WMP Project - Women's Health Market Opportunity

Part
01
of ten
Part
01

US Market Overview - Fertility and In-Vitro Fertilization

The average baby IVF costs $40,000 to $60,000 which most people pay for out-of-pocket. This has encouraged entrepreneurs and investors to define their work as healthcare democratization and increased access, all while positioning themselves for increased revenue. The driving force behind the growth of this trend is the age at which women are choosing to start their families.

Market and Statistics

  • According to a Fortune Magazine article published on January 21, 2020, “Piper Sandler research puts the U.S. fertility market at $15.4 billion by 2023, up from almost $7 billion in 2017. Millennials, now the primary demographic having babies, are aging into fertility treatment and are set to reshape the space in the same ways they’ve transformed so many other parts of our economy.”
  • Statistics show that pregnancy resulting from IVF is associated with an increased risk of complications when compared to naturally conceived pregnancies. For this reason, some insurance plans include in vitro fertilization (IVF), but not the associated injections sometimes necessary. Some insurance companies include minimal attempts at specific treatments. And there are plans that do not cover IVF at all. 15 states mandate fertility treatment. Out of the 15, only 5 have an IVF insurance mandate.
  • Increasing the attention of the key players in the United States is primarily expected to contribute to market growth. The per capita health care expenditure in the area is steadily growing, which is expected to boost growth. Increased occurrence of gynecological disorders coupled with delayed pregnancy fueling the demand in women. Besides, the increase in the number of technological advances in IVF procedures, along with the emphasis and major players' investments, is expected to provide many opportunities for future market development. Consequently, the IVF services market is expected to grow rapidly during the US forecast period.
  • In 2017 there were 422 IVF related businesses in the United States.

Economic Variables

  • Much of this variance is due to the medical risks of more invasive courses of action, but much is down to costs. While many insurance plans will cover an initial consultation on fertility, coverage for further care is less common.
  • Infertility was declared a disease by the American Medical Association in 2017. The association expressed hope in the overview of the decision that the new designation would encourage insurance coverage and reimbursement, and alleviate some stigmas.
  • Resolve advocates and the American Society for Reproductive Medicine hope the designation of the American Medical Association will help them get states to pass laws mandating coverage of infertility.

Part
02
of ten
Part
02

US Market Overview - Peri-Menopausal Women's Health Services

97% of commercial insurers and almost all state Medicaid programs provide peri-menopausal coverage, while the three biggest payors in the market are Express Scripts, Anthem, and Aetna.

Peri-menopausal women's health services market

  • According to the American Journal of Obstetrics and Gynecology, it is estimated that 400,000 hysterectomies are performed each year in the US. Additionally, around 6,000 women in the U.S. are estimated to reach menopause each day, totaling at 2 million per year.
  • North America is known to be the leader of the global hormonal replacement therapy market with a 45% share out of the total revenue earned by the market in 2018.
  • The hormonal replacement therapy market has "conventionally stuck to the oral administration of hormones, but this is changing now with improved drug delivery systems, with some newer methods of drug delivery of hormonal replacement therapy include transdermal, intravenous, intravaginal, and intrauterine ways."
  • Peri-menopausal treatment is estimated to equal to more than $2,100 per woman per year in added costs on the healthcare system and overall economy in the US. Vasomotor Symptoms (VMS), which more than 70% of women experience, adds an additional $600 in costs per year.
  • The three most common conditions regarding peri-menopause are depression with $71 billion in healthcare costs annually, hypertension with $68 billion in healthcare costs annually, and osteoporosis with $9 billion in healthcare costs annually.
  • According to a recent survey done by the American Association of Retired Persons, only 20% of women in the US received a referral to a menopause specialist after displaying systems. Additionally, of the 60% of women who seek medical attention, around 75% are left untreated.
  • 97% of commercial insurers and almost all state Medicaid programs provide peri-menopausal coverage.
  • As of 2019, three of the top ten commercial payers, Express Scripts, Anthem, and Aetna, have been leading the market of commercial health insurance when it comes to peri-menopausal health.
Part
03
of ten
Part
03

US Market Overview - Non Maternal Women's Health Services

60% of women get their insurance through employers, and the three biggest payors for women's health services in the US are Blue Cross Blue Shield, Anthem, and Kaiser Foundation.

Non maternal women's health services market

  • Around 58.6 million women ages 19-64 (amounting to 60%) had their health coverage come from employer-sponsored insurance in 2018.
  • Women in families that have at least one full-time worker are highly likely to have job-based coverage (71%) compared with women in families with only part-time workers (33%) or without any workers (18%).
  • While 60% of women get their insurance through work, 17% get it through Medicaid, 11% are uninsured, and 8% use the direct purchase option for the insurance.
  • The three biggest payors for women's health services in the US are Blue Cross Blue Shield, Anthem, and Kaiser Foundation.

