The Future Of Enteral Nutrition: Key players, disease specific opportunities and market forecasts

Report Summary

Fuelled by an aging population and rising rates of illness, the clinical nutrition markets in the US, Canada and the EU continue to expand. Each of the five major product manufacturers are attempting to differentiate their offerings through the development of new products tailored specifically for certain patient groups. These products offer significantly greater nutritive benefits than more general products, offering manufacturers a means to establish leadership in these segments and capture share. Certain other companies, including start up enterprises, are also entering this market with unique new products.
This report analyzes the clinical nutrition market, identifying new product opportunities, and discusses how they will impact the market in the near and long term. The product development strategies of the leading manufacturers are analyzed and key opportunities are identified.

Key features of this report

• Examines the current products and uses for clinical nutrition
• Identifies and analyzes the most recent trends and issues in enteral nutrition
• Forecasts the market through 2014 for the US, Canada and EU as well as by major European country, including market share information and size/growth forecasts
• Discusses how different market segments will evolve over the next five years and why
• Explores the complexities of market trends and opportunities
• Profiles the major enteral nutrition companies and their growth strategies

Scope of this report

• Develop deeper insight into the size and growth of the enteral nutrition industry by utilizing the report’s unique market forecasts.
• Understand the key new product opportunities for this market in both the near and long term.
• Assess your organization’s position in the market and develop strategies to optimize this position.
• Anticipate future enteral nutrition market trends and make your decisions as effective and economical as possible by understanding the industry dynamics.
• Evaluate important trends in enteral nutrition.

Key Market Issues

• Demand for enteral nutrition products is rising as the populations of the US, Canada and the EU continue to age.
• The continued trend towards personalized medicine is manifesting in the clinical nutrition market via disease-specific products and increased research into nutrigenic products.
• As hospital stays continue to decrease and more patients make use of home healthcare, particularly in Europe, the home market will become an increasingly important segment for enteral nutrition.
• With high and rising rates of obesity, and diabetes many enteral nutrition companies are developing products for these individuals who require medical feeding.
• Malnutrition among newly admitted hospital patients remains high, creating a strong need for enteral nutrition products.

Key findings from this report

• Total sales of enteral nutrition products in the US, Canada and the EU reached $3.6bn in 2009. Of this, 41.2% was derived from US sales, while 3.2% was derived from Canada and the remaining 55.5% was obtained from the EU. Through 2014, total enteral nutrition product sales will rise by 7% per year to reach $5.1bn, reflecting continued downward pricing pressure. The greatest growth will occur in the EU, at 7.1% per year, followed by the US at 7% per year and Canada at 6.2% per year.
• Neuromuscular condition patients accounted for the greatest proportion of enteral nutrition sales in 2009, followed by cancer patients, nutritional depletion/malnutrition patients, surgery/burn patients, gastrointestinal disease patients, dialysis patients, immunotherapy patients and other patients.
• Although many enteral nutrition products may be considered multifunctional, in that they can be safely and effectively used in a wide variety of clinical situations, some newer products are being optimized for certain important disease states.
• In terms of new product opportunities in the near term, patient populations that are currently underserved include those suffering from obesity, diabetics, respiratory patients, seniors and persons with dysphagia. These groups also tend to have a life-long need for medical nutrition products, creating a significant market opportunity.

Key questions answered

• What will the enteral nutrition market size and growth be through to 2014 for the US, Canada and EU?
• Within the EU, how do enteral nutrition product sales vary by country and why?
• Which companies are current and future key players?
• What are the major new product opportunities in the near and long term?
• How do new product opportunities vary by disease and region?
• What factors will affect new product opportunities in the future?

Table of Contents

Executive summary 9
Introduction 9
Enteral nutrition in the US and Canada 10
Enteral nutrition in the EU 11
Opportunities in enteral nutrition 12

Chapter 1 Introduction 13
Summary 13
Introduction 14
Disease populations for enteral nutrition 15
Cancer patients 17
Enteral nutrition for cancer patients 19
Patients with neuromuscular conditions 20
Enteral nutrition for patients with neuromuscular conditions 21
Gastrointestinal disease patients 21
Enteral nutrition for GI disease patients 23
Malnutrition patients 24
Enteral nutrition for malnutrition patients 25
Other clinical nutrition patients 25
Alzheimer's disease sufferers 25
Anorexia nervosa patients 26
Burn patients 26
The critically ill 27
Dialysis patients 28
Immunotherapy/AIDS patients 28
Respiratory patients 30
Surgery and/or transplantation patients 30
Special populations for enteral nutrition 31
Diabetics 31
The obese 32
Seniors 32
Environments for enteral nutrition 32
Inpatient environments 33
Outpatient environments 34
Major types of enteral nutrition 35
Enteral vs. parenteral nutrition 35
Oral vs. tube feeding 36
Nasal intubation 36
Surgical insertion of feeding tubes 37
Products and ingredients 39
Related products 41
Market summary 44

