Varun Kumar Biocon Report

MOLECULES SURVEY IN AIIMS, NEW DELHI AND PATIENT SATISFACTION SURVEY IN BHIWADI A summer training project report on training undertaken at

BIOCON LTD. Post Graduate Diploma in Business Management

Submitted To: RAHUL PALIWAL

Submitted By: VARUN KUMAR

(Regional Business Manager) JAIPUR

PGDM, IILM, AHL,

August 2009

CONTENTS

MOLECULES SURVEY IN AIIMS, NEW DELHI 1. PREFACE 2. ACNOWLEDGEMENT 3. EXECUTIVE SUMMARY 4. INTRODUCTION TO PHARMACEUTICAL INDUSTRY 5. INTRODUCTION OF BIOCON 6. RESEARCH METHODOLOGY OF BIOCON MOLECULES TITLE OF STUDY DURATION OF PROJECT OBJECTIVE TYPE OF RESEARCH SAMPLE SIZE AND METHOD OF SELECTING SAMPLE SAMPLE DESIGN SCOPE OF STUDY LIMITATION OF STUDY ANALYSIS AND INTERPRETATION 1. SURVEY OF AIIMS 2. FACTS AND FINDINGS 3. CONCLUSION 4. RECOMMENDATION AND SUGGESTION

PATIENT SATISFACTION SURVEY IN BHIWADI 1. INTRODUCTION OF PATIENT SATISFACTION 2. RESEARCH METHODOLOGY OF PATIENT SATISFACTION IN

BHIWADI TITLE OF STUDY DURATION OF PROJECT OBJECTIVE TYPE OF RESEARCH SAMPLE SIZE AND METHOD OF SELECTING SAMPLE SAMPLING DESIGN SAMPLE OF PATIENT SATISFACTION SURVEY REPORT ANALYSIS AND INTERPRETATION SCOPE OF STUDY LIMITATION OF STUDY 1. FACTS AND FINDINGS 2. CONCLUSION 3. RECOMMENDATION AND SUGGESTION 4. APPENDIX PATIENTS HEALTHY QUESTIONNAIRE 1. BIBLIOGRAPHY

PREFACE

"Learning categories you and practicing is a learning specialization ". Learning is a prerequisite for behavior. Training is a process of learning a sequence of programmed behavior .It is application of knowledge.

Theoretical and conceptual aspect taught in classrooms prove useful only when there is a projection in practical situation is analyzed and well understood, that is why practical orientation of management student is or must for generally competence to deal with issue at grassroots level .It is for this reason six to eight weeks project training is described as a part of syllabus of Post Graduate Diploma in Business Management. Pharmaceutical is essential pillar of private sector corporate economy .As the topic of my study was Molecules Survey in AIIMS, NEW DELHI and Patient satisfaction in BHIWADI. It was really a wonderful opportunity to get insight in one of the most important aspect of Pharma market and medical field. The study covers the product of BIOCON and other brands of pharmaceutical industry and also the patient suffering from cardiac and other chronic disease. It shows various aspects, latest development in drugs & new techniques for identifying the cardiac patients through survey in a particular area in BHIWADI. As my fortune I have an opportunity to do my project work at “BIOCON LTD.” Leading manufacturing, research supplying unit of medicine. I have tried my best to represent on relevant data and information relating to my project work.

Acknowledgement I am grateful to, Mr. Rahul Paliwal, Regional Business Manager, Biocon Limited, for providing me with this opportunity to work on this project. Without his assistance and continuous guidance this project would not have been completed. My experience from this project is indescribable and it has certainly broadened my knowledge arena by introducing me to the practical problems of the field while performing the market research survey. I am thankful to Mr. Punit Chawla, Area Business Manager, for his inexhaustible support and cooperation during my summer training at BIOCON Ltd. New Delhi. I would like to extend my heartfelt thanks to all the Marketing managers and staff members of BIOCON LTD. without whose support I would not be able to make this project a success one. I am indebted to my family and friends for providing such a support for my project. Finally I would like to thank Almighty for giving me such an opportunity to work with BIOCON Ltd.

Thanks with regards Varun Kumar

Executive summary

The objective of the project was firstly, based on a marketing survey study, as it required to me to understand the market. To execute the study I preferred to study about BIOCON market and all the pharmaceutical competitors in the market. Thus, the first part of the project was executed by learning the following in detail:

1. BIOCON Product marketing in NEW DELHI 2. About given molecules to survey in market 3. Company profile 4. About competitors product in the market 5. Total per week sales of molecules of Biocon in market 6. To do a comparative study of BIOCON product With other market competitor. The second part of the project was patient satisfaction in BHIWADI.The learning is:

1. To know about the patient disease 2. To know about there Risk Factor 3. To know about there other chronic symptoms related to there cardiac disease 4. To know about the ratio of patient suffering from cardiac, diabetes and other chronic disease After undergoing the training about the product and operational features I started exploring the product and contacted the prospective customer by way of telecalling, emails, corporate presentation, my primary aim was to give better options to the prospective customers by offering them products specialized features & its unique incomparable qualities in the services provided by BIOCON LTD and WELLNESS & RADIAL INTERVENTION SOCIETY.

BIOCON LIMITED

INTRODUCTION OF PHARMACEUTICAL INDUSTRY: In the global scenario Indian pharmaceutical market is the world's fourth largest by volume of drugs (8 percent of the global market) and thirteenth largest by value (less than 1 percent of the global market with 2003 estimated sales of $4.1 billion). The prices of medicine are among the lowest in the world. In the present scenario 70 percent of the Indian population doesn't have access to drug therapy. According to the Pharma Handbook Per-capita consumption of drugs in 2003 was only $3.33.

But in spite of such strong positioning, Indian government's patent laws were but put on trial when on 15 feburary,2007 (HINDUSTAN TIMES) the Swiss pharmaceutical company Novartis

accused the government of failing to comply with World Trade

Organization (WTO) rules after it refused to grant the company a patent on its cancer drug Glivec. India signed up to the WTO's Trade Related Intellectual Property Rights (Trips) patent regime when it joined the WTO in 1995.

It was later claimed by Novartis that the failure to acknowledge Glivec as an innovative drug means that India is operating outside these regulations. But this was strongly rejected by the Indian government, arguing that Glivec is an existing drug with only a minor alteration.

The key Indian pharmaceutical players are:

One of the most interesting facts to be noted here is that only three foreign companies break through the top 10 companies in India and the Midwest's own Abbott Labs is one of those companies. But on the other hand only a little more than a third of the Indian market is represented by the top ten companies. Strangely, though world market leader Pfizer is not among them. The top Indian companies – Cipla, Ranbaxy, Sun Pharma and Dr. Reddy's – have all initiated their international strategies by establishing offices and operations in the U.S. Sun Pharma even has some Midwest roots as it has acquired a substantial equity chunk of Caraco Pharmaceuticals in Michigan. Some key changes recently made by the Indian government have altered the dynamics of investing in India for pharmaceuticals companies: 1. In 2002, the Indian government allowed for 100 percent direct foreign ownership. 2. In January 2005, the Indian government implemented a 20-year product patent protection policy. 3. Import duties on new drugs under development (clinical trials) have been eliminated. 4. ICH good clinical practice regulations are now mandated.

