50,000 cases in the US & We believe the diagnosed prevalence of NTM lung disease in Europe is approximately 30,000 patients, and we believe the diagnosed prevalence of NTM lung disease in Japan is also approximately 30,000 patients.
So, toss in the rest of the world and we're looking at 150,000 to 200,000 patients per year across the globe. We know they've trademarked in places like South Africa as well. Looks like a multi-billion revenue upside with no competition and no pricing pressure.
no pricing pressure? maybe yes, maybe no… depends how insmed plays it…
remember, the treatment for NTM is EXACTLY the same as for CF/Pa (560mg once daily).
notice so far, insmed plans to market separately the two indication in two markets…
smart move (unless insmed is stupid and just stumbled on this pathway).
since Arikace won’t be approved for CF/Pa in the US anytime soon, it won’t be sold in the US market for that indication (at price points which compete with cayston & tobi). So for NTM in US, Arikace (as the only approval treatment) will be sold for what that market will bear for as long as it will bear it (12 years QIDP/orphan status) unless/until insmed seeks CF/Pa approved in the US, at which point insmed cannibalizes it’s own NTM cash cow in order just to compete with tobi/cayston…
In Europe CF/Pa approval is first, so (approved or not) Arikace (at CF/Pa pricing) will be used for NTM (which is currently off-label “anything goes” anyway). Hospital buyers are not fooled by marketing BS (eg. Lonspira vs Voncera). NTM will be treated in EU at tobi/cayston price points – period. That’s why insmed will seek NTM approval in the EU (they might as well), whereas they will be in NO HURRY at all to seek CF/Pa approval in the US (if they are smart).
it will be interesting to see just how “patient friendly” insmed's new philosophy is