Chapter 2 Enteral nutrition in the US and Canada 48
Summary 48
Introduction 49
Regulation 49
Insurance reimbursement 51
User populations 54
Enteral nutrition in the US 55
Key products and players 55
Sales and market share, 2009-2014 57
Sales by disease population 59
New product development 60
Opportunities 61
Near term (2010–2012) 61
Long term (2013–2014) 64
Enteral nutrition in Canada 65
Key products and players 66
Sales and market share, 2009-2014 67
Sales by disease population 68
New product development 69
Opportunities 70
Near term (2010–2012) 70
Long term (2013–2014) 70
Conclusions 71

Chapter 3 Enteral nutrition in the EU 72
Summary 72
Introduction 73
Regulation 73
Insurance reimbursement 73
User populations 74
Enteral nutrition in the EU 75
Key products and players 75
Sales and market share, 2009–2014 82
Germany 84
France 85
UK 86
Italy 88
Spain 89
Poland 90
Sales by disease population 91
Germany 92
France 94
UK 94
Italy 95
Spain 96
Poland 96
New product development 97
Opportunities 97
Near term (2010–2012) 97
Long term (2013–2014) 99
Conclusions 102

Chapter 4 Opportunities in enteral nutrition 103
Summary 103
Introduction 104
New products and other opportunities by disease population 104
Cancer 105
Critical illness 106
Diabetes 107
Dysphagia 108
Gastrointestinal disease 108
Liver failure 109
Kidney disease 109
Obesity 110
Respiratory conditions 110
Other conditions 111
Product development strategies of leading enteral nutrition players 111
Abbott Nutrition 112
B. Braun 113
Danone Baby and Medical Nutrition 114
Fresenius Kabi 115
Nestlé HealthCare Nutrition 116
Conclusions 117
Appendix 118
Scope 118
Methodology 118
Abbreviations 118

List of Figures

Figure 1: Key nutritive needs by condition 16
Figure 2: Enteral nutrition patients (‘000) in the US, Canada and the EU, 2009–2014 44
Figure 3: Sales of enteral nutrition products ($m) in the US, Canada and the EU, 45
Figure 4: Sales of enteral nutrition products ($m) in the US, Canada and the EU by disease population, 2009 - 2014 46
Figure 5: Sales of enteral nutrition products ($m) in the US, Canada and the EU by major manufacturer, 2009 47
Figure 6: Number of enteral nutrition patients (‘000) in the US and Canada, 2009 - 2014 54
Figure 7: Total US enteral nutrition market ($m), 2009-2014 58
Figure 8: Leading US enteral nutrition players, 2009 59
Figure 9: US enteral nutrition market ($m) by disease population, 2009-2014 60
Figure 10: Total Canadian enteral nutrition market ($m), 2009-2014 67
Figure 11: Leading Canadian enteral nutrition players, 2009 68
Figure 12: Canadian enteral nutrition market ($m) by disease population, 2009-2014 69
Figure 13: Number of EU enteral nutrition patients (‘000), 2009-2014 74
Figure 14: EU country potential for enteral nutrition, 2010 80
Figure 15: Malnutrition in the EU by country, 2010 81
Figure 16: Total EU enteral nutrition market ($m), 2009-2014 82
Figure 17: Leading EU enteral nutrition players, 2009 84
Figure 18: German enteral nutrition market and patients, 2009-2014 85
Figure 19: French enteral nutrition market and patients, 2009-2014 86
Figure 20: UK enteral nutrition market and patients, 2009-2014 87
Figure 21: Italian enteral nutrition market and patients, 2009-2014 89
Figure 22: Spanish enteral nutrition market and patients, 2009-2014 90
Figure 23: Polish enteral nutrition market and patients, 2009-2014 91
Figure 24: EU enteral nutrition market ($m) by disease population, 2009-2014 92
Figure 25: EU hospital stays vs. home care patients, 1990-2010 100
Figure 26: Enteral nutrition opportunities by disease population, 2010 105
Figure 27: Strategy and product development activities of leading enteral nutrition product manufacturers, 2010 112

List of Tables

Table 1: Inpatient care facilities in the US, Canada and the EU, 2009 33
Table 2: Advantages and disadvantages of feeding routes and types 39
Table 3: Disease specific enteral nutrition products 43
Table 4: US FDA definition of medical food 51
Table 4: US Medicare reimbursement for enteral nutrition products, 2009 53
Table 5: Leading US enteral nutrition products, 2010 56
Table 6: Leading US enteral nutrition products, 2010 (ctd1) 57
Table 7: Leading Canadian enteral nutrition products, 2010 66
Table 8: Leading EU enteral nutrition products, 2010 76
Table 9: Demographic data for EU member countries 2006 78
Table 10: Healthcare data for EU member countries 2006 79