Birth control market

  • The US female contraceptive market is estimated to grow at a CAGR of 8.5% from 2019 to 2023.
  • According to Centers for Disease Control and Prevention (CDC) data, it is estimated that around 194,377 babies are born to women, aged 15-19 years, for a birth rate of 18.8 per 1,000 women, annually.
  • Female contraceptives currently occupying the market include oral contraceptives, contraceptive injections, topical contraceptives, spermicides, female condoms, diaphragms and caps, vaginal rings, contraceptive sponges, sub-dermal contraceptive implants, intra uterine contraceptive devices (IUCDs), copper IUCDs, and hormonal IUCDs. Oral contraceptives occupy almost 40% of the market.
  • In 2018, 43 million women in U.S. were considered to be at the risk of unintended pregnancy. Additionally, 19.5 million women are considered to be lacking access to healthcare centers that offer a full range of contraceptive methods.
  • Female contraceptives dominate around 80% of the $7 billion contraceptive market, amounting to $5.6 billion (0.8 x $7 billion = $5.6 billion).

Preconception planning market

  • The US prenatal vitamin supplements market is estimated to be worth $377.2 million in 2018, with the capsules segment holding the largest share of the market.

Check ups market

  • The global women’s health diagnostics market size was valued at around $43.5 billion in 2018, with North America occupying 30% of the total market, which amounts to $13.05 billion (0.3 x $43.5 billion = $13.05 billion).
Part
04
of ten
Part
04

US Market Overview - Maternal Health Services

Approximately 3.9 million births take place in the US every year, and 43% of all of those are paid for by Medicaid.

Key Findings

  • Medicaid is the largest payer of maternal care services in the United States, paying for 43% of all births (3.9 million) in the country in 2017. However, Medicaid's maternal health coverage typically only extends to 60 days after birth.
  • Since the implementation of the Affordable Care Act (ACA) in 2014, maternity coverage is mandatory for all health insurance plans. Prior to this law, only 12% of individual market insurance plans included maternity care, and these plans typically included a 30% bump in premiums. Pregnancy was also considered a pre-existing condition which could be used as grounds to deny someone health insurance prior to the ACA.
  • Approximately 4 million women give birth every year in the United states, and the country spends a total of $98 billion on childbirth alone.
  • Opportunities in maternal health care are expected to expand in 2020 as awareness rises about the high maternal mortality rates in the US; "Spurred by reports finding that the United States has the worst maternal health outcomes in the developed world, there is newfound interest in government, on the campaign trail and among providers to improve the overall cost and quality of maternal health care."
  • One proposed solution is a bundled payment model, in which long-term maternal care would be bundled into a one-time payment at the beginning of the maternal care period, regardless of the extent of care needed by the mother. This type of model "would better encourage providers to collaborate across settings and stages of women’s health care and to proactively manage conditions that could lead to dangerous complications and unnecessary costs. "
  • Healthcare payers Medicaid, United Healthcare, Cigna, and Humana are leading the way in maternal health care services. All three companies have already launched programs to innovate in this market, testing new ways to pay for maternal care to improve outcomes.
  • One area of opportunity and innovation in this market is digital health care, which can make maternal health care more accessible. Maternal health startup Maven is one example; the company provides "online healthcare support from more than 1,200 providers across the U.S., including OB-GYNs, nutritionists, therapists, lactation counselors, pediatricians and career coaches." The company grew by a factor of 14 in 2018 and secured a $27 million investment, demonstrating the potential in this segment.
Part
05
of ten
Part
05

US Market Size - Fertility and Invitro Fertilization Services

The total US infertility market size is $5.87 billion. The IVF market makes up $4.47 billion of that market. An overview of the fertility and IVF market sizes can be found below.

Fertility Clinics

  • The US market size of fertility clinics is $2.2 billion.
  • The market grew at a CAGR of 3.5% between 2015 and 2020.
  • There are about 480 fertility clinics in the US.
  • There are about 1,700 licensed reproductive endocrinologists in the US.

In-Vitro Fertilization

  • The US market size of IVF services is expected to reach $4.47 billion by 2022.
  • The market is growing at a CAGR of 10.6% from 2017 to 2022.
  • There are approximately 263,000 IVF procedures performed each year.
  • IVF produces approximately 50,000 live births each year in the US.

