CRO Market in Singapore

P4E3-52 March 2011

Disclaimer

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Certification

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Table of Contents
Executive Summary Market Overview Regulatory Environment Clinical Trials in Singapore Clinical Trial Types Clinical Trials by Therapeutic Areas Market Engineering Measurements Market Engineering Measurements Market Analysis Market Drivers Market Restraints Revenue Forecasts Clinical Trial Revenue Contribution by Phase Private Sector Sponsors of Clinical Trials Research and Development Trends in Singapore Competitive Analysis Competitive Structure Decision Support Databases About Frost and Sullivan 7 10 11 12 13 14 15 16 17 18 21 23 25 26 27 28 29 30 37

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List of Figures
CRO Market: Number of Clinical Trial Certificates Issued by the HSA (Singapore), 2000-2009 CRO Market: Market Drivers Ranked in Order of Impact (Singapore), 2010-2015 CRO Market: Market Restraints Ranked in Order of Impact (Singapore), 2010-2015 CRO Market: Revenue Forecasts (Singapore), 2009-2015 CRO Market: Competitive Structure (Singapore), 2009 Decision Support Database: Government Healthcare Expenditure (World), 2002-2012 Decision Support Database: Population Aged 65 and Above (World), 2002-2012 12 18 21 23 29 31 34

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List of Charts
CRO Market: Overview of Regulatory Agencies for Clinical Trials (Singapore), 2009 CRO Market: Types of Clinical Trials Conducted (Singapore), 2008 and 2009 CRO Market: Types of Clinical Trials Conducted by Therapeutic Areas (Singapore), 2007-2009 CRO Market: Market Engineering Measurements (Singapore), 2009 CRO Market: Revenue Forecasts (Singapore), 2009-2015 CRO Market: Clinical Trial Revenue Contribution by Phase (Singapore), 2009-2015 CRO Market: Private Sector Clinical Trial Sponsors by Type (Singapore), 2009, 2012, and 2015 CRO Market: Total R&D Expenditure on Biomedical and Related Sciences (Singapore), 2009-2015 11 13 14 16 24 25 26 27

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Executive Summary

Executive Summary
Market Trends The number of clinical trials conducted in Singapore has increased from 157 in 2000 to 262 in 2009, registering a compound annual growth rate (CAGR) of 5.9 percent. International trials comprise more than 80.0 percent of trials and are likely to continue to make up the majority in the future. There is a growing trend towards regional trials as Japanese regulations allow data from other countries to be accepted for drug launches in Japan. Currently, local trials comprise less than 10.0 percent of the total trials and offer limited growth potential as local pharmaceutical companies face challenges in raising funds. Oncology holds the highest interest for multinational pharmaceutical companies, with clinical pharmacology as the next highest; ophthalmology is also of growing interest. The size of the Singapore clinical trials market (phase I to phase IV) is estimated at US$128.4 million in 2009 and is forecasted to reach US$ 166.5 million in 2015, growing at a CAGR of 4.4% Currently, phases II, III, and IV contribute maximum revenues to the market, but by 2015, phases III and IV are expected to shrink. However, government initiatives for early phase trials are expected to increase the revenues of phase I, along with that of phase II. There is a fairly strong interest in biomarkers research, and Singapore will continue to see strong activity in this area due to companies making significant investments in the same. As a result, there is likely to be an increase in the number of clinical trials that incorporate biomarkers research.
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Executive Summary (Contd)

Growth Segments

Singapores advanced infrastructure and investment from multinational pharmaceutical companies have made it conducive for trials, including early stage trials. From the regulatory perspective, there is likely to be an increased number of applications for trials that use flexible study designs to reduce time and costs of conducting clinical research.

Growth Opportunities

With Pfizer expanding its phase I unit in Singapore, there is an opportunity for the country to attract to similar studies in the country. In tandem with this, abbreviated non-clinical packages (for example, fewer animal studies and shorter duration pre-clinical studies) will become more visible. A growing emphasis on translational research within pharmaceutical R&D will help Singapore due to the Governments $1.10 billion investments in building the countrys translational and clinical research capabilities.

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Market Overview

10

Regulatory Environment
Clinical trial regulation is regulated by: The Medicines Act 1975 Medicines (Clinical Trials) (Amendment) Regulations 1998. Singapore Guideline for Good Clinical Practice (SGGCP) require to be observed.

