Nonionic conversion varies in Asia depending on national conditions

Physicians are eager for latest technology

Just as most radiologists and other clinicians in developing marketsprefer the latest in scanner technology, they are also eager forthe safety and performance advantages of nonionic radiographiccontrast media. But conversion from ionic to nonionic agents innational markets is driven by a range of factors in addition toclinical preference, not the least of which is reimbursement.

Nonionic conversion rates in the Asian region vary widely,from 5% or lower to around 70%, according to Johannes Weid, groupproduct manager for diagnostics in Asia for Schering A.G. of Germany.

At the top of the conversion list are the developed marketsof Japan and South Korea. Surprisingly, however, economicallywell-to-do Taiwan has one of the lowest conversion rates in theregion, he said.

"Most of the reasons for low conversion are related toa lack of reimbursement," Weid told SCAN. "The professionalradiology societies are well aware of the (nonionic) product andits high standards."

Schering sells both ionic and nonionic contrast agents. Demandfor ionics is expected to remain a factor in the market for sometime, he said.

"The ionics will have a certain marketplace even beyond2000," Weid said. "It will differ in various countries.Even in the U.S., which had a boom in nonionics during the mid-1980s, there has been some reconversion back to ionics again."

Of course, contrast use in general has to be developed in amarket before talk of conversion to nonionics has any meaning.Use of contrast agents follows the spread of high-technology imagingequipment. For instance, in Indonesia, a country with nearly 200million people, general contrast usage is very low, he said.

"I am not sure why that is," Weid said. "Itmight be due to the fact that the people are separated by islands,with technology concentrated in the big islands. Whatever thereason, there is no relationship there of population (size) tocontrast media use."

Worldwide, contrast use is growing at a double-digit rate becauseof the rapidly expanding base of capital equipment such as CT,digital subtraction angiography and cath labs, he said.

Schering's largest contrast product in the Asian region isits nonionic agent Ultravist. The vendor is also experiencinggrowth in demand for its MRI agent Magnevist, he said.

"The conversion to use of contrast media in MRI is quitehealthy in this (Asian) market," he said. "In some countries,it is very close to what we see in the U.S. on a percentage basis."

While Ultravist and Magnevist are both available for sale inmost markets, Schering's ultrasound agent Echovist is still movingthrough the regulatory process. Once this agent is approved, prospectsare high, given the strong use of ultrasound in the region.

China offers the largest market potential for contrast sales,although distribution remains a difficulty, Weid said. It is notyet possible, as in the U.S., to make use of overnight deliveriesof agents from central locations.

While scanner vendors are finding it easier to deal directlywith hospital purchasers in China, contrast agents continue toflow through multiple government channels, he said. Eventually,this is bound to change as the country develops.

"Sooner or later, they will have distribution as we knowit from wholesalers and pharmacies," he said.

Schering sells in China from a Hong Kong-based marketing company,but is preparing to enter the market in a bigger way. The pharmaceuticalcompany has a Canton-based joint- venture factory under development,which may begin contrast manufacturing next year.