1. PARIOFORMA
Summary Report
October 2007
Parioforma Ltd
55 Princes Gate
London SW7 2PN
United Kingdom
www.parioforma.com

2. PARIOFORMA
 61 face-to-face interviews in hospitals across Russia:
◦ Respondent breakdown:
 Head of Pharmacy: 79%
 Doctors/ Clinical Pharmacologists: 13%
 Clinical Pharmacists: 3%
 Head Nurses responsible for buying: 5%
 12 interviews with top managers in Russian companies
 8 interviews with distributors
 8 interviews with Western companies
 8 interviews with the Ministry
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
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3. PARIOFORMA
• Estimated at ~USD $75 mln in 2006
Total Market: Basic solutions (by value)
$140
$120 Basic solutions sales by value, mln. USD
$100
$80
$60
$40
$20
$0
2001 2002 2003 2004 2005 2006 2007 (E) 2008 (F) 2009 (F) 2010 (F) 2011 (F)
NB: Includes imports and domestic manufacturing but not In-house production
NB: In-house production not included. Source: RMBC sales audit, Diamond-Vision import data, ex-manufacturer prices calculated assuming average
wholesaler margin = 25% and VAT = 10%.Packs recalculated in litres
§ For a list of solutions included under each heading see appendix
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
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4. PARIOFORMA
Total Market: Basic solutions (by volume)
60 $2.5
50
$2.0
Ex-manufacturer price in USD
40
Sales in mln litres
$1.5
30
$1.0
20 Basic solutions sales by volume, mln. litres
Basic solutions price per litre, USD $0.5
10
0 $0.0
2001 2002 2003 2004 2005 2006 2007 (E) 2008 (F) 2009 (F) 2010 (F) 2011 (F)
NB: In-house production not included. Source: RMBC sales audit, Diamond-Vision import data, ex-manufacturer prices calculated assuming
average wholesaler margin = 25% and VAT = 10%.Packs recalculated in litres
Equivalent price per litre used
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
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5. PARIOFORMA
DRIVERS: RESTRAINERS:
• Substitution of hospital in situ • Hospitals financially constrained
production
• Infusion solutions under-funded
• Change of medical practice
• Variations in funding
• Price increases
• Lack of market education
• Increased volumes of more expensive
commercially produced solutions
• Expanding economy
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
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6. PARIOFORMA
• Market for basic solutions is dominated by domestically manufactured solutions
45
40
35
30
Mlns, litres
25
20 Domestic Basic Solutions
15 Imported Basic Solutions
10
5
0
2004 2005 2006
Source: RMBC sales audit, Diamond-Vision import data, ex-manufacturer prices calculated assuming average wholesaler
margin = 25% and VAT = 10%.Packs recalculated in litres
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
www.parioforma.com

7. PARIOFORMA
 38% of hospitals interviewed continue to produce infusion solutions in-
house
 The bulk of production is composed of NaCl and glucose (~80%)
 Main reason for the decline in in-hospital production is the increasing
restrictions by RosZdravNadzor
 The majority of respondents agreed that in-hospital production would
continue to decline over the next 5 years
 Respondents noted that the decline in in-house production will be
accompanied by a switch to manufactured solutions
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
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8. PARIOFORMA
• Most infusion solution sales go through hospital tenders
• Pharmacy sales are direct patient purchases
Pharm acy vs. Hospital Sales of Basic IVs in Pharm acy vs. Hospital Sales of Plasm a
m ln litres 2006 Expanders in m ln litres 2006
19%
Through pharmacy sales 32% Through pharmacy sales
Through hospital sales Through hospital sales
68%
81%
Source: RMBC sales audit, expert opinion
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
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9. PARIOFORMA
DRIVERS: RESTRAINERS:
• Cheaper to utilise polymer line (for • Preference for glass persists
new entrants)
• Glass recycled for in-house
•Transportation of glass costly and production
complicated
• Majority of domestic players continue
• Special features to offer glass
• More convenient to use • Upfront unit cost
• Rigid plastic replicates the form of • Poor quality of domestically produced
glass PVC
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
www.parioforma.com

10. PARIOFORMA
 200ml and 400ml dominate
100%
90%
80%
70% 100 ml
60% 1000 ml
500 ml
50% 250 ml
400 ml
40%
200 ml
30%
20%
10%
0%
2004 2005 2006 2007 (F) 2008 (F) 2009 (F) 2010 (F) 2011 (F)
Source: RMBC sales audit, Diamond-Vision import data, RMC/Aston estimates
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
www.parioforma.com

11. PARIOFORMA
• Estimated at ~$23 mln in 2006
Total market: Plasma Expanders
$50
$45
$40
Plasma Expanders sales by value, mln. USD
$35
$30
$25
$20
$15
$10
$5
$0
2001 2002 2003 2004 2005 2006 2007 (F) 2008 (F) 2009 (F) 2010 (F) 2011 (F)
*
Source: RMBC sales audit, Diamond-Vision import data, ex-manufacturer prices calculated assuming average
wholesaler margin = 25% and VAT = 10%.Packs recalculated in litres
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
www.parioforma.com

12. PARIOFORMA
DRIVERS: RESTRAINERS:
• Increased financing of hospitals • Financial constraints
• Increasing complexity of surgeries • Variations in funding
• Developing private healthcare • Price sensitivity
• Heavy investment in sales & • Market education required
marketing of branded product
manufacturers
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
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13. PARIOFORMA
• Domestic solutions dominate by volume
• Market moving in favour of imported solutions by value - reflecting marketing efforts
Domestic Plasma Expanders Domestic Plasma Expanders
5 $25
Imported Plasma Expanders Imported Plasma Expanders
4 $20
Mlns Litres
$ Mlns
3 $15
2 $10
1 $5
0 $0
2004 2005 2006 2004 2005 2006
Source: RMBC sales audit, Diamond-Vision import data, ex-manufacturer prices calculated assuming average
wholesaler margin = 25% and VAT = 10%.Packs recalculated in litres
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
www.parioforma.com

14. PARIOFORMA
 200ml and 400ml dominate
100%
90%
80%
70%
100 ml
60% 450 ml
50% 250 ml
500 ml
40%
200 ml
30%
20%
10%
0%
2004 2005 2006 2007 (F) 2008 (F) 2009 (F) 2010 (F) 2011 (F)
Source: RMBC sales audit, Diamond-Vision import data, RMC/Aston estimates
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
www.parioforma.com

15. PARIOFORMA
 Premixes are used rarely
 Novocaine was the most frequently purchased ready-mixed solution by study
respondents
 The second most frequent class was anti-infectives/ anti-bacterials
DRIVERS: RESTRAINERS:
• Increased financing of hospitals • Financial constraints
• Safety • Limited availability
• Time efficiency • Variations in funding
• Developing private healthcare • Price
• No market education
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
www.parioforma.com

16. PARIOFORMA
Basic Solutions Plasma Expanders
Sodium Chloride Starches 6%/ 10%
Dextrose Dextrans
Ringer’s Acetate/ Quintasol Gelatins
Ringer’s solution Polyvinylpyrrolidon (PVP)
Mannitol/ Mannit
Hartmann’s Solution NB: Blood products were outside the scope of the study
Acesolum
Disolum
Trisolum
Chlo-salt
Mafusol
Sodium Bicarbonate
Calcium Chloride
Potassium Chloride
Parioforma Ltd – 55 Princes Gate – London SW7 2PN – United Kingdom
www.parioforma.com

17. PARIOFORMA
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