The contract research organization (CRO) market in India is expected to grow substantially from a level of $70 million in 2004 to $200 million by 2008 as a result of the above changes. It doesn't hurt that doing clinical trials in India is between 50 percent and 60 percent cheaper than in the U.S. Beside there is fertile ground for the study of chronic diseases: 1. 34 million diabetics 2. 30 million with cardiovascular disease 3. 8 million epileptics Source: Pharma Marketing News 2005

THE SUCCESS STORY OF THE INDIAN PHARMACEUTICAL INDUSTRY: (PEOPLE BEFORE PATENTS) The colonial patent law of 1911 secured the Indian market to British industry. A large majority of drugs were imported from abroad until the Patents Act 1970 brought a turnaround. Early in the 21st century India has a highly efficient pharmaceutical industry, blossoming thanks to the weak patent protection of medicines. It provides essential drugs at affordable prices and creates considerable employment. Today over 90 percent of modern medicine consumed in India are produced locally. From 1 January 2005 India has been complying with the Trade Related Intellectual Property Rights (Trips) of the World Trade Organization (WTO). The new rules of the game do threaten India’s achievements. The Indian pharmaceutical industry is a success story. It is also a potential employment generator. More than 500 000 people are employed in this sector, in some 12 000 firms out of which 2900 of them are large scale units. Besides a further 2.5 million jobs are thought to be involved in the pre- and post-production sector. When compared to the general price index, the drug prices have risen much less in the last 15 years so much so that it still remains far below average. "Worldwide, India is a country of very low drug

prices while producing high quality medicines", Nihchal H. Israni, president of the Indian Drug Manufacturers’ Association (IDMA), states proudly. The pharmaceutics selfsufficiency exceeds 90 percent – in spite of the fact that the policy of open economy is being pursued by India since 1991. Now a question may arise as to what are the main factors that transformed the status of the Indian pharmaceutical industry from a mere importer and distributor of drugs and pharmaceuticals to an innovator driven by cost and effective producer of quality drugs. The answer is strategic government policies that helped India in emerging as one of the fast growing pharmaceutical industry in the world. To add to this with every passing year trade surpluses and exports are also growing.

Industry revenues For the first time ever, in 2006, global spending on prescription drugs topped $643 billion, even as growth slowed somewhat in Europe and North America. The United States accounts for almost half of the global pharmaceutical market, with $289 billion in annual sales followed by the EU and Japan. Emerging markets such as China, Russia, South Korea and Mexico outpaced that market, growing a huge 81 percent. US profit growth was maintained even whilst other top industries saw slowed or no growth. Despite this, "The pharmaceutical industry is — and has been for years — the most profitable of all businesses in the U.S. In the annual Fortune 500 survey, the pharmaceutical industry topped the list of the most profitable industries, with a return of 17% on revenue." Pfizer's cholesterol pill Lipitor remains the best-selling drug in the world for the fifth year in a row. Its annual sales were $12.9 billion, more than twice as much as its closest competitors: Plavix, the blood thinner from Bristol-Myers Squibb and Sanofi-Aventis; Nexium, the heartburn pill from AstraZeneca; and Advair, the asthma inhaler from GlaxoSmithKline.

IMS Health publishes an analysis of trends expected in the pharmaceutical industry in 2007, including increasing profits in most sectors despite loss of some patents, and new 'blockbuster' drugs on the horizon. Teradata Magazine predicted that by 2007, $40 billion in U.S. sales could be lost at the top 10 pharmaceutical companies as a result of slowdown in R&D innovation and the expiry of patents on major products, with 19 blockbuster drugs losing patent. Market leaders in terms of revenueThe following is a list of the 20 largest pharmaceutical and biotech companies ranked by healthcare revenue. Some companies (e.g. Bayer, Johnson and Johnson and Procter & Gamble) have additional revenue not included here. The phrase Big Pharma is often used to refer to companies with revenue in excess of $3 billion, and/or R&D expenditure in excess of $500 million.

INTRODUCTION OF ORGANIZATION:

Biocon is India's leading biotechnology enterprise. Established in 1978, the company today is an integrated biotechnology enterprise focused on the development of biopharmaceuticals. The company serves partners and customers in over 50 countries. Within the biotechnology space, the company ranks first in Asia in terms of revenues and market capitalization and sixteenth globally. The company is headed by Kiran Mazumdar-Shaw. Biocon went for an IPO in 2004. Biocon became only the second Indian company to cross a market capitalization of one billion U.S. $ on the first day of listing. Mazumdar-Shaw and her husband John Shaw own over 60% of the company's stock. Biocon Limited is a fully integrated biopharmaceutical company focused on biopharmaceuticals, custom research and clinical research.

Subsidiary Companies: Syngene International Limited is a custom research organisation offering synthetic chemistry and molecular biology services for early stage drug discovery and development.

Clinigene International Limited is a clinical research organization offering Phase I-IV clinical trials and studies for novel/generic molecules to international pharmaceutical majors. Biocon Biopharmaceuticals Private Limited (BBPL) is a joint venture with CIMAB to develop and market a range of monoclonal antibodies and cancer vaccines. AxiCorp GmbH is a Friedrichsdorf (Germany) based pharmaceutical marketing company and is amongst the fastest growing in Europe. Biocon Limited acquired a majority stake in AxiCorp GmbH (70%) in February, 2008. NeoBiocon FZ LLC is a research and marketing pharmaceutical company based in Abu Dhabi. Incorporated in January 2008, NeoBiocon is a 50:50 joint venture with Dr. B.R.Shetty, Managing Director of NeoPharma, Abu Dhabi. Intellectual Profile of 3600+ Personnel

Biocon, Syngene and Clinigene together employee approximately 3600 qualified personnel - from biologists, chemists, medical practitioners, pharmacologists, engineers, finance / legal / marketing analysts, HR generalists to general administrators. 5% of our employees have PhD degrees, 41% have a master’s degree in science and the remaining are graduates with a bachelors degree in science, commerce or arts. 15% of Biocon employees are women (across the group). The employee attrition last quarter was 7% and last year it was over 20%. The average age of the employees is 29 years.

Biocon has rapidly developed a robust drug pipeline, led by monoclonal antibodies and several other molecules at exciting stages in the biopharmaceutical value chain. With the successful commercial launch of our first anti-cancer drug and several promising discovery partnerships in the clinic, we remain committed to scaling new heights in frontier science and achieving new milestones in affordable medicine.

The Innovation Matrix: A Strategic Framework To navigate the challenges of innovation in the next decade company adopted a welldefined strategic framework that will transform scientific discoveries into advances in human healthcare and generate incremental value for shareholders. The Innovation Matrix is a four-dimensional endeavour which extends into the realms of the known and the unknown. Creativity in the known realm builds on existing knowledge and can result in two types of innovation: INCREMENTAL and EVOLUTIONARY. Creativity that challenges unknown boundaries and creates new knowledge is EXPERIMENTAL and TRANSFORMATIONAL in its impact. A portfolio that covers allfour spheres enables Biocon to sustain innovation in the short, medium and long term

HISTORY OF ORGANISATION November 29, 1978 Biocon India is incorporated as a joint venture between Biocon Biochemicals Ltd. of Ireland and an Indian entrepreneur, Kiran Mazumdar-Shaw . It was the Biocon’s

Founding Day - the start of a biorevolution in India 1979 Biocon is the first Indian company to manufacture and export enzymes to USA and Europe

1989 Unilever plc. acquires Biocon Biochemicals Ltd. in Ireland and merges it with its subsidiary, Quest International Biocon is the first Indian biotech company to receive US funding for proprietary technologies 1990 Biocon scales up its in-house research programme, based on a proprietary solid substrate fermentation technology, from pilot to plant level 1993 Biocon's R&D and manufacturing facilities receive ISO 9001 certification from RWTUV, Germany 1994 Biocon establishes Syngene International Pvt. Ltd. as a Custom research Company (CRC) to address the growing need for outsourced R&D in the pharmaceutical sector 1996 The commercial success of Biocon's proprietary fermentation plant leads to a 3-fold expansion Biocon leverages its technology platform to enter biopharmaceuticals and statins 1997

Biocon spearheads initiatives in human healthcare through a dedicated manufacturing facility 1998 Unilever inks a deal with ICI to sell its specialty chemicals division of which Quest International is a part. Unilever agrees to sell its shareholding in Biocon to the Indian promoters. Biocon becomes an independent entity 2000 Biocon commissions its first fully automated submerged fermentation plant to produce specialty pharmaceuticals Biocon establishes Clinigene, India's first Clinical Research Organisation (CRO) to pursue clinical research and development 2001 Biocon becomes the first Indian company to be approved by US FDA for the manufacture of lovastatin, a cholesterol-lowering molecule Biocon's proprietary bioreactor, PlaFractor™ is granted a US 2001 and world-wide patent 2002 Clinigene's clinical laboratory is the first in India to receive CAP accreditation 2003 Biocon is the first company worldwide to develop human insulin on a Pichia expression system 2004 Biocon creates a buzz in the stock market in March 2004 with its hugely successful IPO. Day 1 on the bourses closes with a market value of $1.11 billion, making Biocon

only the second Indian company to cross the $1 billion mark on the first day of listing. Biocon Limited announces the launch of INSUGEN®, the new generation bio-insulin, manufactured in Asia's largest human insulin plant.

