Market size for a world-first Dengue antiviral

2 Oct

Kimer Med is developing a pipeline of broad-spectrum antiviral drug candidates. As a lead indication, we’re working towards a world-first antiviral treatment for Dengue fever, a disease that ranks in the top 10 of global public health problems.

In spite of the obvious need - the enormous suffering and the economic burden caused by this disease - we often get asked why we’ve chosen Dengue as our first target.

To support this business decision, we set out to estimate global case numbers from the epidemiological burden data in order to establish the market size and commercial opportunity for an effective Dengue therapeutic.

Reliably estimating Dengue case numbers has proved to be challenging, for reasons which this article will expand on. Here we attempt to accurately quantify what is both a significant commercial opportunity and a meaningful way to reduce the suffering of millions of people by providing a much-needed, and currently unavailable antiviral treatment for Dengue.

A brief introduction to Dengue

Dengue fever is a mosquito-borne illness caused by a virus. It's prevalent in tropical and subtropical regions around the world and is characterised by symptoms such as high fever, headache, rash, pain behind the eyes, and joint and muscle pain. While most people recover within a week to ten days, some will develop severe Dengue that can lead to complications like bleeding and organ impairment, requiring hospitalisation.

Dengue is rarely fatal, but because there are so many infections globally, it still causes tens of thousands of preventable deaths each year, mostly among children under five years old and the elderly. [1]

It’s worth noting that the impacts of Dengue extend far beyond health. It affects family finances, national economies, workforce productivity, tourism, and social equity, while also causing psychological stress and hindering long-term economic development. A Dengue outbreak can cause a significant and measurable reduction in a country’s GDP, as evidenced by a 2019 outbreak in Thailand that shaved an estimated US$1.8 billion off the national economy. [2]

Establishing the market size

Diagnosed and officially reported Dengue cases numbers often significantly underestimate the actual number of infections. Epidemiological burden data can provide a more accurate picture, and includes not only case numbers but also estimates of actual infections (including unreported ones), severity distribution, hospitalisation rates, geographic spread, and the overall impact on population health (morbidity, mortality, economic costs). This fuller picture is essential to accurately gauge the potential patient population and assess demand, as well as the wider potential impact of a Dengue antiviral.

The challenges of estimating Dengue case numbers

Accurately recording the number of Dengue cases worldwide is beset with challenges, leading to persistent uncertainty about the exact scale of the problem.

The main problems are summarised below:

1. Diagnostic difficulties

Dengue’s clinical symptoms often mimic those of other fever-causing illnesses common in the same regions, such as chikungunya, Zika, and influenza. This, combined with a lack of highly sensitive point-of-care diagnostics, makes accurate identification of dengue cases difficult, especially in low-resource settings. As a result, many cases either go undiagnosed or are misclassified as other diseases.

2. Under-reporting and surveillance gaps

Many countries where Dengue is endemic lack robust detection and reporting systems. Even where disease surveillance exists, reporting delays are common, due to the multi-layered process of data collection and transfer from regional clinics and hospitals to national health authorities. In some regions, only a fraction of cases are ever officially reported and surveillance often misses cases that do not result in hospitalisation or laboratory confirmation. This means official figures can often dramatically under-report true infection numbers.

3. Lack of defined standards

There is no universal standard for classifying dengue cases, and so practices vary widely between countries, and even within regions. Some systems rely on clinical diagnosis alone, while others require laboratory confirmation. The introduction of rapid diagnostic testing (such as NS1 antigen tests) has improved detection in some places, but disparities in access and implementation persist. This variability complicates efforts to track case numbers across countries, or over different time periods.

4. Limited access to healthcare

Many individuals with Dengue do not seek medical care, particularly those with mild symptoms or limited access to healthcare. This is especially true among marginalised populations, who are often most affected by Dengue but least likely to access treatment, or be captured in official statistics.