Related Findings

  • The total US infertility market size is about $5.87 billion.
  • The infertility market is growing at a CAGR of 7%.
  • The US market size of fertility drugs is between $600-$700 million and is growing at a CAGR of 6%.
Part
06
of ten
Part
06

US Market Size - Peri-Menopausal Women's Health Services

While there was no market size statistic for the United States menopausal healthcare services market available in the public domain, the research team estimates the size of the market to be $4.31 billion.

MARKET SIZE & STATISTICS

  • The size of the menopausal health services industry--includes perimenopause, menopause, and postmenopause stages--in the US is estimated to be $4.31 billion.
  • According to AARP's survey, for 44% of women aged 40-89, the "primary source of information about menopause" are their doctors or healthcare providers.
  • According to the North Americal Menstrual Society, around 75% of women "experience some kind of menopausal distress".
  • The average outpatient-visit cost for vasomotor symptoms (VMS) patients is $395.
  • There are 10.9 million women in the US that are presently consulting a healthcare provider for menopausal symptoms.
  • Severe menopausal symptoms usually last up to 7 years.
  • Most women experience menopause between the ages of 45 and 55; perimenopause typically starts in the 40s.
  • World over, 75% of women experience "Vasomotor Symptoms (VMS), including hot flashes and night sweats".

RESEARCH STRATEGY

We began by searching research reports, government databases, and industry portals for the market size of the menopausal healthcare services market. While we were able to find several statistics related to menopause, there was no data publicly available on the market size. However, we used statistics from across sources to triangulate the size of the United States menopausal services market:

Number of Women Presently Consulting a Doctor for Menopausal Symptoms

According to AARP's survey, for 44% of women aged 40-89, the "primary source of information about menopause" are their doctors or healthcare providers. Severe menopausal symptoms typically last for 7 years. And most women experience menopause between the ages of 45 and 55.

The group consulting or having consulted a doctor is the largest in the 50-59 age group (50%). The average age of menopause is 51 years. While the women presently consulting doctors are likely to be dispersed across the 40+ age group, for the purpose of triangulation, we have assumed that they are typically 50-56 years (7-year range around the average age).

The number of women aged 50-56 in the US is 21,802,000 (10,682,000 + 40%*11,120,000); the distribution of population across all ages in the 55-to-59-year group has been assumed to be even. As 50% of the women aged 50-59 consult a doctor, the number of women presently consulting a doctor for menopausal symptoms is 10,901,000 (50%*21,802,000).

Average Per-Patient Outpatient Visit Cost for Menopausal Symptom Treatment

According to Sarrel and colleagues, in 2015, the average annual healthcare costs of VMS patients was $1,346 higher than non-VMS patients, of which VMS-specific direct costs were $423. Outpatient visits accounted for a large part ($395) of the direct costs. Another estimate pegs the "per-patient direct cost of menopausal symptoms", not accounting for the cost of prescribed medicines, at $248 in 2010–2012 dollar terms. We have used the more recent estimate ($395) for our calculations.

Market Size of Healthcare Services for Menopausal Women

Therefore, the size of the menopausal health services market in the United States is approximately 4,305,895,000 ($395*10,901,000).


Part
07
of ten
Part
07

US Market Size - Maternal Women's Health Services

The size of the United States obstetrics/gynecology and neonatal-perinatal services market is $93.19 billion.

Market Size for Maternal Health Services

  • According to Merritt Hawkins, the average salary of an obstetrics/gynecology physician is $324,000.
  • The average annual revenue generated by obstetrics/gynecology physicians for the hospitals they work for is $2,024,193.
  • Therefore, obstetrics/gynecology physicians generate annual revenues 6.25 times ($2,024,193/$324,000) their salaries for the hospitals they work for.
  • According to Doximity, the average salary of a neonatal/perinatology physician is $317,000.
  • According to the "AMA Physician Masterfile (December 2017)", there are 41,619 obstetrics and gynecology physicians in the United States and 5,526 neonatal-perinatal physicians.
  • Assuming neonatal-perinatal physicians also generate revenues 6.25 times their salaries, the total revenue generated by obstetrics/gynecology physicians and neonatal-perinatal physicians is $93.19 billion ($2,024,193*41,619+$317,000*6.25*5,526).
  • Therefore, the market size for obstetrics/gynecology and neonatal-perinatal services is $93.19 billion.

Additional Information

  • According to the Busines Research Company, the size of the United States gynecologists market is $506.6 billion. The market comprises three segments: gynecologic oncologist, urogynecologist, and reproductive endocrinologist.
  • According to Ibis World, the size of the United States "Gynecologists & Obstetricians" industry is $24.4 billion.