2005 Biocon signs a commercial agreement for supply of insulin API to Asia, Africa and the Middle East. 2006 Biocon inaugurates Biocon Biopharmaceuticals, India's largest multi-product Biologics facility at Biocon Park Biocon inaugurates Biocon Park, India's largest integrated biotechnology hub, comprising an integrated cluster of research laboratories and manufacturing facilities spread across 90 acres in KIADB (Karnataka Industrial Areas Development Board) industrial estate. Biocon announces a licensing agreement with Bayer HealthCare (BHC) for the exclusive marketing and trademark rights for INSUGEN® for the Chinese market.

Biocon launches India's first anti-cancer drug BIOMAb EGFR™. 2007 Biocon and Abu Dhabi based pharmaceutical company Neopharma sign an MOU to establish a JV to manufacture and market a range of biopharmaceuticals for the GCC countries (Gulf Cooperation Council). . Biocon announces the launch of its Nephrology Division and a comprehensive portfolio of renal therapy products.

Syngene enters into a research partnership with Bristol-Myers Squibb and completes the ground breaking ceremony of new research facility at Biocon Park. Biocon presents the results of Phase 1 studies on its oral insulin product, IN-105 at the European Association for Study of Diabetes (EASD) meeting held at Amsterdam.

2008 Biocon acquires a 70% stake in German pharmaceutical company, AxiCorp GmbH for a consideration of €30 Million Biocon and Abraxis Bioscience launch ABRAXANE in India for treatment of Breast Cancer. Biocon is ranked among the top 20 global biotechnology companies (Med Ad News). Biocon is the 7th largest biotech employer in the world (Med Ad News). 2009 Biocon's Syngene partners with Sapient Discovery to expand integrated drug discovery offerings Biocon's Syngene and DuPont Crop Protection Forge Alliance Partnership Bristol-Myers Squibb and Biocon's Syngene open new R&D Facility at Biocon Park Biocon launches BASALOG - long lasting basal insulin for Type 1 & Type 2 Diabetics

Products & Services

“Biocon’s impressive range of products and partnered services continue to build a robust pipeline of biosimilar and discovery-led biologicals programs in oncology, nephrology, diabetes and autoimmune diseases” Through partnerships and alliances, Biocon has strategically moved up the value chain from supplying pharmaceutical bulk actives to developing proprietary molecules and branded formulations. Differentiation and a high degree of innovation distinguish all products and services. Biopharmaceuticals Biocon is among few companies in the world with a diverse scientific skill base and advanced manufacturing capabilities for the development and commercialisation of biopharmaceuticals. It offers a range of products from fermentation derived small molecules to recombinant proteins and antibodies. Anti-Diabetic Agents: Acarbose Acarbose is an alpha-glucosidase inhibitor that helps in slowing down digestion of carbohydrates. By lengthening the time taken to convert carbohydrates to glucose, it facilitates better blood glucose control, after meals, used in the treatment of type II diabetes mellitus.

Pioglitazone Pioglitazone lowers glucose level in the blood by reducing its production and secretion from the liver. In addition, it alters the concentration of lipids (fats) in the blood, specifically, decreasing triglycerides and increasing HDL level. Used in the treatment of type II diabetes mellitus. Repaglinides Repaglinide is a fast & short-acting, oral hypoglycemic agent. It is an insulin secretogogue that stimulates the release of insulin from beta cells of the pancreas. Used in the treatment of type II diabetes mellitus.

Rosiglitazone Rosiglitazone is a hypoglycemic agent that sensitizes insulin binder cells in the body to increase uptake of glucose from the blood, thereby reducing blood glucose level. Used in the management of type II diabetes mellitus. Anti-Inflammatory Agents: Serratiopeptidase Serratiopeptidase is a proteolytic enzyme derived from bacteria. It specifically digests the Bradykinins and fibrin formed in the process of inflammation and hence acts as an anti- inflammatory agent. Used in the treatment of various diseases caused by inflammation. Trypsin Chymotrypsin Trypsin is a proteolytic enzyme involved in the digestion of proteins, cleaving peptide bonds at only positively charged side chains of amino acids, like lysine and arginine. It is considered a debriding agent for cleaning of necrotic wounds, ulcers, sinuses and fistulas. Used in the treatment of bronchial asthma, bronchitis and thrombophlebitis. Anti-Oxidants: Alpha Lipoic Acid Alpha lipoic acid is a fat and water soluble antioxidant that traps free radicals in the body and thus prevents cell damage. Alpha Lipoic Acid supplementation protects the brain from damage caused by free radicals. Widely used in the treatment of various diseases caused by free radicals such as Dementia, Stroke, Parkinsons and Alzheimer’s. L-Carnitine L-Carnitine, an amino acid derivative, is found in nearly all cells of the body. It transports long-chain fatty acids across the inner mitochondrial membranes in the mitochondria, where they are processed by beta-oxidation to produce biological energy in the form of adenosine triphosphate or ATP. Used in the management of cardiac ischemia and peripheral arterial disease.

Cardiovascular Agents: Atorvastatin Atorvastatin is a cholesterol-lowering agent that acts by inhibiting the HMG CoA reductase, enzyme which plays an important role in the biosynthesis of cholesterol. Used in the treatment of Coronary heart diseases. Lovastatin Lovastatin is a cholesterol lowering agent that decreases the LDL levels, totalcholesterol and LDL-cholesterol and below average HDL-cholesterol. Used to prevent coronary heart disease, without symptomatic cardiovascular disease. Pravastatin Pravastatin is competitive inhibitor of HMG-CoA reductase, the enzyme catalysing the early rate-limiting step in cholesterol biosynthesis, i.e. conversion of HMG-CoA to mevalonate. Widely used in the treatment of arteriosclerosis. Simvastatin Simvastatin is a hypolipidemic drug used to treat hypercholesterolemia. It is competitive inhibitor of HMG-CoA reductase, the enzyme catalysing the early rate-limiting step in cholesterol biosynthesis, i.e. conversion of HMG-CoA to mevalonate .Successfully used in the treatment of coronary heart diseases. Fluvastatin Fluvastatin is a water soluble cholesterol-lowering agent. It is competitive inhibitor of HMG-CoA reductase; the enzyme catalysing the early rate-limiting step in cholesterol biosynthesis, i.e. conversion of HMG-CoA to mevalonate .It also reduces low density lipoproteins and triglycerides while increasing high density lipoprotein levels in the blood. Used in the treatment of hypercholesterolemia. Rosuvastatin Rosuvastatin is an oral cholesterol-lowering agent. It is competitive inhibitor of HMGCoA reductase, the enzyme catalysing the early rate-limiting step in cholesterol

biosynthesis, i.e. conversion of HMG-CoA to mevalonate Used for the treatment of pure hypercholesterolemia and mixed hyperlipidaemia. Ezetimibe Ezetimibe is a cholesterol lowering agent that selectively inhibits intestinal absorption of cholesterol. Used to treat hypercholesterolemia. Anti-Obesity Agents: Orlistat Orlistat is a reversible inhibitor of lipases. It exerts its therapeutic activity in the lumen of the stomach and the small intestine. It is indicated for obesity management including weight loss and weight maintenance, when used in conjunction with a low-calorie diet. Digestive-Aid Enzymes: Bile Extract Bile contains bile acids, which are critical for digestion and absorption of fats and fatsoluble vitamins in the small intestine. Oxbile extract is prepared from the fresh bile of the ox. Widely used for replacement therapy in pathological conditions in which the concentration of bile acids in upper intestine is low for e.g. biliary fistula, disease of the ileum, hepatic or extra-hepatic cholestasis. Fungal Lactase Lactase is the enzyme in the small intestine that digests lactose (the naturally occurring sugar in milk).Fungal lactase is an enzyme obtained by the controlled fermentation of aspergillus oryzae and is characterized by its ability to hydrolyse lactose over a wide range of temperatures and pH. The lactase catalyses the hydrolysis of the lactose betaD-galactoside linkage liberating one mole of D-glucose and one mole of D-galactose. Used to treat lactose intolerance. Pancreatin Pancreatin plays a major role in the human digestive system. It is composed of different enzymes like amylases, proteases and lipases that hydrolyse food components and facilitate their digestion and assimilation in the intestinal tract. Used as a digestive aid.

