瑞士信贷：美国胆固醇行业研究报告2008年12月

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US Cholesterol Market
COMMENT
The Survey Says...Downside Manageable
■
Although the market expects further downside to Vytorin and Lipitor share, the
magnitude is uncertain. Vytorin (MRK/SGP) has lost 41% of its total prescription
share at end 2007 (12.2%), stemming from publicity of the ENHANCE and SEAS
studies. PFE’s Lipitor has lost 11% of its end 2007 market share (32.3%),
primarily due to therapeutic substitution.
■
To project future baseline share, we surveyed 208 physicians (20% cardiologists,
80% generalists) regarding their prescribing patterns before and after awareness
of ENHANCE, SEAS and, most recently, JUPITER (Crestor) studies.
■
Survey results provide a realistic scenario of where drug utilization could go if
SGP, MRK & PFE are unsuccessful at repositioning drug benefits. The profile of
physician respondents aligns well with the characteristics of doctors responsible
for most prescriptions, rather than category luminaries.
■
Vytorin may lose an additional 22% of current share (now 7.2%) before reaching
steady state, according to our survey. We forecast a base share of 5.5%,
reached by 2010, a 24% decline. Zetia, the only cholesterol absorption inhibitor,
seems closer to its recovery and we forecast 2009 prescription growth of 1%,
relative to the 21% decline it has experienced in 2008. Lipitor losses are also
likely to continue per survey respondents. We project market share will decline
from current share (28.8%) by roughly 15% with 2010 share at 24.5%.
■
Awareness of positive JUPITER results is high, a positive cross-current to our
downward adjustments to Vytorin and Lipitor share. Significant increases in
hsCRP screening are expected and should increase cholesterol prescribing.
Our category growth expectations are conservative in this regard (Rx growth of
4% in 2008 and 4.5% in 2009), tempered by risk of consumer softness in Rx use.
■
85% of MDs were aware of ENHANCE, 60% of SEAS but 50% of them thought
SEAS had minimal or no prescribing impact. Patient choice was a top reason for
switching so lower media attention on these studies should help.
■
Upside scenarios include grassroots efforts by lipid specialists on the need for
more potent lowering of LDL-c, a greater appreciation for CRP screening and
rebating strategies. Downside scenarios may imply negative [unanticipated]
future media coverage of Vytorin and reduced formulary access (although
access was identified as a prescribing criterion in our survey).
■
Consensus agreement on a base case view for cholesterol sales is important to
stock performance given the material contribution to EPS (Exhibit 1). We prefer
SGP to MRK and PFE as it best positioned through the industry’s 2012 patent
cliff and this will gain importance with resolution of the cholesterol outlook.
■
2009 EPS changes as follows: SGP from $1.78 to $1.71, MRK from $3.21 to
$3.19 and PFE from $2.49 to $2.45. Our target prices for SGP ($22), MRK
($30) and PFE ($19) are unchanged.

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