Research Note

We searched research reports; government websites such as the CDC; and industry portals such as the American College of Obstetricians and Gynecologists, and the American Medical Association. While we did not find any reports specific to the maternal health services industry in the US, we found a few related to gynecologists and obstetricians. However, the overviews of the reports did not provide any data on the maternal services segment. Also, there wasn't complete clarity on what the reports covered and seemingly great disparity (based on report overviews literature) in the statistics published in the reports. Given these limitations, we attempted triangulating the market size. While we were able to estimate the size of the obstetrics/gynecology and neonatal-perinatal services market, we did not find any statistics on the proportion of revenue the maternal services segment generates. Therefore, the market size estimate provided also includes revenue generated by an ob-gyn from services other than maternal health.
Part
08
of ten
Part
08

US Market Size - Adolescent/Young Adult Women's Health Services

Introduction

The US non-maternal women's health services industry far surpasses spend in men's health, with women often requiring more care for reproductive health needs. While there were no public figures on the market size of non-maternal women's health services specifically as it pertains to adolescents and young adults, we were able to triangulate existing data to estimate a market size that would allow one to gain an understanding of market opportunity in this segment of the industry, which you'll find below.

Market Sizing

  • The total health care spend in the US in 2018 was estimated at $3.6 trillion.
  • Women spend an estimated 21% more than males on health services.
  • Given this, we can estimate that female spend was approximately $1.9 trillion.
  • While there was not exact data showing adolescent and young adult spend, one report shows that female children age 0-18 represented 9% of total female healthcare spend, and working age female adults (19-64) also represented approximately 62% of total female healthcare spend.
  • From this we can estimate that 71% of total healthcare spend market is adolescent and adult females of reproductive age, or $1.3 trillion. (Calculation 62+9= 72% x $1.9 trillion)
  • In order to provide an estimate of what was non-maternal services, we also found a figure on the spend in the US on maternal care, approximately $111 billion per year.
  • From this, we can estimate that the market for adolescent and adult female health services that are non-maternal is approximately $1.19 trillion (calculation: $1.3 trillion - $111 billion = $1.189 trillion).
However, please be aware that no data was publicly available to differentiate this by young adults vs. older adult women. We did however find the following additional relevant data to offer further insight into the market opportunity in this segment of the industry:

Additional Relevant Data

Research Strategy

In order to provide an estimated market size for US non-maternal women's health services, we first examined industry reports and government data. Finding no direct data to this specific segment, we then continued to seek data points from healthcare reports, government sources, and industry sources that would allow us to provide an estimate. This included combining data points on overall health care spend, gender based data, and age based data, to gain an estimate of the market size and thus potential market opportunity in this space.




Part
09
of ten
Part
09

US Market Overview - Neonatal Intensive Care Services

Medicaid dominates the neonatal intensive care services market as the primary payor for the NICU services as of 2018.

Neonatal intensive care services market overview

  • Neonatal intensive care (NIC) is estimated to cost around $26.2 billion a year in the United States. It is considered to be an expensive but also a cost effective service.
  • According to academic research, "while the costs of care have an inverse relationship with gestational age (GA) and the lifetime medical costs of the extreme preterm can be as high as $450,000, the total NICU expenditure are skewed towards the care of moderate and late preterm infants who form the main bulk of patients."
  • The cost for an infant stay at a hospital averaged $2,500 — $2,900 with an average of duration of stay being 2.2 days, and $800 for an uncomplicated newborn. For preterm babies that require NICU services, the costs for the most extreme preterm cases vary from $12,910 to $297,627, and climb to $11,640 to $149,101 for very preterm babies.
  • According to The Guardian, the average cost of the stay for the baby at the NICU is $10,000.
  • The Dartmouth Atlas of Neonatal Intensive Care reported in 2019 that the number of neonatal intensive care beds in the U.S. grew by 65% from 1995 to 2013.
  • Neonatal intensive care unit stays are considered to be very expensive. The cost for the average stay was around $56,000 for patients covered by commercial health plans, and over $39,000 among Medicaid beneficiaries, according to a 2017 study published in the journal Pediatrics.
  • At some academic medical centers, NICU care can make up only 4% of total hospital admissions but account for as much as 69% of net profits.
  • The primary payors for NICU stays were commercial/managed care payors (45.3%), medicaid (49.5%), and self-pay and other assistance (2.8%).
Part
10
of ten
Part
10

Market Size - US Neonatal Intensive Care Services

The US market size of the neonatal intensive care services is estimated to be $1.77 billion.