Papain Papain is a proteolytic enzyme derived from papaya and certain other plants. It digests protein to give smaller peptides and amino acids. It is used as a digestive aid. Pepsin Pepsin is an excellent fibrinolytic and caseinolytic enzyme, which in combination with amylase and lipase, has proved to be a formidable digestive aid. It may be administered in acid solution to increase the digestive power of gastric juices, particularly where there is a deficiency of pepsin secretions. Used as a digestive aid. Amylase Amylase catalyzes the hydrolysis of alpha -1, 4- glycosidic linkages of polysaccharide to yield dextrins, oligosaccharides, maltose and glucose. Used to treat natural digestive enzyme deficiency. Hemicellulase Hemicellulase breaks down hemicellulose (a variety of polysaccharides) that are more complex than sugars and less complex than cellulose found in plant walls. Hemicellulase is often used in baking. Used as a supplement for digestive system and general nutritional support.

Alpha Galactosidase Alpha Galactosidase catalyzes the hydrolysis of terminal, non-reducable alpha D galactose residues in alpha galactosides, including galactose oligosaccharides, galactomanans and galactoloipids. Used as an anti flatulent food supplement. Hemostatic Agents: Ethamsylate Ethamsylate reduces bleeding time by improving platelet adhesion. It is a membranestabilising agent that acts on capillary walls and inhibits the individual prostaglandin-

specific enzyme in its synthetic pathway. Used in gynecological as well as surgical hemorrhagic conditions. Tranexamic Acid Tranexamic Acid is an anti-fibrinolytic agent. Used to treat serious bleeding, especially when it occurs after dental surgery (particularly in patients with hemophilia) or certain other kinds of surgery. Hepatoprotective Agents: L-Ornithine L-Aspartate L-Ornithine-L-Aspartate is a combination of two "conditionally-essential" amino acids, i.e. amino acids that are specifically needed under disturbed liver conditions. Used in the treatment liver disorders. Urso Deoxy Cholic Acid Urso Deoxy Cholic Acid is an oral gallstone solubilising agent intended for dissolution of radiolucent gallstones and to treat primary biliary cirrhosis. UDCA is a naturally occurring bile acid, found in small quantities in normal human bile that suppresses hepatic synthesis, secretion of cholesterol and the intestinal absorption of cholesterol. Used in the treatment liver disorders. Immunosuppressant: Mycophenolate Mofetil Mycophenolate Mofetil (MMF) is a pro drug for the immunosuppressive agent mycophenolic acid (MPA). It is an inosine monophosphate dehydrogenase (IMPDH) inhibitor. Used in conjunction with cyclosporine and corticosteroids for the prevention of transplant rejection in patients undergoing organ transplantation. Mycophenolic Acid Sodium Mycophenolate Acid Sodium, a mycophenolic acid prodrug, is an inhibitor of Tlymphocyte proliferation. Mycophenolic acid reduces the incidence of acute rejection in renal transplantation. Mycophenolate Acid Sodium is enteric coated and has been

suggested as a potential method to reduce the gastrointestinal adverse events seen with Mycophenolate Mofetil Tacrolimus Tacrolimus is a macrolide antibiotic that suppresses both cellular and humoral mediated immune responses. It specifically binds T cell receptors, inhibits cytokine production and IgE sensitivity. Used to lower the body's natural immunity in patients who receive organ transplants. Also a topical immunomodulator indicated for use in moderate to severe eczema. Sirolimus Sirolimus reduces organ rejection in patients receiving kidney transplants. To be used in combination with cyclosporine and corticosteroids and has been shown to significantly reduce rejection rates when compared to control regimens.

Pimecrolimus Pimecrolimus is a new topical steroid-free medication with immune-modulating and anti-inflammatory properties. It is an ascomycin macrolactam derivative. Pimecrolimus cream is used for mild to moderate atopic dermatitis. Everolimus Everolimus is an immunosuppressive agent used to prevent the rejection of organ transplants. Used in various Organ transplantation process. Gastro-Intestinal Agents: Prebiotics Prebiotics are nondigestible food ingredients that may beneficially affect the host by selectively stimulating the growth and activity of a limited number of bacteria in the colon. Prebiotics consist mainly of oligosaccharides, sugar molecules of 3 to 6 chains and soluble fiber. Prebiotic foods are vital to encourage probiotic organisms to survive

and thrive in the human gut. Used to treat constipation and hepatic encephalopathy. Probiotics Probiotics are cultures of live microorganisms that, when ingested in sufficient amounts, confer beneficial health effects on a host by improving the balance of the intestinal micro flora. Widely used to prepare fermented dairy products such as yogurt or freezedried cultures. Used to treat diarrhea, bloating and constipation. Neutraceuticals: Chondroitin Sulphate Chondroitin Sulphate is a glycosaminoglycan found in human cartilage and the cornea. It is a cartilage matrix enhancer, which is purported to prevent the breakdown and promote the rebuilding of cartilage. Treatment with Chondroitin leads to significant increases in hyaluronate concentration and the intrinsic viscosity of the synovial fluid. Used in the treatment of Osteoarthiritis. Glucosamine Sulphate Glucosamine Sulphate is one of several naturally-occurring 6-carbon amino sugars found in the body. Amino sugars are essential building blocks for mucopolysaccharides, mucoproteins, and mucolipids. The exact mechanism of action of Glucosamine has not been studied. Used in the treatment of arthritis.

MOLECULES USED IN SURVEY : ENOXAPARIN - Enoxaparin is a low molecular weight heparin marketed as Lovenox or Clexane. It is used to prevent and treat deep vein thrombosis or pulmonary embolism, and is given as a subcutaneous injection (by a health care provider or the patient). Its use is evolving in acute coronary syndromes (ACS). Enoxaparin is manufactured by Sanofi-Aventis and is derived from the intestinal mucosa of pigs.

ENOXAPARIN

SODIUM

STREPTOKINASE - Streptokinase is a protein produced by beta-haemolytic streptococcus and is used as an effective and inexpensive clot-dissolving medication in some cases of myocardial infarction (heart attack) and pulmonary embolism. It belongs to a group of medications known as fibrinolytics, and works by activating plasminogen through cleavage to produce plasmin. The half life of streptokinase is approximately 20 minutes (quoted in SPC). ATORVASTATIN - Atorvastatin (INN) (pronounced /əˌtɔrvəˈstætən/) (Lipitor, Pfizer), is a member of the drug class known as statins, used for lowering blood cholesterol. It also stabilizes plaque and prevents strokes through anti-inflammatory and other mechanisms. Atorvastatin inhibits HMG-CoA reductase, the rate-determining enzyme located in hepatic tissue that produces mevalonate, a small molecule used in the synthesis of cholesterol and other mevalonate derivatives. This lowers the amount of cholesterol produced which in turn lowers the total amount of LDL cholesterol.

Atorvastatin was first synthesized in 1985 by Bruce Roth while working at Parke-Davis Warner-Lambert Company (now Pfizer).With 2006 sales of US$12.9 billion, Lipitor is the largest-selling drug in the world.Lipitor is not the only statin; there are several other statins on the market

ATORVASTATIN

TELMISARTAN - Telmisartan (INN) is an angiotensin II receptor antagonist (ARB) used in the management of hypertension. It is marketed under the trade names Pritor or Kinzal (Bayer Schering Pharma), Micardis (Boehringer Ingelheim), Telma (Glenmark Pharma), Telday (Torrent Pharmaceuticals) and Teleact D by (Ranbaxy). The usually effective dose Telmisartan (Telso marketed by Mascot Health Series) is 40 mg once daily. Some patients may already benefit at a daily dose of 20 mg. In cases where the target blood pressure is not achieved, telmisartan dose can be increased to a maximum of 80 mg once daily.