CRO Market: Overview of Regulatory Agencies for Clinical Trials (Singapore), 2009
Health Sciences Authority
Protects and advances national health and safety National regulator for health products Administers clinical trials for new drugs; issues clinical trial certificates and pre-marketing product approvals

Guidelines fall within the broad framework of the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). For technical guidelines not covered by the ICH, reference is taken from the Food & Drug Administration (FDA) and European Agency for the Evaluation of Medicinal Products (EMEA). Regulatory approval is issued by the Health Products regulation Group (HPRG) and Health Sciences Authority (HSA) in the form of Clinical Trial Certificates (CTC). Pre-clinical studies do not require to be registered with the HSA. However, they are reviewed for adherence to ICH safety requirements prior to approval of a clinical trial.

Health Promotion Board

Main driver for national health promotion and disease prevention programs

Singapore Bioethics Advisory Committee

Addresses ethical, legal, and social issues arising from biomedical sciences research

Genetic Modification Advisory Committee

Oversees and provides advice on R&D and the use and handling of genetically modified organisms
Source: Singapore Ministry of Health

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Clinical Trials in Singapore

CRO Market: Number of Clinical Trials Certificates Issued by the HSA (Singapore), 2000-2009
Phase I II III IV Total Trials/Year Private Sector Public Sector 2000 21 44 63 29 157 126 31 2001 19 50 68 28 165 132 33 2002 20 52 97 26 195 156 39 2003 24 19 91 26 160 128 32 2004 31 49 88 32 200 160 40 2005 44 50 90 17 201 161 40 2006 48 35 116 18 217 174 43 2007 47 45 135 26 253 202 51 2008 54 61 140 31 286 229 57 2009 54 61 108 39 262 210 52 CAGR (%) 11.1 3.7 6.2 3.4 5.9 -

Clinicaltrials.gov (no. of trials started)

95

98

87

104

Note: All figures are rounded; the base year is 2009. Source: www.hsa.gov.sg; Frost & Sullivan

These numbers show the total number of trials started each year. About 80.0 percent of the trials are initiated by industry, while 20.0 percent are initiated by investigators this is a trend consistent over the decade. There is a variance in the number of trials recorded in clinicaltrials.gov and HSA. The latter provides a more complete picture since obtaining a CTC is mandatory, while listing on clinicaltrials.gov is voluntary.
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Clinical Trial Types

CRO Market: Types of Clinical Trials Conducted (Singapore), 2008 and 2009
100.0 90.0 80.0

International trials are likely to remain the majority of clinical trials in Singapore during the next 2-3 years, from 2011 to 2013.
84.0 82.0

Clinical Trials (%)

70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Local Trials International Trials 8.0 8.0 2008 10.0 8.0 2009 Regional Trials

There is a growing trend toward regional trials, and this is likely to continue in the future as Japans regulations now allow trial data from other countries to be accepted in Japan. There is an increasing interest in conducting trials in the region from companies based in South Korea, Taiwan, and China that would also increase the demand for clinical research outsourcing in the country.

Note: All figures are rounded; the base year is 2009. Source: Frost & Sullivan

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Clinical Trials by Therapeutic Areas

CRO Market: Types of Clinical Trials Conducted by Therapeutic Areas (Singapore), 2007-2009

Note: All figures are rounded; the base year is 2009. Source: Frost & Sullivan

Note: the category of Others includes respiratory, central nervous system, and nephrology. Oncology remains a therapeutic area of the highest interest for multinational pharmaceuticals investing in Singapore, followed by clinical pharmacology. There has been growing interest in ophthalmology from 2007, with trials being conducted for conditions such as glaucoma and myopia. Cardiology and neurology have declined in percentage, with neurology decreasing to zero trials in 2009.
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Market Engineering Measurements

15

Market Engineering Measurements

CRO Market: Market Engineering Measurements (Singapore), 2009

Measurement Name Market age

Measurement Low growth stage

Trend Increasing

Revenues (2009)

$128.4 million

Increasing

Potential Revenues (maximum future market size) Base year market growth rate Compound annual growth rate Degree of competition

$166.5 million 4.4% 4.4% Medium

Increasing Increasing Increasing Increasing

Note: All figures are rounded; the base year is 2009. Source: Frost & Sullivan

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Market Analysis

17

Market Drivers
CRO Market: Market Drivers Ranked in Order of Impact (Singapore), 2010-2015
Rank 1 Driver
Strong environment in terms of infrastructure, medical talent, regulatory approvals, and IP protection will attract increasing numbers of international trials Strong government commitment and investment in the biomedical sciences sector, with a focus on clinical research, will lead to the market expansion Singapores focus on globally relevant disease areas will increase the countrys attractiveness as a favored trials market Strong interest in translational medicine will lead to an increase in the number of clinical trials that incorporate biomarker research, an area of high interests for pharmaceutical MNCs