US neonatal intensive care services

Research methodology

According to World Health Organization data, there are 712,300 cases of neonatal intensive care unit services in North America (517,400 in the US + 29,000 in Canada + 165,900 in Mexico = 712,300). By using this data, we were able to calculate the share of the cases recorded in the US as follows:
  • 517,400 / 712,300 = 72.64% of registered cases of neonatal intensive care unit services in North America were recorded in the US
North America is estimated to hold 38% of the total neonatal intensive care market, while the global neonatal intensive care market was valued at $6.39 billion in 2018. Therefore, we were able to calculate the share of the North American market as follows:
  • 0.38 x $6.39 billion = $2.43 billion (North American market size)
By using this data, we applied the share of the registered cases of neonatal intensive care unit services in the US to the North American market size:
  • 0.7264 x $2.43 billion = $1.77 billion (US market size)
Sources
Sources

From Part 01
From Part 06
Quotes
  • "A woman has reached menopause when she has not had a period for 12 months in a row. This often happens between 45–55 years of age."
Quotes
  • "Vasomotor Symptoms (VMS), including hot flashes and night sweats, are experienced by approximately 75% of them."
  • "Research estimates that menopausal women experiencing VMS had 121% higher utilization of healthcare resources and nearly 60% more work productivity loss days compared to women without symptoms."
  • "This equals to over $2,100 per woman per year in added costs on the healthcare system and overall economy."
  • "The additional healthcare burden of menopausal women experiencing VMS is approximately $660 billion globally; the burden on the economy due to productivity losses can total over $150 billion. The combined total is more than $810 billion."
  • "According to findings from a survey conducted by the American Association of Retired Persons in 2017-18, only 1 in 5 women in the US received a referral to a menopause specialist. Of the 60% of women who seek medical attention, an appalling 75% of them are left untreated."
Quotes
  • "Nearly one-third of American women ages 40 to 89 don’t receive any information about menopause, according to the national sample of 1,509 women. "
  • "When they do, 44% say physicians and health care providers are their primary resources."
  • "AARP found women have a range of emotions about entering menopause: 31% report feeling indifferent, while 20% are concerned, 18% relieved, 17% anxious and 14% depressed. "
  • " Just 50% of all women surveyed by AARP report ever having discussed menopause with their health care provider and only 35% of women age 40-49 have done so."
  • "About 75% of women who discussed menopause with their provider say their health care provider offered to treat their menopause symptoms and 62% say their provider discussed hormone therapy with them. Only 15% of those surveyed say they needed treatment for symptoms and pursued it but did not receive it. "
  • "This online survey of 1,509 women age 40-89 was fielded in April 2018 using AARP’s online proprietary panel. "
Quotes
  • "Approximately 6,000 women in the U.S. reach menopause each day. By 2020, 50 million women will be postmenopausal. According to NAMS, about 75 percent of women experience some kind of menopausal distress. And for some 20 percent of these women, symptoms — in particular hot flashes and night sweats — are severe enough to interfere with just about every meaningful aspect of their lives: sleep, work and relationships. Severe symptoms typically last up to seven years; 15 percent of women who have hot flashes suffer with them for more than 15 years. "
Quotes
  • "Over eight in ten (81%) women age 40-89 have experienced menopause symptoms, either in the past or currently. "
Quotes
  • "The annual per-patient direct cost of menopausal symptoms was $248 in 2010–2012 dollars."
  • "In another analysis, the annual direct costs of VMSs were estimated at $1346 per person, and the annual indirect costs, primarily resulting from absenteeism, were estimated at $770 per person."
  • "In another analysis comparing women who had no menopausal symptoms with those who did, the women with menopausal symptoms had $1343 higher overall direct costs, $457 higher prescription drug costs, $48 more sick leave costs, 0.27 more sick leave days annually, lower hourly productivity rates by 2 units of work, and lower annual productivity rates by 2600 units of work."
  • "The annual direct per-person costs of menopausal symptoms (excluding prescription drug costs) in our analysis ($248) are conservative compared with the costs reported in a recent analysis by Sarrel and colleagues ($423)."
  • "Women in the VMS group had $1346 higher all-cause annual direct costs and $423 higher annual VMS-specific direct costs than the non-VMS group."
  • "The main driver of VMS-related costs was again outpatient visits ($395 higher for women with VMS vs women without VMS) followed by pharmacy costs ($33 higher for women with VMS)"
  • "The lower costs found in our analysis compared with those of Sarrel and colleagues may be attributable to differences in the populations studied and the claims databases used, and that we did not include prescription drug claims. (However, given that pharmacy costs were only $33 in their analysis,17 those costs do not account for the entire difference between their results and ours.) The costs in our analysis are expressed in 2010, 2011, and 2012 US dollars without adjustment; in their analysis, all costs were expressed in 2011 US dollars."