TELMISARTAN

METAPROLOL - Metoprolol is a selective β1 receptor blocker used in treatment of several diseases of the cardiovascular system, especially hypertension. It is marketed under the brand name Lopressor by Novartis, and Toprol-XL (in the USA); Selokeen (in the Netherlands); as Minax by Alphapharm (in Australia), Metrol by Arrow Pharmaceuticals (in Australia), as Betaloc by AstraZeneca, as Neobloc by Unipharm (in Israel) and as Corvitol by Berlin-Chemie AG. A number of generic products are available as well. The active substance metoprolol is employed either as metoprolol succinate or metoprolol tartrate (whereas 100 mg metoprolol tartrate corresponds to 95 mg metoprolol succinate), respectively as prolonged-release or conventional-release formulation.

METOPROLOL

ROSUVASTATIN - Rosuvastatin is a member of the drug class of statins, used to treat high cholesterol and related conditions, and to prevent cardiovascular disease. Shionogi developed the product and the pharmaceutical company AstraZeneca markets it as Crestor. Rosuvastatin is available as Crestor in tablet form (5, 10, 20, or 40 mg) for oral administration. Tablets are pink, round or oval (40 mg), biconvex, film-coated, and imprinted with "ZD4522" and tablet strength.[1] Japanese approval is in the dose range of 2.5 mg to 20 mg; therefore, smaller dose tablet forms might also be available outside the United States. Note that 97% of worldwide sales have been at or below the 20 mg dose.

ROSUVASTATIN CALCIUM

RAMIPRIL - Ramipril (marketed by Sanofi-Aventis as Tritace and by King Pharmaceuticals as Altace) is an angiotensin-converting enzyme (ACE) inhibitor, used to treat hypertension and congestive heart failure. ACE inhibitors lower the production of angiotensin II, therefore relaxing arterial muscles while at the same time enlarging the arteries, allowing the heart to pump blood more easily, and increasing blood flow due to more blood being pumped into and through larger passageways.

Ramipril is a prodrug and is converted to the active metabolite ramiprilat by liver esterase enzymes. Ramiprilat is mostly excreted by the kidneys. The half-life of ramiprilat is variable (3-16 hours), and is prolonged by heart and liver failure, as well as kidney failure.

It is marketed by King Pharmaceuticals under the brand name Altace and was protected by the U.S. Patent 5,061,722 (was scheduled to expire on 29th Oct, 2008) assigned to Aventis. On September 11, 2007 in an appeal by Lupin Pharmaceuticals the United States Court of Appeals for the Federal Circuit reversed a district court trial verdict, finding that Aventis's patent on Altace was invalid for obviousness - opening the gate of this medicine to generic manufacturers.

RAMIPRIL

CLOPIDOGREL - Clopidogrel is an oral antiplatelet agent (thienopyridine class) to inhibit blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease. It is marketed by Bristol-Myers Squibb and Sanofi-Aventis under the trade name Plavix, by Sun Pharmaceuticals under the trade name Clopilet, by Ranbaxy Laboratories under the trade name Ceruvin. It works by irreversibly inhibiting a receptor called P2Y12. Adverse effects include hemorrhage.

Plavix is marketed worldwide in nearly 110 countries, with sales of US$5.9 billion in 2005. It had been the 2nd top selling drug in the world for a few years as of 2007 and was still growing by over 20% in 2007.

In 2006, generic clopidogrel was briefly marketed by Apotex, a Canadian generic pharmaceutical company before a court order halted further production until resolution of a patent infringement case brought by Bristol-Myers Squibb. The court ruled that Bristol-Myers Squibb's patent was valid and provided protection until November 2011.

Generic clopidogrel is also produced by several pharmaceutical companies in India at significantly lower retail prices, up to 1/30th of the price.

Counterfeit Plavix is in circulation, as with many popular medicines.

About cardiovascular diseases Cardiovascular disease refers to the class of diseases that involve the heart and/or blood vessels (arteries and veins). Heart attacks are a form of cardiovascular disease. Heart attacks are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. Strokes can also be caused by bleeding from a blood vessel in the brain or from blood clots. Cardiovascular diseases are among the leading causes of death across the world. The prevalence of chronic disease is showing an upward trend in most countries and for several reasons this trend is likely to increase. For one reason, life expectancy is increasing in most countries and a greater number of people are living to older ages and are at greater risk to chronic diseases of various kinds. For another, the life-styles and behavioral patterns of people are changing rapidly, these being favorable to the onset of chronic diseases. Modern medical care is now enabling many with chronic diseases to survive. The impact of chronic diseases on the lives of people is serious when measured in terms of loss of life, disablement, family hardship and poverty and economic loss to the country. Cardiovascular disease accounts for 16.7 million or 29.2 per cent of total global deaths in 2003. With modernization, a large proportion of Asians are trading healthy traditional diets for fatty foods, physical jobs for deskbound sloth, the relative calm of the countryside for the stressful city. Heart-attack victims are just the first wave of a swelling population of Asians with heart problems. While deaths from heart attacks have declined more than 50% since the 1960s in many industrialize countries, 80% of global cardiovascular diseases related deaths now occur in low and middle-income nations, which cover most countries in Asia.

RESEARCH METHODOLOGY Research methodology is a way to systematically solve the research problem. It includes the various steps that are generally adopted by a researcher in studying in the research problem along with reason behind them. According to Clifford Woody, “ research methodology comprises of defining and redefining the problem, formulating the hypothesis or suggesting the solutions, collecting, evaluating the data, making deductions and reaching to conclusion and at last carefully testing the conclusion to determine whether they fits the formulated hypothesis”.

TITLE OF STUDY: The title of the study is “market survey of various molecules of Biocon in AIIMS and other Hospitals”.

DURATION OF PROJECT:

6 weeks

OBJECTIVE: Cardiovascular has been a key therapy area for BIOCON and launching of a polypill is a major strategy towards strengthening their cardiovascular portfolio. The basic aim of the study is: 1. To find out about the market condition of cardiovascular drugs.

2. To determine the number of prescriptions of various molecules per week. 3. To determine the top three brands in cardio-polypill according to the chemists .

4. To determine the names of the doctors who are prescribing various pills. 5. To determine the source of purchasing of various chemists.

TYPE OF RESEARCH: The research done is descriptive in nature where researcher is aware of the problem.

SAMPLE SIZE AND METHOD OF SELECTING SAMPLE: Nineteen chemists near various hospitals and ten chemist in AIIMS were selected to collect the required information. The survey method was used to gather the primary data for the study. Based on the objectives of the study, the Standardized Questionnaires were distributed. We are having open ended questionnaires as this type of questionnaires give a concrete answer and based on the facts.

For this study populations of chemists from various hospitals were examined. The first were from the east region hospitals of Delhi and secondly chemists from south region were surveyed. This sample becomes more specific by limiting the chemists that are interviewed to those that specifically deal with cardio drugs.

SAMPLE DESIGN In this project non-probability sampling is being used. Here the sampling involves the selection of the sample based on factors other than random chance. The methods being used is convenience sampling. Since we have not been given a list of particular chemists that must be targeted therefore, we are able to target anyone that fits into our different sample populations. This type of sampling is of convenience

SCOPE OF STUDY India is undergoing an epidemiological transition and is on the threshold of an epidemic of cardiovascular disease. Cause-specific mortality data indicate that cardiovascular disease is already an important contributor to mortality. Demographic projections suggest a major increase in cardiovascular disease mortality as life expectancy increases and the age structure of the growing population changes. Surveys in urban areas suggest that coronary risk factors are already widespread and that urgent action is needed to prevent a further rise as socioeconomic development proceeds. Current projections suggest that by the year 2020 India will have the largest cardiovascular disease burden in the world. One fifth of the deaths in India are from

coronary heart disease. By the year 2020, it will account for one third of all deaths. Sadly, many of these Indians will be dying young. Heart disease in India occurs 10 to 15 years earlier than in the west. There are an estimated 45 million patients of coronary artery disease in India. An increasing number of young Indians are falling prey to coronary artery disease. This study would help in formulating the initial lunching and subsequent marketing strategies while taking into account a holistic view about the market condition. The polypill would be more effective as it would simultaneously reduce cardiovascular risk factors. This would mean success both for the company and also for patients.

LIMITATIONS OF THE STUDY 1. Some respondents did not provide authentic information. 2. Some respondents were reluctant to provide all essential information regarding their attitude towards the product.