1-2 Years

3-4 Years

5-6 Years

High

High

High

Medium/High

High

Very High

Medium/High

High

High

Medium

Medium

Medium/High

Source: Frost & Sullivan

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Market Drivers (Contd)

1. Strong Environment in Terms of Infrastructure, Medical Talent, Regulatory Approvals, and IP Protection will Attract Increasing Numbers of International Trials The strategic focus involves developing infrastructure and capabilities for early stage clinical trials through investigational medicine units and phase I centers. Medical professionals and key opinion leaders are recognized as world class, whereas patient management is of global standards. Pro-business environment: It takes 3 weeks to obtain clinical trial approval. Intellectual property and copyright laws are harmonized with standards of protection prescribed by the World Trade Organization's Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and the Berne and Paris Conventions.

2. Strong Government Commitment and Investment in the Biomedical Sciences Sector, with a Focus on Clinical Research, will Lead to the Market Expansion Total R&D expenditure comprised 3.0 percent of GDP in 2010. Biomedical Sciences Initiative was being built up as fourth pillar of economy. 2006-2010: $1.10 billion committed to translational and clinical research.

3. Singapores Focus on Globally Relevant Disease Areas will Increase the Countrys Attractiveness as a Favored Trials Market Singapores research initiatives and expertise are focused in cancer, eye diseases, neuroscience, metabolic diseases, and infectious diseases. These are in line with disease areas of global concern and major pharmaceutical companies product portfolios. This strategic alignment will attract companies to Singapore for clinical trials.

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Market Drivers (Contd)

4. Strong Interest in Translational Medicine will Lead to an Increase in the Number of Clinical Trials that Incorporate Biomarker Research, an Area of High Interests for Pharmaceutical MNCs The inclusion of translational and clinical research in the countrys Biomedical Sciences Initiative mandate has attracted significant investment from the industry in the recent past; for example, multi-million dollar commitments from Roche and Schering Ploughs Translational Medical Research facilities. These investments coupled with the governments interest will allow for an increased number of clinical trials that incorporate biomarker research, which is an area gaining traction within pharmaceutical MNCs.

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Market Restraints
CRO Market: Market Restraints Ranked in Order of Impact (Singapore), 2010-2015
Rank 1 2 Restraint
Limited population size will restrain the expansion of late stage trials Limited talent pool results in the need to import specialized talent

1-2 Years
Medium

3-4 Years
Medium

5-6 Years
Medium

Low/Medium

Low

Low
Source: Frost & Sullivan

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Market Restraints (Contd)

1. Limited Population Size will Restrain the Expansion of Late Stage Trials The countrys limited population size is not suitable for conducting trials on rare conditions and for late phase trials that require large sample size. This factor is likely to restrain the growth of the clinical trials market in Singapore Currently, India and China are the preferred choices due to their large population size.

2. Limited Talent Pool Results in the Need to Import Specialized Talent Sources of new highly specialized talent are limited as the current workforce, while qualified, is young and has limited experience in this field. Currently, several of the countrys key scientific leaders are foreigners, while there is still a relatively small number of medical specialists, resulting in a need to bring in specialists from the United States and Europe for clinical trials.

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Revenue Forecasts
CRO Market: Revenue Forecasts (Singapore), 2009-2015 Year 2009 2010 2011 2012 2013 2014 2015 CAGR (2009-2015) Revenues ($ Million) 128.4 132.6 138.0 143.8 151.3 158.6 166.5 Revenue Growth Rate (%) 4.4 3.3 4.1 4.2 5.2 4.8 5.0 4.4
Note: All figures are rounded; the base year is 2009. Source: Frost & Sullivan

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Revenue Forecasts (Contd)

CRO Market: Revenue Forecasts (Singapore), 2009-2015
180.0 160.0
CAGR (2009-2015): 4.4%

Revenues ($ Million)

140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0

128.4

132.6

138.0

143.8

5.0 4.0 3.0 2.0 1.0 0.0

2009

2010

2011

2012 Year

2013

2014

2015

Revenues ($ Million)

Revenue Growth Rate (%)

Note: All figures are rounded; the base year is 2009. Source: Frost & Sullivan

The clinical trials market in Singapore (phase I through phase IV) is estimated to generate $166.5 million by 2015, driven strongly by expansion in the number of early stage trials (phases I and II). The current interest in translational medicine will intensify and will contribute to the expansion of the market in terms of an increase of trials involving biomarker research.
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Revenue Growth Rate (%)

151.3

158.6

166.5

6.0

Clinical Trial Revenue Contribution by Phase

CRO Market: Clinical Trial Revenue Contribution by Phase (Singapore), 2009-2015
180.0 160.0 140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0