5. Epidemiological and social factors

Rapid urbanisation, changing weather patterns and the increased movement of people and goods are expanding Dengue’s reach, sometimes outpacing the ability of surveillance systems to track new outbreaks. Additionally, the co-circulation of multiple dengue serotypes and other arboviruses further complicates diagnosis and reporting.

The combination of these factors means that official or reported Dengue case numbers likely represent only a fraction of the true burden. In fact, it’s been estimated that the actual number of cases may be anywhere from 3 times, to over 500 times higher than official reports, depending on the country and disease surveillance methods employed.[3]

Recent historical estimates

In spite of these challenges we have to start somewhere, and recent historical case number estimates provide that starting point.

In 2009 the World Health Organisation (WHO) published ‘Dengue - Guidelines for Diagnosis, Treatment, Prevention and Control’ in conjunction with the Special Programme for Research and Training in Tropical Diseases (TDR). [4]

It reported the following:

Dengue is the most rapidly spreading mosquito-borne viral disease in the world
In the last 50 years, incidence has increased 30-fold
An estimated 50 million dengue infections occur annually
Approximately 2.5 billion people live in Dengue endemic countries.

Four years later in 2013, a study called The global distribution and burden of Dengue was published in Nature that drew new conclusions about Dengue case numbers. [5]

Drawing on an exhaustive compilation of known records of Dengue occurrence worldwide, coupled with a complex modelling framework, the authors arrived at an estimate of 390 million Dengue infections per year, of which 96 million manifest with symptoms, and noted, “This infection total is more than three times the Dengue burden estimate of the World Health Organization.”

(It's worth noting here that the proportion of total infections (390 million) to symptomatic infections (96 million) is around 4:1 or 25%)

Likely due to this upward revision, the WHO now reports similar numbers to those presented in the 2013 Nature study. A WHO Fact Sheet from April 2024 states, “About half of the world's population is now at risk of dengue with an estimated 100–400 million infections occurring each year”. [6] The Fact Sheet lists the 2013 Nature article as the source for these case numbers.

In 2023, Kimer Med carried out an extensive analysis of the size and spread of the Dengue market, compiling a 102 page report that included detailed case studies of 20 countries where Dengue is endemic.

The report’s author noted the 2013 numbers, (390 million infections, 96 million symptomatic cases) and made the comment that based on population growth between 2013 and the present day (2023), and the increasing spread of dengue, these numbers could be proportionately re-estimated at around 450 million infections and 126 million symptomatic cases.

It was also noted that the earlier study on the prevalence of Dengue estimates 3.9 billion people are at risk of infection annually, but based on the evidence of increasing geographic spread and prevalence, a significantly higher figure of 5.2 billion could now be estimated. Looking to the future, it has been estimated that 63% of the world’s population (approx. 6.5 billion people) will be at risk in 2080. [7]

Current estimates of Dengue numbers

At the time of writing (Sep 2025), the most recent analysis on Dengue numbers was published in May of the same year, analysing trends in the global burden of Dengue from 1990 to 2021 using data from the ‘Global Burden of Diseases, Injuries, and Risk Factors Study’ (2021). [8]

Whilst acknowledging (in somewhat understated fashion) that “true incidence may exceed reported numbers” the authors conclude that “the global burden of dengue approximately doubled during the study period, with the global incidence surging from 26.45 million to 58.96 million cases and the number of related deaths climbing from 14,315 to 29,075 between 1990 and 2021.” [9]

In many ways, the findings of this study highlight the inherent challenges of trying to source accurate Dengue case numbers. While the reported numbers of deaths in 2021 (29,075) sits comfortably alongside other credible sources, (the WHO, CDC and World Mosquito Program all estimate actual Dengue deaths at between 21,000 and 36,000 annually), the global incidence figure of 58.96 million is well below other recent estimates and closer to the WHO’s 2009 number of 50 million.

Where does that leave us?

Given the current challenges and systemic limitations, it remains unlikely that we will be able to determine an accurate number for Dengue cases in any one year. At best, a large range may have to suffice, and currently, the numbers most often cited are the 2013 estimates of around 100 to 400 million, with approximately 25% of those cases symptomatic, at 96 million (or 126 million in today’s terms).

