Womens health management, surgical procedures, techniques and key trends in Asia Pacific 2011

CHRISTIAN MOERSHEIM th 25 June 2011

A highly heterogeneous region, Asia is one of the most exciting and challenging markets, even more so for medical products and services. Beyond price affordability issues, logistical challenges, and the regulatory labyrinths, many parts of Asia are also plagued by cultural barriers, especially for womens health management in a highly paternalistic society. Clearstate, investigated into some of the top surgical and treatment procedures across various Asian countries to uncover the trends and key differences across Asia. The chart below illustrates our results specifically for procedures involving womens health management particularly for the treatment of urinary incontinence and pelvic prolapses.
Fig. 1. Surgical procedures for Women's Health in Asia (2010)

100% 90%
36,175 24,496 0 12,628 12,628

1024 1,560 2,624 1,321 2,624 32,406 3,484 7,216 37,748 32,754 5,882 437 1,644 334 60 9,761 3,635 11,205 27,322

% of procedure volume

80% 70% 60% 50% 40% 30% 20% 10% 0%

China
Suprapubic Sling Operation

India

Indonesia

Malaysia

S. Korea

Suspension procedures Other Repair Of Urinary Stress Incontinence

Injection Of Implant Into Urethra And/Or Bladder Neck Repair procedures for Cystocele and Rectocele

Source: Clearstate

Suspension and cystocele/rectocele repair procedures take up by far the greatest percentage of surgeries done as compared to the other surgeries in China, India and South Korea. These surgeries are often used to treat vaginal prolapse involving risk factors such as by multiple child births, menopause, or hysterectomy.

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It is visible that China has more repair and suspension procedures compared to India, however the female population in India should have a higher incident rate than in China due to the much higher child birth rates, especially with Chinas one-child-policy over the past decades. It is highly possible that a majority of Indian women suffering from the condition either do not seek treatment or lack access to treatment for vaginal collapse.

The proportion of procedures is however insufficient to draw any conclusion. A further analysis illustrated by the following chart assesses the procedure volume vs. total women population in each country, a compounded indicator of possibly, disease incidence, diagnosis efficiency, and access to medical facilities and treatment.
Procedure volumes as a percentage of total female population
Fig. 2. Surgical procedures index for Women's Health in Asia (2010)
1.E-03 1.E-03 8.E-04 6.E-04 4.E-04 2.E-04 0.E+00 0
Suprapubic Sling Operation Injection Of Implant Into Urethra And/Or Bladder Neck Repair procedures for Cystocele and Rectocele

4
Suspension procedures

Other Repair Of Urinary Stress Incontinence

Note:

Surgical procedure index took into account the total procedure volume vs. an estimate of the addressable female population in the countries by age.

Source: Clearstate

An initial assessment of the procedure volumes index led us to believe that South Korea, could potentially have a much higher incidence of prolapses and urinary incontinence. However, verification with key opinion leaders in the countries noted that disease incidences for womens health issues though not well documented, are unlikely to be very different due to similar ethnographic, genetic, and perhaps even lifestyle habits. This is particularly seen between China and South Korea. However, largely due to the embarrassment of their condition compounded by the lack of awareness, especially in rural areas, the diseases and conditions are often diagnosed only in the late stages.

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Fig. 3.

Symptom map: Severity vs. acuteness

The acuteness and severity of the conditions also affects the patients decisions to take action on seeking help or treatment, leading many illinformed patients to accept their condition as a norm of aging. Fig. 3. Illustrates the various varying symptoms of pelvic prolapse and urinary incontinence. Perhaps understanding the way sufferers behave and their pathway to seek diagnosis and treatment could be a key to reach out to greater population.

Key issues and challenges in administration of the appropriate treatment A major issue in large countries like India, China, and in less developed countries such as Indonesia is the accessibility to hospitals that can offer the appropriate treatment in rural areas. The lack of facilities and trained doctors in rural areas often mean that people have to travel long distances to the major cities of the country to get the appropriate treatment, likely a major financial investment and burden to the rural families. Beyond just a rural problem, a large proportion of India, China, and Indonesias population still live in poverty or below the middle class income level and hence cannot afford the appropriate treatment even if they are aware of it. In order to make such treatments more affordable to the masses reimbursement for underprivileged people might be a key driving factor. Effective diagnosis and treatments in the early stages of disorders such as pelvic prolapses might ultimately be more cost effective than subsidising high surgical procedure costs for late stage prolapses. The lack of awareness and education the general public has about personal health management in Asia is compounded by the cultural issues with women being shy or embarrassed about their complications in a paternalistic society that also views aging as a process plagued by various degenerative conditions as a norm. In order to overcome this challenge, community driven education programs about the illnesses and its treatment could be done to reach out to women so that they can become aware of the symptoms and to men as well so that they become more accepting and encouraging when faced with the situation. In order to reach out to the masses, local communities, government, and the medical institutions will have to work together, whilst attempting to protect their own interests, by prioritizing and overcoming the challenges ahead of time.

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