Revenues ($ Million)

27.0 47.3 33.8 20.3 2009

25.3 48.4 36.6 22.3 2010

23.8 49.7 39.8 24.7 2011

22.2 51.1 43.2 27.3 2012 Year

21.0 52.8

19.7 54.2

18.5 55.5

47.1 30.4 2013

51.2 33.6 2014

55.5 37 2015

Phase I

Phase II

Phase III

Phase IV

Note: All figures are rounded; the base year is 2009. Source: Frost & Sullivan

Corporate and government investment in translational and clinical research, along with early phase trials, will be the key reasons for the growth of the phase I and phase II segments. The share of contribution from later stage trials is estimated to decline as Singapores relatively small population and patient pool will restrain the growth of the phase III and phase IV segments.

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Private Sector Sponsors of Clinical Trials

CRO Market: Private Sector Clinical Trial Sponsors by Type (Singapore), 2009, 2012 and 2015

2015

47.0

14.0

12.0

12.0

15.0

2012

60.0

12.0

7.0

12.0

9.0

2009 0.0 10.0 20.0 30.0

77.0 40.0 50.0 60.0 70.0

8.0 2.0 80.0

12.0 90.0

1.0 100.0

Clinical Trials (%) MNC Pharmaceutical Biotech Company Specialty Pharmaceutical Emerging Biotech Company
Note: All figures are rounded; the base year is 2009. Source: Frost & Sullivan

Emerging Pharmaceutical

Multinational pharmaceutical companies contribute to nearly 80.0 percent of clinical trial revenues. In the next few years, there will be an increase in revenue share from specialty pharmaceutical companies as well as emerging biotech/biologics companies as pharmaceutical industrys focus on these areas increases.

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Research and Development Trends in Singapore

CRO Market: Total R&D Expenditure on Biomedical and Related Sciences (Singapore), 2009-2015
1,600.0 1,400.0 1,200.0 1,000.0 800.0 600.0 400.0 200.0 0.0 2009 2010 2011 2012 Year 2013 2014 2015
R&D Expenditure ($ Million)

Note: All figures are rounded; the base year is 2009. Source: Frost & Sullivan

Private sector R&D expenditure on biomedical and related sciences constitutes over two-fifths of the sectors R&D expenditure, reaffirming Singapores attractiveness as a hub for biomedical sciences. The government has committed $1.10 billion to drive translational and clinical research (TCR). The initiative includes increasing the base of clinician scientists and clinical research publications. A total of $90.0 million has also been committed to TCR programs, which focus on key disease areas such as cancer, eye diseases, and metabolic diseases. Recent investments in Singapore include Roches announcement in 2010 to invest $134.0 million to build a Translational Medical Research Hub, Eli Lilly, Merck & Co, and Pfizers 2010 announcement to combine resources to form the Asian Cancer Research Group (ACRG), and Abbott Nutritions investment of $75.0 million to set up a global R&D center in 2009.
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Competitive Analysis

28

Competitive Structure
CRO Market: Competitive Structure (Singapore), 2009
Number of CROs in Singapore Types of Competitors ~15 Type 1 : Full service multinational CROs headquartered outside Singapore Type 2 : Full service CROs headquartered in Singapore with multi-Asian operations Type 3 : Specialized services provider, e.g., preclinical only Tiers of Competition Tier 1 : Market share more than 30.0% each Quintiles Tier 2 : Market share 10.0%-20.0% each PPD, Covance, Parexel Tier 3 : Market share up to 10.0% each Maccine, Kendle, ICON, i3 Global, others Key End-user Groups MNC pharmaceutical companies Specialty pharmaceutical companies Biotechnology/biologics companies
Source: Frost & Sullivan
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Decision Support Databases

30

Decision Support Databases

Decision Support Database: Government Healthcare Expenditure (World), 2002-2012
Decision Support Database
Table Region / Country
North America Canada United States TOTAL Latin America Argentina Brazil Chile Mexico Peru Venezuela TOTAL Asia - Pacific Australia China Hong Kong India Indonesia Japan Malaysia New Zealand Philippines Singapore South Korea Taiwan Thailand TOTAL

Government healthcare expenditure (Bn USD) 2002

50.8 718.0 768.8

2003
61.6 765.7 827.3

2004
70.7 824.2 895.0

2005
81.4 891.3 972.7

2006
89.8 999.5 1,089.3

2007
95.7 1,077.2 1,172.9

2008
101.5 1,158.4 1,259.9

2009
107.0 1,243.4 1,350.3

2010
112.1 1,332.9 1,445.0

2011
116.7 1,426.8 1,543.5

2012
120.7 1,531.8 1,652.5

CAGR % (2005 - 2012)

