The worldwide contrast agent market has matured to a greater extent in recent years. According to the report of MarketsandMarkets, the market of contrast agents was growing at a stable pace. The worldwide market value of contrast agents in 2016 was around 4.45 billion dollars, and was anticipated to reach 5.44 billion dollars in 2021, with a compound annual growth rate of 4.1%. Among the worldwide contrast agent market, the market share of the US is about 34.66%, of the Europe is about 27.83%, and of the China is about 30%. The contrast agent market in China is growing rapidly, with a compound annual growth rate of 11.67% in the past 5 years.

Bright prospect of the iodixanol market

The contrast agents are divided into 4 large types, namely, x-ray CT contrast agents, MRI contrast agents, ultrasound contrast agents and radionuclide contrast agents. According to the statistical data of Chinese Pharmaceutical Association, the sales amount of contrast agents in sample hospitals in 2018 reached CNY 4.237 billion, with a compound annual growth rate of 11.67% in the past 5 years; the sales amount of X-ray CT contrast agents from 2014 to 2018 accounted for 78.45% of the total amount in China (see Figure 1).

X-ray CT contrast agents can be divided into 2 types based on the molecular structure and characteristics: ionic and nonionic contrast agents. The ionic contrast agents have a very small market due to the less satisfactory safety; the nonionic contrast agents, including iohexol, iopamidol, iopromide, ioversol and iodixanol, enjoy a bright development prospect.

The rapid growth of X-ray CT contrast agents is mainly driven by iodixanol, and a stable growth has already been obtained in the sale of iohexol, iopamidol, iopromide and ioversol. The sales amount distribution map of top 5 contrast agents in the sample hospitals from 2014 to 2018 in China showed a significant growth in the sales amount of iodixanol. The iodixanol became the single type of contrast agent with the largest sales amount in 2017 when it exceeded the iohexol (see Figure 2).  

Iodixanol, a type of nonionic dimeric organoiodine contrast agents used with X-ray and CT, applies to intraspinal angiography, cardiovascular angiography and intravenous urography. The data show that iodixanol, isotonic with blood, will improve the tolerance and reduce the risk of serious adverse reaction. In the past several years, the market of iodixanol keeps growing at a fast pace, and we believe that it will become more and more popular.

In 2018, the sales amount of iodixanol in sample hospitals in China reached CNY 1.06 billion, accounting for 24.96% among the domestic contrast agents. A significant growth has been obtained in the sales amount of iodixanol from 2014 to 2018, with a compound annual growth rate of 29.26%, topping the sales amount of domestic contrast agents.

According to the report of MarketsandMarkets, in 2016 the consumption rate of bulk drugs of X-ray contrast agents was 1.49 tons per million users, higher than the average global level. There is still room for growth for it only accounts for 17.45% of the US, and 69.95% of the Europe.

The public data showed that the compound annual growth rate of CT equipment in 2019 was around 10% in China. Due to a large population base in China and high incidence of tumors, cardiovascular and cerebrovascular diseases and urinary system diseases, the X-ray and CT angiography were more widely used in examination. The third-generation nonionic contrast agent odixanol with a relatively high biological safety is expected to maintain its rapid growth momentum.

In 2018, the market value of contrast agents in China was around 1.8 billion dollars, with a compound annual growth rate of 11.67% in the past 5 years. If the grow rate can be maintained, it is expected that the value will exceed 2.25 billion dollars in 2020.

5 enterprises in the market

Currently, there are 5 enterprises competing in the odixanol market in China, 4 from China and 1 from other country (Nycomed, an original drug enterprise, was transferred to GEHealthcare). Among the 5 enterprises, Nanjing Chia Tai Tianqing Pharmaceutical Co., Ltd. entered the market since June, 2018. By relying on the quality and cheap original drugs provided by Zhejiang Starry Pharmaceutical Co., Ltd., Hengrui Medicine expands its market by its edge in cost performance and localized academic marketing.

According to the data of sample hospitals in China, Hengrui Medicine enjoys the absolute advantage in the iodixanol market. In 2018, Hengrui Medicine’s the sales amount was CNY 624 million, accounting for 58.98% of the total market value, with a compound annual growth rate of 43.21% over the past 5 years. Chances are that the iodixanol may be a hit product with a sales amount over CNY 1 billion in Hengrui Medicine.

Is there a chance for the new enterprises to find their places in the iodixanol market under rapid growth? It depends on whether they can obtain the quality and cheap original drugs.

Zhejiang Starry Pharmaceutical Co., Ltd., a leading enterprise that has been producing and selling the original drugs of contrast agents for over 10 years, is one of the enterprises that own a complete product line concerning the original drugs of contrast agents in China. Its products have been approved in China, the US, EU, Japan and other countries and regions. Hengrui Medicine’s success in the contrast agent market cannot be made without the original drugs provided by Zhejiang Starry Pharmaceutical Co., Ltd.

Low dosage and toxicity is the direction of research and development

Except the X-ray CT contrast agents, ultrasound contrast agents have the smallest market. Hence, it has little value for the enterprises to invest in ultrasound contrast agents.

According to the data of sample hospitals in China, despite of a compound annual growth rate of 39.82%, new enterprises have little chance to find their places in the radionuclide contrast agent market for the raw materials are highly monopolized.

Recently, the market of MRI contrast agents increases rapidly with the growing number of installed MRI equipment and examined patients. In 2018, the market value of MRI contrast agents (gadolinium-based contrast agents) in sample hospitals in China reached CNY 0.52 billion, with a year-on-year growth rate of 21.82% and compound annual growth rate of 11.44% in the past 5 years. It is expected that MRI contrast agents have a bright market prospect to maintain a grow rate of 12%.

Currently, it has been a common sense in the contrast agent study to reduce the toxicity against living bodies by lowering the use of contrast agents. Problems in the clinical use of contrast agents include high dosage, low ability to target tumors and toxic and side effects. Low toxicity, cost, high targeting ability, and satisfactory stability in bodies are the future study trend of contrast agents.