3. Most of the chemists were not aware about the Biocon’s pollypills.

4. Time also proved as one of the constraints for the study.

5. The area of survey has been restricted to Delhi only. 6. The formidable heat was another constraint.

ANALYSIS AND INTERPRETATION For the analysis purpose, I have the South Region AIIMS in Delhi into various Chemists- . REGIONS IN DELHI

CHEMISTS COVERED

SOUTH (AIIMS)

BHUTANI’S MEDICOS, SOUTH DELHI MEDICOS, B.L & CO., TIRUPATI MEDICOS, HELPLINE CHEMIST, CHAWLA CHEMIST, SUPER CHEMIST, SAFDARGUNG MEDICOS, PARAS CHEMIST,

Survey of AIIMS BHUTANI’S MEDICOS

MOLECULES

PRODUCTS AVAILABLE

QUANTITY SOLD/WEEK

STREPTOKINASE

STREPTASE (UNITED BIOTECH), THROMBOSOL

1

ENOXAPARIN

CLEXIN (GSK)

70

ATORVASTATIN

STORVAS, ATORVAS

210

TELMISARTAN

TELISTAIR,TELMA

350

METAPROLOL

METOLAR

385

ROSUVASTATIN

ROSUVAS (RANBAXY)

35

RAMIPRIL

CARDACE

30

SOUTH DELHI MEDICOS

MOLECULES

PRODUCTS AVAILABLE

QUANTITY SOLD/ WEEK

STREPTOKINASE

THROMBOSOL, THROMBOFLOX (BHARAT SERUM)

28

ENOXAPARIN

CLEXIN (GSK)

42

ATORVASTATIN

STORVAS, ATORLIP (CIPLA), ESTER (S.P), LIPICURE (INTAS)

210

TELMISARTAN

TELMA

420

METAPROLOL

METOLAR, BETALOC

105

ROSUVASTATIN

ROSUVAS (RANBAXY),

56

RAMISTAR (LUPIN) CLOPIDOGREL

DIPLET

400

RAMIPRIL

CARDACE

40

MOLECULES

PRODUCTS AVAILABLE

QUANTITY SOLD/ WEEK

STREPTOKINASE

NOT AVAILABLE

0

ENOXAPARIN

CLEXIN (GSK)

7

ATORVASTATIN

STORVAS, ATORLIP (CIPLA), ESTER (S.P), LIPICURE (INTAS)

210

TELMISARTAN

TELMA

10

METAPROLOL

METOLAR, BETALOC

15

ROSUVASTATIN

ROSUVAS (RANBAXY), RAMISTAR (LUPIN)

4

RAMIPRIL

CARDACE

15

B.L & CO.

TIRUPATI MEDICOS MOLECULES

PRODUCTS AVAILABLE

QUANTITY SOLD/ WEEK

STREPTOKINASE

CHEMIKINASE

2

ENOXAPARIN

CLEXIN(GSK), CLEXIPARIN(SUNOFFY)

40

ATORVASTATIN

STORVAS, AZIRVA,ASTOR, LIPICURE(INTAS)

10

TELMISARTAN

TELMA

5

METAPROLOL

METOLAR, METPURE

4

ROSUVASTATIN

ROSUVAS (RANBAXY), RAMISTAR (LUPIN), BESTOR

4

RAMIPRIL

CARDACE

20

HELPLINE CHEMIST MOLECULES

PRODUCTS AVAILABLE

QUANTITY SOLD/ WEEK

STREPTOKINASE

STREPTOKINASE

1

ENOXAPARIN

CLEXIN(GSK), LMWX

5

ATORVASTATIN

STORVAS, ATORVAS

10

TELMISARTAN

TELMA

5

METAPROLOL

BETALOC

4

ROSUVASTATIN

ROSUVAS (RANBAXY),

4

RAMIPRIL

CARDACE, ZIGPRIL

1

CHAWLA CHEMIST

MOLECULES

PRODUCTS AVAILABLE

QUANTITY SOLD/ WEEK

STREPTOKINASE

STREPTOKINASE

2

ENOXAPARIN

CLEXIN(GSK),

4

ATORVASTATIN

STORVAS, ATORVAS

10

TELMISARTAN

TELMA

10

METAPROLOL

BETALOC

25

ROSUVASTATIN

ROSUVAS (RANBAXY),

9

RAMIPRIL

CARDACE, ZIGPRIL

25

CLOPIDOGREL

DIPLET, CLAVIX

30

SUPER CHEMIST

MOLECULES

PRODUCTS AVAILABLE

QUANTITY SOLD/ WEEK

STREPTOKINASE

STREPTOKINASE (U.B)

2

ENOXAPARIN

CLEXIN (GSK),

5

ATORVASTATIN

STORVAS, ATORVAS

10

TELMISARTAN

TELMA

28

METAPROLOL

BETALOC

15

ROSUVASTATIN

ROSUVAS (RANBAXY), RAZEL, CRESTOR

9

RAMIPRIL

CARDACE, RAMISTA

12

CLOPIDOGREL

DIPLET, CLAVIX, CLOPITAB

40

SAFDARGUNG MEDICOS

MOLECULES

PRODUCTS AVAILABLE

QUANTITY SOLD/ WEEK

STREPTOKINASE

THROMBOSOL

3

ENOXAPARIN

CLEXIN (GSK),

120

ATORVASTATIN

ATORVA, SYMBASTATIN

224

TELMISARTAN

TELMA

450

METAPROLOL

METOLAR, REVILOL

350

ROSUVASTATIN

ROSUVAS (RANBAXY)

60

RAMIPRIL

CARDACE, RAMISTA

20

CLOPIDOGREL

DIPLET, CLAVIX, CLOPITAB

84

PARAS CHEMIST

MOLECULES

PRODUCTS AVAILABLE

QUANTITY SOLD/ WEEK

STREPTOKINASE

THROMBOSOL

1

ENOXAPARIN

CLEXIN (GSK),

10

ATORVASTATIN

STORVAS, STATIX, METADOZ-1PR

28

TELMISARTAN

TELMA

35

METAPROLOL

METOLAR, BETALOC

42

ROSUVASTATIN

ROSUVAS (RANBAXY)

60

RAMIPRIL

CARDACE

10

CLOPIDOGREL

DIPLET, CLAVIX

10

From the above finding in AIIMS HOSPITAL , the average prescription per week for different molecules can be calculated as : Average prescription/week = Total quantity sold / week Total no. of chemists surveyed

MOLECULES

QUANTITY SOLD/ WEEK

STREPTOKINASE

4

ENOXAPARIN

31

ATORVASTATIN

77

TELMISARTAN

134

METAPROLOL

95

ROSUVASTATIN

28

RAMIPRIL

17

CLOPIDOGREL

57

It shows that the sales of ENOXAPARIN among inject-able drugs are maximum and that of TELMISARTAN is maximum among all oral molecules. As per the study of various chemists near AIIMS hospital, the top three brands are TELMA, STORVAS and METOLAR. Various doctors who prescribe these products are Dr. SANDEEP MISHRA, DR. R.K. MARYA, DR. GAUTAM NAGAR, DR. S. SETH, DR. B. BHARGAVA, DR. S. RAMAMURTHY, DR. S. MISHRA, DR. N. NAYAK, DR. G. KARTHIK, DR. D. PRABHAKARAN, DR. R. YADAV, DR. SANDEEP SINGH, DR. GAUTAM SHARMA and DR. R. NARANG. According to chemists of AIIMS, their source of purchasing is central purchasing from A.R. LAB, KOTLA, and R.K/D.R distributors.

FACTS AND FINDINGS By the extensive market analysis done, it is clear that various established brands like SUN-PHARMA, RANBAXY, GLAXOSMITH KLINE, CIPLA, LUPIN and INTAS are giving tough competition to BIOCON in cardiology division in Delhi. Some points as a brief of findings are: 1. Since it has been only one year for the Biocon to come up with its various pills in cardiology department in NCR region, its sales was not so impressive compared to other competitors. 2. According to the information provided by most of the chemists, most of the pills were getting expired. 3. Most of the chemists were unaware of the all products of Biocon. The sales of only Atorvastatin molecule i.e. statix was satisfactory among all the molecules. Various products of Biocon are-

MOLECULES

BIOCON’S PRODUCT

STREPTOKINASE

MYOKINASE

ENOXAPARIN

DYNALIX

ATORVASTATIN

STATIX

TELMISARTAN

TELISTA

METAPROLOL

ACTIBLOCK-IPR

ROSUVASTATIN

BESTOR

RAMIPRIL

ZIGPRIL

4. Some chemists have flat out refused to answer the questionnaire once they

discovered that it was on the behalf of Biocon.