5.79 8.04 7.87

5.8 18.7 1.7 26.8 1.2 2.2 56.3

7.4 21.1 2.0 25.9 1.3 2.2 59.8

8.8 25.6 2.6 27.4 1.5 2.8 68.8

10.4 34.2 3.2 31.6 1.8 3.3 84.5

11.2 36.5 3.7 34.1 1.9 3.7 91.1

12.0 39.0 4.2 36.6 2.0 4.2 98.1

12.8 42.0 4.7 39.3 2.2 4.7 105.8

13.6 45.5 5.3 42.0 2.3 5.2 113.9

14.3 49.5 5.8 44.8 2.5 5.9 122.7

14.9 54.0 6.4 47.5 2.6 6.6 132.0

15.5 59.1 6.9 50.2 2.8 7.6 141.9

5.77 8.12 11.58 6.83 6.58 12.69 7.69

27.1 24.2 5.4 5.9 2.3 257.7 1.9 4.0 0.9 1.2 13.4 11.0 2.6 357.5

34.7 27.7 5.6 7.6 2.9 278.5 2.2 5.3 0.9 1.2 16.0 11.5 3.0 396.9

42.5 32.3 5.9 8.7 3.2 306.1 2.5 6.7 1.0 1.3 18.2 12.4 3.4 444.1

47.4 37.7 6.5 10.0 3.5 305.5 2.8 7.5 1.1 1.4 21.4 14.1 3.8 462.4

50.4 43.0 7.1 11.1 4.0 315.6 3.2 8.3 1.2 1.5 24.0 15.2 4.3 488.8

53.4 48.4 7.8 12.0 4.6 327.0 3.7 9.2 1.4 1.6 27.0 16.1 4.8 516.7

56.3 54.0 8.6 13.1 5.2 336.8 4.2 9.9 1.5 1.7 30.2 17.2 5.4 543.9

59.0 59.9 9.6 14.3 6.0 348.5 4.8 10.5 1.6 1.8 33.6 18.7 6.0 574.3

61.8 66.3 10.6 15.6 6.9 361.9 5.4 11.1 1.8 1.9 37.3 19.9 6.9 607.3

64.4 73.2 11.7 16.8 7.9 376.0 6.0 11.7 2.0 1.9 41.4 21.1 8.1 642.0

66.9 81.3 12.9 18.1 9.1 390.9 6.7 12.1 2.2 2.0 45.8 22.1 9.3 679.4

5.05 11.62 10.34 8.82 14.83 3.59 13.13 7.11 10.70 5.45 11.52 6.61 13.80 5.65

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Decision Support Databases (Contd)

Decision Support Database
Table Region / Country
Western Europe Austria Belgium Denmark Finland France Germany Greece Iceland Ireland Italy Luxembourg Netherlands Norway Portugal Spain Sweden Switzerland United Kingdom TOTAL Eastern Europe Czech Republic Hungary Poland Russia Turkey TOTAL

Government healthcare expenditure (Bn USD) 2002

10.7 16.1 1.7 7.2 105.7 165.7 6.9 0.7 7.3 75.3 1.3 25.6 15.3 8.0 35.4 18.9 17.2 100.9 619.8

2003
13.5 20.9 2.1 9.0 134.6 203.3 9.1 0.9 9.6 92.4 1.6 31.3 18.9 10.1 46.4 24.2 21.5 118.3 767.6

2004
15.5 24.3 2.5 10.3 156.6 231.6 10.4 1.1 11.6 105.6 1.9 35.7 21.6 11.6 55.0 28.6 24.2 142.6 890.9

2005
16.2 25.7 2.6 10.9 166.3 240.6 11.9 1.4 12.2 108.5 2.1 36.2 25.1 12.3 63.2 29.1 25.2 152.3 941.8

2006
16.9 26.8 2.7 11.6 174.8 247.9 12.8 1.5 13.4 112.9 2.3 39.8 26.8 12.9 67.6 30.4 26.9 162.6 990.3

2007
17.5 28.0 2.9 12.2 182.9 255.1 13.7 1.7 14.5 116.7 2.4 40.7 28.5 13.6 71.8 31.7 28.7 173.0 1,035.3

2008
18.1 29.1 3.0 12.9 191.3 262.2 14.5 1.8 15.5 120.5 2.4 41.8 30.3 14.3 76.1 33.5 30.5 183.5 1,081.3

