Published On: January 2018
Ascites is an abnormal accumulation of fluid in the abdominal cavity. Liver cirrhosis is the most common case of ascites. Its presence is a sign of significant portal hypertension. Other less common factors that may contribute to ascites development are heart failure, kidney failure, cancers, and infection in the pancreas. Malignant ascites has a characteristic role in the progression of ovarian cancer. Malignancy-related ascites have also been observed in malignancies of breast, lung, pancreas, gastric, and liver. Ascites can be detected by physical examination at a volume greater than 1.5 ascites. For a smaller amount of fluid ultrasound and CT scan are preferred.
Which type of treatment option will witness most demand in the coming years?
As ascites formation represents a hallmark in the history of chronic liver failure, and it predicts a poor outcome of 50% mortality rate within 3 years, adequate management of ascites and its complications would better quality of life and escalate the survival rate. Patients with mild ascites are advised to follow a low sodium intake diet to increase mobilization of the fluid retention. Diuretics are also a first-line treatment option for ascites. The most commonly recommended diuretics are spironolactone, furosemide, amiloride, metolazone, and mannitol. The second line treatment options for ascites includes discontinuation of beta blockers, serial therapeutic paracentesis, evaluation for liver transplantation, and TIPS. The third line treatment option includes peritoneovenous shunt. As there is not even a single pharmaceutical drug approved by FDA for the management of ascites. So, surgical interventions i.e. peritoneovenous shunting, liver transplantation, and transjugular intrahepatic portosystemic shunt (TIPS), also holds a strong share in the market.
However, various complications have been observed with ascites treatment approaches such as bleeding, small bowel perforation, stent placement complications, post-procedural complexities, and others. Some of these complications are rare and life-threatening. Thus, development of new drugs may emerge as the new revenue pockets for the growth of this market.
Keen Players Bank on Novel Treatment Offering for Growth in Global Ascites Market
A number of players are operating in the global ascites market. Becton, Dickinson and Company (BD) has been recognized as a global leader with a broad range of products. BD develops and manufactures medical supplies, laboratory equipment, and diagnostic products worldwide. It operates through two segments worldwide i.e. BD Medical and BD Life Sciences. The product portfolio of company includes antibodies i.e. BD Pharmingen Ascites Mouse Anti-Ubiquitin, and BD Pharmingen Ascites Mouse Anti-PARP, and drainage products such as denver shunt, pleurX drainage system, and BD heimlich chest drain valve.
Medtronic is another well-established player in the ascites market. The company is the global leader in medical technology services. Medtronic Public Limited Company develops, manufactures and markets its medical devices to clinics & hospitals in approximately 160 countries. On January 26, 2015, Medtronic acquired Covidien plc for USD 42.9 Billion. The product portfolio of the company includes mainly Argyle Swan Neck Presternal Peritoneal Dialysis Catheter, Argyle Swan Neck Missouri Peritoneal Dialysis Catheter, Argyle Swan Neck Curl Cath Missouri Peritoneal Dialysis Catheter, Argyle Moncrief-Popovich Swan Neck Curl Cath Peritoneal Dialysis Catheter, and Argyle Peritoneal Dialysis Catheter Accessories, and turkel paracentesis procedure tray.
There are some pipeline drugs available for the management of ascites such as BIV201 by BioVie, Cell-in-a-Box capsule by PharmaCyte Biotech Inc., and others.
Improvement in Reimbursement Policies Stoking Growth of the Ascites Market
Ascites is one of the most common complications of cirrhosis, and it presents acute-on-chronic liver failure (ACLF). According to the data suggested by the Centres for Disease Control and Prevention in 2015, around 1.6% adults have been diagnosed with the chronic liver disease in the United States i.e. 3.9 million. It is also stated that from 2000 to 2015 death rates due to chronic liver disease and cirrhosis was increased by 31% in the United States among individuals aged 45–64 years.
The rising burden of ascites and related complications at an alarming rate are triggering various government or private associations to amend and improve their reimbursement policies. For instance, ALFApump System by Sequana Medical, a Switzerland based medical device company, has received approval from German Neue Untersuchungs und Behandlungsmethode (NUB), which allows hospitals to receive reimbursement for innovative new products. ALFApump System is a specially designed implantable pump system to treat ascites. The Medicare National Average Payment suggested by CMS for Peritoneal Drainage, used for the management of ascites, in 2017 is USD 1,453 in ambulatory surgery payment system and USD 2,862 for hospital outpatient payment system. The main aim of this support is lowering the mortality rate by ensuring proper post-operative procedures.
There are very few treatment options available in the market thus, there are a number of opportunities for the manufacturers to develop new therapeutic devices and drugs for ascites management. Existing treatment options such as paracentesis, TIPS, PleurX system, Catumaxomab, Terlipressin, Vaptans drugs, and others are successful in the management of ascites but associated with certain complications.