5. Less promotional activities From the analysis done earlier, it is revealed that sales of Clexin (Glaxo smith cline) is maximum among inject-able drugs, similarly that of Rosuvas (Ranbaxy), Atorva (Ranbaxy) and storvas among oral products.

CONCLUSION As we know that BIOCON is a very big organization and ranks first in Asia in terms of revenues and market capitalization and sixteenth globally but its sales in in cardiology products in Delhi is not satisfactory since it has been only one year for the company to

come up with its cardio products. Doctors have believed in Biocon’s product and they will prescribe its products also if effective actions will be taken.

The survey resulted into following conclusions:  Biocon must come up with new promotional activities such that doctors

become aware about its new products.  Quality is the dominating aspect which influences consumer to purchase

product, but prompt availability of other pharma brands and aggressive promotional activities by others influences the consumer towards them and also leads to increase sales.  In comparison to Biocon, the other players such as Sun-pharma, Ranbaxy,

GSK, Intas etc. provide a better availability at retail outlet and give competition to the hilt.  Doctors are mostly satisfied with the overall quality of Biocon products, but for

the existence in the market Biocon must use aggressive selling techniques.

RECOMMENDATIONS AND SUGGESTIONS After analyzing and interpreting the response gathered in the process of survey work, certain conclusions were reached. On the basis of these, certain recommendations are being proposed which in my view may help the company in formulating future strategies for BIOCON products:

1. It has been concluded that awareness level of BIOCON products is less than expected in Delhi, which leaves a large room for betterment. This is because company has low level of promotional activities , which is required to build up its image among the customers (doctors) 2. The company should try to reconcile its sales by awarding some monetary benefits to its sales people so they recommend more to doctors. 3. The company should sponsor any contest like quiz program on T.V. This will work automatically as an advertisement for its products. 4. Biocon should give national advertisements apart from the advertisements given at the local level. 5. Try and change the perception of the doctors through word of mouth about

Biocon’s products.

APPENDIX

CHEMIST QUESTIONNAIRE: 1. How many Prescriptions are coming per week of BIOCON Product?

2. Which Doctor is prescribing the most of the product of BIOCON?

3. Who are the competitors of BIOCON?

4. Which molecules of BIOCON are mostly prescribed by the Doctor’s?

5. In near AIIMS which are the most competitor of BIOCON product?

6. Through which sources you were collecting the BIOCON product?

PATIENT SATISFACTION SURVEY IN BHIWADI: INTRODUCTION OF PATIENT SATISFACTION: This patient satisfaction survey is conducted by BIOCON and WARIS (WELLNESS AND RADIAL INTERVENTION SOCIETY Helping people, saving lives).

Definition : The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. Survey shows many doctors find the management of atrial fibrillation difficult and patients are unaware of the risks, complexities and treatment for this most common of heart rhythm disorders. June 8, 2009: Four leading patient and medical associations announced today the formation of AF AWARE (Atrial Fibrillation Awareness and Risk Education), a joint initiative to highlight and address issues that contribute to the growing burden of atrial fibrillation (AF) worldwide. AF is a common yet under-recognized and poorly understood abnormal heart rhythm that is associated with poor quality of life, substantial numbers of hospitalizations, increased risk of severe and potentially fatal cardiovascular complications such as stroke, as well as death. Marking the start of World Heart Rhythm Week, the World Heart Federation (WHF), Atrial Fibrillation Association (AFA), Stroke Alliance For Europe (SAFE), and European Heart Rhythm Association (EHRA) have come together to call upon their peers around the world to raise awareness and understanding of AF and its cardiovascular consequences.

Atrial fibrillation (AF), is the most common cardiac arrhythmia (abnormal heart rhythm) seen by doctors. It is a fast growing public health concern currently affecting an estimated seven million people in the USA and Europe alone and it is expected to double by 2050, reflecting the growing proportion of elderly individuals.1,2 AF results from abnormal electrical activity in the upper chambers of the heart (atria), leading to an irregular heart rhythm which prevents the blood from efficiently being pumped toward the rest of the body1. Common symptoms of AF include palpitations (a rapid, irregular, “flopping” movement or pounding sensation in the chest), shortness of breath, dizziness and feeling of heaviness in the chest3. “Patients with AF, have a substantially lower quality of life than healthy individuals as a result of their condition. If left untreated, they are at higher risk of experiencing stroke or other cardiovascular complications, which can have serious and debilitating consequences” said Trudie Lobban, CEO of the AFA. "As AF carries a fivefold increase in the risk of stroke, the risk of death or severe morbidity is considerably increased as well. In addition patients who have a stroke and have AF often have a worse prognosis compared to patients without AF." Age, obesity, hypertension, myocardial infarction (MI), congestive heart failure (CHF) and valvular heart diseases4 put patients at increased risk of developing AF and AF itself worsens the prognosis of patients with cardiovascular risk factors.4,5 “Very few people truly understand the real and significant impact of atrial fibrillation.” Said Professor Günter Breithardt, from the WHF “There is an urgent need for better

information for patients. AF AWARE aims to expose the poor understanding of this complex disease and to help healthcare professionals, patients, policy makers and the

General public understand that comprehensive management of AF should address its multiple impacts.” Results from an AF AWARE international survey of more than 1600 cardiologists and patients in 11 countries, confirm that patients need a better understanding of AF, its consequences and management options. Despite the nature and risks of AF, [one in four] patients in this survey said he or she did not understand and could not explain what AF is and [only a third] were worried or fearful about having AF. Patients indiscriminately rated all risks of complications as high and confirmed the significant impact of AF on their quality of life and ability to conduct day to day activities. Many patients in the survey preferred to receive information about AF from their cardiologists and primary care practitioners than from any other source. However, the majority of cardiologists ([61%]) in the survey said their patient’s needed more and better information on AF: they rated the quality of patient education materials for AF as inferior to that available for other common cardiovascular diseases, heart attack, hypertension, high cholesterol, diabetes and stroke. “AF patients need much better information about their disease and doctors can play a central role in providing this help.” Said Professor Vardas, president-elect of EHRA. “These results indicate that AF patients may feel resigned about living with this illness and its complications. World Heart Rhythm Week and AF AWARE are opportunities for us to come together to improve patients’ experience of living with AF through awareness and education.”

For the clinicians, the survey also showed that AF is a challenging disease to manage, placing increased strain on healthcare systems. Previous research has shown that AF

represents one third of hospitalizations for arrhythmia1 and that 70 percent of the annual cost of AF management in Europe is driven by hospitalization care and interventional procedures.6 In this survey, patients visited a doctor nearly nine times ([8.9 times]) a year for AF management. A key concern highlighted in this survey was the average delay of [2.6] years between the onset of symptoms and diagnosis. “These findings confirm the need for greater awareness and education about atrial fibrillation. It is a common condition and growing public health concern, with serious Consequences for patients and their families. Early identification and treatment of AF could help to reduce the risk of serious cardiovascular complications associated with this disease” said [insert local spokesperson from AF AWARE]. “In order to address the full impact of the disease we call upon the medical profession and our peers to increase awareness of the disease and improve patient education.”

Research methodology: Title of the study: Patient satisfaction survey in BHIWADI. Duration of the project: 6 weeks Objective: To find out the cardiac and other chronic patient in particular area of BHIWADI. Type of Research: Descriptive Sample size: The size of the sample is 300 but 54 of them are suffering from cardiac and other chronic disease. Method of selecting sample: Primary Data: The survey method was used to gather the primary data for the study. Based on the objectives of the study, the Standardized Questionnaires were distributed. We are having open ended questionnaires as this type of questionnaires give a concrete answer and based on the facts. Sampling Design In this project non-probability sampling is being used. Here the sampling involves the selection of the sample based on factors other than random chance. The methods being used is convenience sampling.