2009
18.7 30.1 3.2 13.6 199.0 269.1 15.4 1.9 16.6 124.3 2.5 42.9 32.2 14.9 80.5 35.5 32.3 194.7 1,127.3

2010
19.2 31.1 3.3 14.2 206.4 276.3 16.3 2.1 17.7 127.6 2.6 44.4 33.8 15.6 84.5 37.6 34.2 206.0 1,172.8

2011
19.7 32.1 3.5 14.9 213.9 283.6 17.2 2.2 18.8 130.7 2.7 45.9 35.4 16.3 88.6 39.9 36.1 217.1 1,218.6

2012
20.2 33.1 3.6 15.5 221.0 290.7 18.2 2.3 19.9 133.3 2.7 47.3 37.0 17.0 92.3 42.6 38.1 229.0 1,263.7

CAGR % (2005 - 2012)

3.15 3.68 4.76 5.13 4.14 2.74 6.32 7.95 7.29 2.98 3.59 3.88 5.67 4.76 5.57 5.60 6.07 6.00 4.29

4.6 3.4 9.1 11.9 7.7 36.6

6.2 4.8 9.9 14.6 10.4 45.9

6.9 6.0 11.0 18.2 12.9 54.9

8.1 6.7 13.0 21.3 16.9 66.0

9.1 7.5 14.3 24.3 18.5 73.7

9.9 8.2 15.4 27.2 20.3 80.9

10.7 8.9 16.6 29.9 21.8 88.0

11.5 9.6 18.0 32.6 23.3 95.1

12.4 10.3 19.3 35.1 24.8 102.0

13.3 10.9 20.6 37.6 26.1 108.5

14.1 11.6 21.9 39.8 27.3 114.7

8.25 8.05 7.79 9.34 7.08 8.21

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Decision Support Databases (Contd)

Decision Support Database
Table Region / Country
Middle East & Africa Egypt Israel Saudi Arabia South Africa TOTAL WORLD TOTAL

Government healthcare expenditure (Bn USD) 2002

1.3 5.7 6.1 3.0 16.0 1,855.1

2003
1.2 6.2 6.8 4.7 18.8 2,116.2

2004
1.1 6.3 7.4 6.8 21.6 2,375.2

2005
1.3 6.4 8.0 6.5 22.3 2,549.6

2006
1.5 6.7 8.7 6.8 23.7 2,756.9

2007
1.7 7.1 9.1 7.2 25.1 2,929.0

2008
1.9 7.4 9.6 7.6 26.5 3,105.3

2009
2.2 7.9 10.0 8.0 28.1 3,288.9

2010
2.4 8.5 10.5 8.3 29.7 3,479.5

2011
2.7 9.1 11.0 8.7 31.5 3,676.2

2012
3.0 9.7 11.4 9.2 33.3 3,885.5

CAGR % (2005 - 2012)

12.39 6.06 5.15 5.14 5.93 6.20

Note: All figures are rounded; the base year is 2005. Source: Frost & Sullivan Definition The above figures indicate health care expenditure by government

Note
1. Figures for 2005 are Frost & Sullivan estimates

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Decision Support Databases (Contd)

Decision Support Database: Population Aged 65 and Above (World), 2002-2012
Decision Support Database
Table Region / Country
North America Canada United States TOTAL Latin America Argentina Brazil Chile Mexico Peru Venezuela TOTAL Asia - Pacific Australia China Hong Kong India Indonesia Japan Malaysia New Zealand Philippines Singapore South Korea Taiwan Thailand TOTAL

Population aged 65 and above (Mn) 2002

4.1 35.6 39.7

2003
4.2 35.9 40.1

2004
4.2 36.3 40.5

2005
4.3 36.7 41.0

2006
4.4 37.2 41.6

2007
4.5 37.9 42.4

2008
4.6 38.7 43.3

2009
4.7 39.5 44.2

2010
4.9 40.2 45.1

2011
5.0 41.1 46.1

2012
5.2 42.6 47.7

CAGR % (2005 - 2012)

