ph.D., “A Decade of Direct-to-Consumer Advertising of Prescription Drugs,” The New England Journal of Medicine, August 16, 2007. For data from 2006 through 2008 the data are from Nielsen Media press releases.
Posted on January 20, 2012

Medical Marijuana

As of March 2011 there were laws in seven U.S. states that made it legal to sell and use marijuana for medicinal purposes. Those states were California, Colorado, Michigan, Montana, New Mexico, Oregon, and Washington. Four additional states and the District of Columbia are scheduled to open markets for medical marijuana before the end of 2011: Arizona, Maine, New Jersey and Rhode Island. The laws regulating the sale and use of marijuana in these states vary widely which makes tracking the market a complicated task. But as a fast growing market the motivation to track it is present and the task is made easier by the fact that marijuana is a highly regulated commodity and is therefore tracked carefully by most of the states in which its use for medical purposes is legal.

Today’s market size is the estimated value of marijuana sold legally in the United States. As a point of comparison, and according to the source, the sale of Viagra in the United States in 2010 was valued at $1.93 billion.

Geographic reference: Select states within the United States
Year: 2011
Market size: $1.7 billion
Source: Wayne Heilman, “Report: Medical Marijuana Sales to Reach $1.7B This Year,” The Gazette, Colorado Springs, March 24, 2011, available online here.
Original source: See Change Strategy and Medical Marijuana Markets

Drug Company R&D

The market size presented here is an estimate of the dollars spent by the pharmaceutical industry on research and development in 2009. This is a thorny and complex subject—what costs are included in R&D and how do pharmaceutical companies decide what to spend on developing new drugs and to modify old ones. For anyone interested in the subject beyond this quick snapshot, we recommend a report titled “Research and Development in the Pharmaceutical Industry,” published in 2006 by the Congressional Budget Office, and available online here.

Geographic reference: World
Year: 2009
Market size: $45.8 billion
Source: “New Federal Research Center Will Help Develop Medicines,” The New York Times, January 23, 2011, page 1.
Original source: Industry estimate

Allergy Treatments

The size of the market for drugs to treat allergies has fallen during the first decade of the 2000s. The likely reason for this decline in the value of sales is not a decline in the number of people suffering from allergies, rather it has to do with the fact that generic drugs have come onto the scene to compete with the leading name brand drugs. This was possible because the patents on several of those name brand drugs expired in the middle of the decade.

Geographic reference: United States
Year: 2003 and 2007
Market size: $7.5 billion and $5.1 billion respectively
Source: Medical Marketing & Media, May 2008, page 64.
Original source: IMS Health

Antipsychotic Drug Market

Just two decades ago antipsychotic drugs were a minor part of the overall pharmaceutical business. Today, according to The New York Times article from which this market size was taken, antipsychotics lead all other drug classes in term of revenue generated. One’s first thought upon reading this may be that we must be getting way more psychotic but it turns out that these strong drugs are now prescribed for a much broader range of ills.

The top-selling brand of this drug category is Seroquel, produced by AstraZeneca. Other leading brands include Abilify, Geoden, Leponex, Risperdal and Zyprexa. Some of these drug names may be familiar to you even though they are prescription drugs and even though you may never have used one. That has to do with direct-to-consumer advertising (DTC advertising) which was made legal in the United States in 1997. Since then, we have all become far more educated about brand name prescription drugs. Interestingly, only one other nation in the world (New Zealand) allows the direct-to-consumer advertising of prescription drugs.

Geographic reference: United States
Year: 2009
Market size: $14.6 billion
Source: The New York Times, October 3, 2010, page B1.

Compounding Pharmacies in the United States

Data show the number of compounding pharmacies in the United States in 2010. Compounding pharmacists mix raw ingredients to prepare customized medications to meet the specific needs of patients. Between 1 and 5 percent of the population needs medications that are not commercially available. For example, compounding pharmacies can prepare gluten-free and lactose-free medications, specialized hormone therapy, or specialized doses of pain medication. Of the 400 compounding pharmacies in the United States, only 76 are nationally accredited by the Pharmacy Compounding Accreditation Board.

Geographic reference: United States
Year: 2010
Market size: 400
Source: Rebecca Jones, “Custom Cures,” Wayne State, Spring 2010, page 14. The publication is accessible online here.