SAMPLE OF PATIENT SATISFACTION SURVEY REPORT: NAME

AGE

SEX

DISEASE

RISK FACTOR

Mr. SANJAY GUPTA Mr. AMIT KAPOOR Mr. D.C.SETH

38

M

CARDIAC

40

M

CARDIAC

HIGH B.P.

66

M

CARDIAC

HIGH B.P.

Mrs. ASHA SETH Mrs. CHARU KAPOOR Mr. VIVEK SHARMA Mr. PRDEEP CHATURVE DI Mr. ASHISH GUPTA Mr. UJLA KATOCH Mr. SURESH AGARWAL Mr. SURESH KUMAR Mr. VEERAT

60

F

CARDIAC

HIGH B.P.

36

F

CARDIAC

HIGH B.P.

36

M

CARDIAC

SMOKING

38

M

CARDIAC

32

M

CARDIAC

SMOKING

49

M

CARDIAC

HIGH B.P.

52

M

CARDIAC

61

M

CARDIAC

49

M

CARDIAC

DIABETES , SMOKING HIGH B.P., HIGH LIPID HIGH B.P.

Mr. U.B. PANT

68

M

CARDIAC

HIGH B.P., HIGH LIPID

OTHER CHRONIC AL ILLNESS

DIABETES , ASTHAMA

Mr. ROBIN

50

M

CARDIAC

DIABETES

Mr. SUDESH DOGRA Mrs. USHADEVI SHARMA Mrs. V.LAKSHMI SHARMA Mr. COLONAL K.K. SHARMA Mr. SHARAD JAIN Mr. RAMESH TOMAR Mr. VIVEK GOYAL Mrs. VANDANA SHARMA Mr. UMAKANT SHARMA Mr. PAWAN

57

M

CARDIAC

83

F

CARDIAC

57

F

CARDIAC

HIGH B.P.

58

M

CARDIAC

SMOKING

39

M

CARDIAC

HIGH B.P.

54

M

CARDIAC

39

M

CARDIAC

SMOKING

37

F

CARDIAC

HIGH LIPID

42

M

CARDIAC

HIGH B.P.

42

M

CARDIAC

Mrs. KALPANA SHARMA Mrs. RENU CHATURVE DI

34

F

CARDIAC

HIGH B.P., HIGH LIPID HIGH B.P., HIGH LIPID

34

F

CARDIAC

Mr. G. PRAVEEN KUMAR Mr. SANDEEP RASTOGI

48

M

CAREDIAC

52

M

CARDIAC

ASTHAMA

SMOKING

Mr. GAURAV CHIOKAR Mrs. MANGLA NAND JHA Mr. SOMNATH PANDEY Mr. N.N. KAUSHIK Mr. P.R. VASHISHT

41

M

DIABETES

38

F

CARDIAC

56

M

DIABETES

49

M

CARDIAC

51

M

CARDIAC

Mr. M.K.DIXIT Mr. D.D. DUA Mr. G.S. BAMRAH Mr. Y.P. VERMA Mr. SANJEEV BHATIA Mr. S.K. GUPTA Mrs. SEEMA Mr. VIVEK PATHAK Mr. M.K. AGARWAL Mrs. SUNITA Mr. H.K. GOYAL Mr. RAJESH KUMAR Mr. AMIT PANDEY Mr. SANJAY KATIYAR Mr. MANISH KUMAR

47

SMOKING, HIGH B.P. HIGH B.P., HIGH LIPID

CARDIAC M

54

CARDIAC

HIGH B.P.

48

M M

CARDIAC

39

M

CARDIAC

58

M

CARDIAC

HIGH B.P.

47

M

DIABETES

HIGH B.P.

CARDIAC

LOW B.P.

41 53

F M

CARDIAC

48

M

DIABETES

HIGH B.P.

53

F

CARDIAC

DIABETES

49

M

DIABETES

38

M

CARDIAC

SMOKING

56

M

CARDIAC

45

M

CARDIAC

HIGH B.P., SMOKING SMOKING

49

M

DIABETES

HIGH LIPID

JAIN Mrs. VANDANA SHRIVASTA VA Mr. PRASHANT TIWARI Mr. P.D. PAHUJA Mr. J.K. YADAV

57

F

CARDIAC

48

M

CARDIAC

SMOKING

51

M

CARDIAC

58

M

CARDIAC

HIGH B.P., SMOKING HIGH B.P.

DIABETES

ANALYSIS AND INTERPRETATION: NUMBER OF PATIENT OF DIFFERENT AGE SUFFERING FROM CARDIAC AND DIABETES: AGE 31-40 41-50 51-60 61-70 71-80

FEMA CARDI DIABET MALE LE AC ES 9 5 12 2 15 1 14 2 12 4 15 1 3 0 3 0 0 1 1 0

INTERPRETATION: Here in this pie and bar graph it shows that the female of different age in particular area suffering from cardiac and diabetes.

INTERPRETATION: Here in this pie and bar graph it shows that the male of different age suffering from cardiac and diabetes

INTERPRETATION: Here in this graph 43% are suffering from cardiac and 7% are suffering from diabetes in the total population of age between 31-40yrs.. INTERPRETATION: Here in this graph 44% are suffering from cardiac and 6% are suffering from diabetes in the total population of age between 41-50yrs.

INTERPRETATION: Here in this graph 47% are suffering from cardiac and 3% are suffering from diabetes in the total population of age between 51-60yrs.

INTERPRETATION: Here in this graph 50% are suffering from cardiac and 0% is suffering from diabetes in the total population of age between 61-70yrs

INTERPRETATION: Here in this graph 50% are suffering from cardiac and 0% is suffering from diabetes in the total population of age between 71-80yrs

Total patient Male and Female suffering from cardiac and diabetes

INTERPRETATION: In this graph it shows different ages of persons suffering from cardiac and diabetes.

Scope of study: By the help of patient survey report we can easily find out the average of particular area suffering from cardiac and other chronic disease, with this report we reduce the cardiac problem of patients by proper diagnosing and treatment by various technology such as “By-pass surgery, By pacemaker or by medicines prescribed by the cardiologist”

Limitation of study: Unawareness of patients regarding to there health Lack of knowledge Unavailability of past data

Facts and findings: • •

•

Depending upon my questionnaire I got that many person don’t know about the risk factor of there disease and its symptoms. According my study I found that the patients who is in between the age of 60-80 yrs have less chance of curing from cardiac disease because of there weak heart which can’t be operated or transplanted or by having By-pass surgery. By having survey is the best hedging instrument which reduce the heart attack of person due to awareness of there disease and by treatment through best cardiologist.

ANALYSIS: By having survey I analyze that person suffering from cardiac disease is more in the particular area in Bhiwadi in comparison to person suffering from Diabetes or other chronic disease.

CONCLUSION: Through my study I reached to the point that the Male cardiac patients are more in comparison to female in that particular area of BHIWADI. Some of the persons of that area are also suffering from other chronic disease which is less in comparison to cardiac.

Recommendation and suggestion Patient should be check up regularly in time to time by there cardiology doctor. Medicine should be taken by the patients in prescribe time. Proper healthy food should be taken by the patient

INTERPRETATION: In this graph it shows the patient of different age suffering from cardiac disease in particular area in BHIWADI.

INTERPRETATION: In this graph it shows that patients suffering from cardiac as well as his/ her Risk Factor and Other Chronic illness.

APPENDIX

PATIENTS HEALTHY QUESTIONNAIRE: DATE: NAME: AGE: SEX: ADDRESS: ……………………………………………………………………………………… …………………………………………………………………………………………………… …………………………………………………………………………………………………… … MOBILE NO. .………………………………. TELEPHONE NO………………………….. RISK FACTOR Diabetes M,

(Tick those present) High BP,

Family H/O, High Lipid,

Smoking

Other Chronic Illness if any: Medicines: Family Dr’s name:

Survey by: Varun Kumar

Referred by: Dr.S.K.Chugh Biocon Ltd.

BIBLIOGRAPHY: 1.

www.google.co.in

2.

www.scribd.com

3.

www.biocon.com

4. Research methodology (Harper W. Boyd, C.R. Kothari)

5. Marketing research and report preparation by- N.K. MALHOTRA

6. http://www.henrystewart.com/conferences/january2005/N05655/ programme.html