2.66 2.14 2.19

4.0 10.0 1.2 5.3 1.3 1.2 22.9

4.0 10.3 1.2 5.5 1.4 1.2 23.7

4.1 10.7 1.2 5.8 1.4 1.3 24.5

4.2 11.1 1.3 6.0 1.5 1.3 25.3

4.2 11.5 1.3 6.2 1.5 1.3 26.1

4.3 11.9 1.4 6.4 1.6 1.4 27.0

4.4 12.3 1.4 6.7 1.6 1.4 27.9

4.5 12.7 1.5 6.9 1.7 1.5 28.8

4.6 13.2 1.6 7.2 1.7 1.6 29.8

4.6 13.7 1.6 7.5 1.8 1.6 30.8

4.7 14.3 1.7 7.7 1.8 1.7 31.9

1.88 3.67 3.76 3.74 3.35 3.84 3.40

2.5 92.6 0.8 48.7 11.1 23.1 1.0 0.5 3.2 0.3 3.7 2.0 4.4 193.8

2.5 95.0 0.8 49.9 11.6 23.7 1.0 0.5 3.3 0.3 3.9 2.1 4.6 199.2

2.6 97.1 0.9 51.1 12.2 24.2 1.1 0.5 3.4 0.3 4.1 2.2 4.8 204.3

2.6 99.3 0.9 52.5 12.7 24.8 1.1 0.5 3.5 0.4 4.3 2.2 5.0 209.6

2.7 101.7 0.9 54.0 13.2 25.5 1.2 0.5 3.6 0.4 4.5 2.3 5.2 215.4

2.7 104.0 0.9 55.6 13.6 26.3 1.2 0.5 3.8 0.4 4.7 2.3 5.4 221.4

2.8 106.1 0.9 57.4 14.1 27.0 1.2 0.5 3.9 0.4 4.9 2.4 5.5 227.1

2.8 108.5 0.9 59.2 14.6 27.7 1.3 0.5 4.0 0.4 5.0 2.4 5.7 233.2

2.9 111.3 1.0 61.2 15.0 28.1 1.3 0.5 4.2 0.4 5.2 2.5 5.9 239.4

3.0 114.4 1.0 63.3 15.5 28.3 1.4 0.5 4.3 0.4 5.3 2.5 6.1 246.0

3.1 118.2 1.0 65.5 15.8 29.1 1.5 0.6 4.5 0.5 5.6 2.6 6.3 254.0

2.59 2.54 1.96 3.29 3.13 2.18 3.91 2.29 3.61 4.07 3.56 2.24 3.26 2.79

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Decision Support Databases (Contd)

Decision Support Database
Table Region / Country
Western Europe Austria Belgium Denmark Finland France Germany Greece Iceland Ireland Italy Luxembourg Netherlands Norway Portugal Spain Sweden Switzerland United Kingdom TOTAL Eastern Europe Czech Republic Hungary Poland Russia Turkey TOTAL

Population aged 65 and above (Mn) 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 CAGR % (2005 - 2012)

1.3 1.8 0.8 0.8 9.7 14.2 1.9 0.0 0.4 10.7 0.1 2.2 0.7 1.7 7.0 1.5 1.1 9.4 65.4

1.3 1.8 0.8 0.8 9.8 14.6 2.0 0.0 0.5 10.9 0.1 2.2 0.7 1.8 7.1 1.6 1.1 9.4 66.4

1.3 1.8 0.8 0.8 9.9 15.1 2.0 0.0 0.5 11.1 0.1 2.3 0.7 1.8 7.1 1.6 1.1 9.5 67.4

1.4 1.8 0.8 0.8 10.0 15.6 2.0 0.0 0.5 11.3 0.1 2.3 0.7 1.8 7.1 1.6 1.2 9.5 68.4

1.4 1.8 0.8 0.9 10.0 16.0 2.0 0.0 0.5 11.5 0.1 2.4 0.7 1.8 7.2 1.6 1.2 9.6 69.3

1.4 1.8 0.8 0.9 10.0 16.3 2.0 0.0 0.5 11.6 0.1 2.4 0.7 1.8 7.2 1.6 1.2 9.6 70.0

1.5 1.8 0.9 0.9 10.1 16.5 2.1 0.0 0.5 11.7 0.1 2.4 0.7 1.9 7.3 1.7 1.2 9.7 70.8

1.5 1.8 0.9 0.9 10.2 16.7 2.1 0.0 0.5 11.7 0.1 2.5 0.7 1.9 7.4 1.7 1.2 9.9 71.7

1.5 1.9 0.9 0.9 10.3 16.8 2.1 0.0 0.5 11.8 0.1 2.5 0.7 1.9 7.5 1.8 1.3 10.0 72.4

1.5 1.9 1.0 0.9 10.5 16.7 2.1 0.0 0.5 11.9 0.1 2.6 0.8 1.9 7.5 1.8 1.3 10.2 73.3

1.5 1.9 1.0 1.0 10.8 16.8 2.1 0.0 0.6 12.1 0.1 2.7 0.8 2.0 7.6 1.8 1.3 10.5 74.6

1.38 0.99 2.81 2.23 1.26 0.80 0.88 0.00 2.65 0.95 2.25 2.53 2.09 1.24 1.00 2.37 2.03 1.58 1.24

