Among all the corporate presentations at the 2025 J.P. Morgan Healthcare Conference, one small graphic from Roche (page 7), along with its purpose statement of “Doing now what patients need next”, stood out. The analysis was of how Roche’s product portfolio stacks up against global disease burden, both now and 10 years in the future. In prioritizing areas of unmet need that are growing due to demographic, economic, and technological shifts, Roche is positioning itself not just for the next year, but rather for the next generation. But how do the efforts of the wider industry compare?
The latest numbers and estimates from the influential Institute for Health Metrics and Evaluation (IHME) suggest that the burden of disease will rise globally. As measured by disability-adjusted life years (DALY), the sum of all diseases reached a total impact of 2.7 billion in 2022, and will rise to 3.1 billion by 2050. We encourage you to look at the Global Burden of Disease study in greater depth.
Within these totals, unmet need is shifting. Our first figure aims to visualize this, plotting the current burden of disease against the expected increase in the next decade (a reasonable pharma investment timeframe). The complex, three-tiered hierarchy that IHME uses has been simplified and mapped to therapeutic areas that form the basis of Norstella’s disease taxonomy, akin to how pharma companies classify their portfolios. This separates out the high- and low-burden categories against their expected growth, with the averages creating four discrete quadrants.
Source: IHME; Norstella analysis
Of the major therapeutic areas that pharma caters to, cardiovascular disease has the largest collective DALY footprint, slightly ahead of infectious diseases. This is actually a recent reversal, as the dramatic improvement in COVID-19 outcomes has reduced the footprint of infectious diseases. Throughout the next decade, continued progress in access to vaccines and anti-infectives will see a further 20% reduction in DALYs. Conversely, cardiovascular diseases will see a 9% greater burden and represent a growth market, for the want of a better word.
This increase in disease burden – around the average of all major pharma TAs – is rather modest when compared to other pharma R&D focuses. Metabolic diseases, oncology, and central nervous system disorders all share the unwanted dual characteristics of a large (>250 million DALYs) and fast-growing (>15% increase) societal impact. It is little surprise that these three therapeutic areas receive the most investment and research activity, as we will show in the next analysis.
Elsewhere in the chart, musculoskeletal, sensory, and respiratory disorders are all expected to increase at notably above-average rates. These represent opportunities for drug development to have a notable benefit, but without the same competitive intensity as the categories in the upper right quadrant. Genitourinary diseases, blood disorders, and dermatology are all lesser therapy areas, but will increase in prominence over the next decade.
The non-pharma category refers to diseases and causes of disability that are not applicable to the pharmaceutical industry. The most burdensome in terms of DALY impact are neonatal disorders, while road traffic accidents, falls, and violent conflict also fall within this grouping.
In our next analysis, the IHME projections are overlaid with biopharma industry pipeline data, sourced from Citeline’s Pharmaprojects. The rationale is that the pipeline of today should be designed for the needs of patients in 10 years, considering standard drug development timelines. And in the whole, the pipeline is well matched to the scale of unmet need. Most therapy areas lie close to the line depicting perfect matching of R&D investment to unmet need.
Source: IHME; Citeline, Pharmaprojects; Norstella analysis
The two exceptions are two of the largest therapy areas, with opposing biases. The degree of investment and clinical development within oncology is exceptional, with a pipeline that greatly exceeds those of other TAs. The separation of oncology from the rest of the pack began in the early part of last decade and concerted investment has yielded considerable clinical progress in subsequent years. A combination of factors has enabled this, from scientific advancements (e.g. immune checkpoints, next-gen sequencing), new drug innovation (CAR-Ts, ADCs), and favorable reimbursement, all leading to a strong return on investment.
On the opposite end of the spectrum, cardiovascular has a much larger burden than is served by pharma’s pipeline. With less than 1,000 clinical-stage drugs, the likelihood is that current efforts will be insufficient to address the tremendous societal impact that cardiovascular diseases cause. Looking at it from another angle, there is considerably more room for the companies that operate in this space to improve patient outcomes and capture market share.
Larger companies, whose portfolios span several therapy areas and budgets allow for pivoting via deal-making, can apply such analyses in a tactical way. This is something Roche has done, communicating to investors that its priority therapy areas all grow notably above average, and that its total portfolio addresses >60% of the total burden of disease. This positions the company not only for today, but also in response to the needs of patients in the future. It would be an interesting exercise to compare a large pharma peer set on these metrics; perhaps one for us to explore in the future.
Smaller companies will not have the luxury of aligning portfolios in such a broad way. Nevertheless, their decision makers will find it worthwhile to quantify the evolution of unmet need in their own targeted areas at a more granular level. The choice of prioritizing one individual disease over another is a multi-factorial decision, and one in which societal burden should be considered.
We would like to close with another quote, again from Roche but in the personal capacity of former CEO Bill Burns who held the helm between 2001 and 2009. “Good medicine will always be good business” was an experience and mantra that he shared in accepting the Lifetime Achievement Award at the 2024 Scrip Awards.
This holds true regardless of company size, corporate strategy, and therapeutic focus. It is important to consider the path to commercialization and profitability for new therapies, but this cannot come at the expense of medical benefit. After all, there are plenty of examples that disprove the inverse statement, and good business is not always good medicine.
VP Thought Leadership | Norstella
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