1.4 1.5 4.9 18.8 4.2 30.8

1.4 1.5 5.0 19.3 4.4 31.6

1.4 1.5 5.0 19.8 4.5 32.3

1.5 1.5 5.1 20.3 4.7 33.0

1.5 1.5 5.1 20.6 4.8 33.5

1.5 1.5 5.1 20.8 4.9 33.9

1.5 1.5 5.2 20.4 5.1 33.7

1.6 1.6 5.2 19.8 5.2 33.3

1.6 1.6 5.2 19.2 5.3 32.9

1.7 1.6 5.3 18.8 5.5 32.8

1.7 1.6 5.4 18.9 5.6 33.2

2.64 0.86 0.83 (1.38) 2.54 (0.14)

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Decision Support Databases (Contd)

Decision Support Database
Table Region / Country
Middle East & Africa Egypt Israel Saudi Arabia South Africa TOTAL WORLD TOTAL

Population aged 65 and above (Mn) 2002

3.1 0.6 0.6 2.1 6.4 358.9

2003
3.2 0.6 0.6 2.2 6.6 367.4

2004
3.3 0.6 0.6 2.2 6.7 375.7

2005
3.4 0.6 0.6 2.3 6.9 384.3

2006
3.5 0.6 0.6 2.3 7.1 393.1

2007
3.7 0.6 0.7 2.4 7.4 402.0

2008
3.8 0.6 0.7 2.4 7.6 410.3

2009
4.0 0.7 0.7 2.5 7.8 418.9

2010
4.1 0.7 0.7 2.5 8.0 427.6

2011
4.3 0.7 0.7 2.6 8.3 437.4

2012
4.5 0.7 0.8 2.6 8.6 450.1

CAGR % (2005 - 2012)

4.12 2.04 2.91 1.77 3.09 2.28

Note: All figures are rounded; the base year is 2005. Source: Frost & Sullivan Definition The above figures represent total midyear population aged 65 years and above

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About Frost & Sullivan

37

Who is Frost & Sullivan

The Growth Consulting Company

Founded in 1961, Frost & Sullivan has over 45 years of assisting clients with their decision-making and growth issues

Over 1,700 Growth Consultants and Industry Analysts across 32 global locations Over 10,000 clients worldwide - emerging companies, the global 1000 and the investment community Developers of the Growth Excellence Matrix industry leading growth positioning tool for corporate executives
o

Developers of T.E.A.M. Methodology, proprietary process to ensure that clients receive a 360 perspective of technology, markets and growth opportunities

Three core services: Growth Partnership Services, Growth Consulting and Career Best Practices

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What Makes Us Unique

Exclusively Focused on Growth

Global thought leader exclusively focused on addressing client growth strategies and plans Team actively engaged in researching and developing of growth models that enable clients to achieve aggressive growth objectives.

360o Perspective
Proprietary T.E.A.M. Methodology integrates all 6 critical research methodologies to significantly enhance the accuracy of decision making and lower the risk of implementing growth strategies.
TM

Growth Monitoring
Continuously monitor changing technology, markets and economics and proactively address clients growth initiatives and position.

Industry Breadth
Cover the broad spectrum of industries and technologies to provide clients with the ability to look outside the box and discover new and innovative ideas.

Trusted Partner
Working closely with client Growth Teams helping them generate new growth initiatives and leverage all of Frost & Sullivan assets to accelerate their growth.

Global Perspective
32 global offices ensure that clients receive a global coverage/perspective based on regional expertise.

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T.E.A.M. Methodology
Frost & Sullivans proprietary T.E.A.M. methodology, ensures that clients have complete 360 Degree Perspective from which to drive decision-making. Technical, Econometric, Application, and Market information ensures that clients have a comprehensive view of industries, markets and technology. Technical
Real-time intelligence on technology, including emerging technologies, new R&D breakthroughs, technology forecasting, impact analysis, groundbreaking research, and licensing opportunities. In-depth qualitative and quantitative research focused on timely and critical global, regional, and country specific trends, including the political, demographic, and socioeconomic landscapes. Insightful strategies, networking opportunities, and best practices that can be applied for enhanced market growth; interactions between the client, peers, and Frost & Sullivan representatives that result in added value and effectiveness. Global and regional market analysis, including drivers and restraints, market trends, regulatory changes, competitive insights, growth forecasts, industry challenges, strategic recommendations, and end-user perspectives.

Econometric

Application

Market

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Global Perspective

1,700 staff across every major market worldwide Over 10,000 clients worldwide from emerging to global 1000 companies

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