Based on our own analysis, the consensus around reported numbers, and adjusting for population growth, Kimer Med used the following figures in our July 2024 Series A pitch deck market size slide:

Total Addressable Market (TAM): 450 million cases

Serviceable Available Market (SAM): 126 million clinical cases needing treatment

Serviceable Obtainable Market (SOM) 6.3m (5% of clinical cases)

Understanding the whole picture

As mentioned earlier, we need much more than just an estimate of case numbers to generate a useful understanding of the size of this market opportunity. It’s also important to understand our potential customers as well as existing treatment options for supportive care, growth forecasts, distribution factors, and pricing and reimbursement methods.

And while determining the market for a product that does not yet exist creates additional challenges, we can at least test the validity of an antiviral market size prediction against the current dengue treatment market. Supportive care (hydration and pain relief) provided in a clinical setting (such as a hospital) currently makes up the bulk of this segment, given the absence of any licenced or approved antiviral treatment option.

Severe dengue and hospitalisation rates

Dengue can progress from a mild, symptomatic infection to severe dengue which requires hospitalisation and can result in organ failure and ultimately, death. It’s helpful to have an understanding of these factors, and how they affect the market, as it’s likely that any antiviral treatment would be administered in a clinical setting initially.

Severe dengue (dengue haemorrhagic fever) is seen in about 4 to 5 percent of reported symptomatic cases. Although most infections are self-resolving, the warning signs associated with complications arise late in the course of the disease, making them difficult to predict. Hospitalisation can then occur both as the result of disease progression, or as a precautionary measure.

Not surprisingly, hospitalisation rates are highly variable at between 20 percent to more than 50 percent of cases, and vary significantly depending on geographic factors, admission criteria, disease severity, demographics and accessibility to healthcare. Higher rates tend to be seen during major outbreaks and in areas where hospital admission is used for close monitoring as a precaution.

Case studies demonstrate that hospitalisation costs are considerably higher than outpatient care, and that private care is more expensive than government or insurance-supported care, which is as expected.

The length of time patients are hospitalised also varies, and tends to fluctuate depending on age and disease severity, with studies consistently reporting around 3 to 5 days of inpatient care as typical.

To estimate the commercial opportunity for a dengue antiviral, we have extrapolated from the most credible epidemiological burden data, based on our workings as follows:

1. Market segmentation

Total infections:

We accept the consensus view on global range as 100–400 million infections annually, with the range adjusted upward to a high end of 500 million, based on population growth in the intervening years.

Clinical cases:

Here we use the 25% symptomatic rate; e.g., 25–125 million clinical cases per year.

In general, we expect that asymptomatic cases will not present for treatment or be given a therapeutic. There is, however, a scenario whereby a therapeutic with a protective (prophylactic) function could be widely administered to both symptomatic and asymptomatic persons to reduce the spread of an outbreak. We address this scenario later.

Hospitalisations:
Hospital admission rates range from 20–50% for symptomatic cases but are highly variable. Patients hospitalised because of severe dengue may be past the point where an antiviral can be effective, whereas those hospitalised as a precaution should benefit from treatment.

• Lower end: 25 million cases x 20% hospitalised = 5 million

• Upper end: 125 million cases x 50% hospitalised = 62.5 million

2. Clinical need and market uptake

Current standard of care:

There is no specific antiviral for dengue. Treatment mainly consists of careful monitoring and supportive care, such as IV hydration, pain and fever medications.

Potential uptake:
Only a fraction of symptomatic patients will realistically access and pay for an antiviral, especially in resource-limited settings. However, many dengue-endemic countries have publicly funded healthcare systems and private insurance providers, so we should expect to see a mixture of publicly-funded and private purchase of antivirals.

Here we suggest an initial 5% uptake of clinical cases (25–125 million). This equates to:

• Lower end: 1.25 million doses

• Upper end: 6.25 million doses

3. Pricing

Current cost of care:
Hospitalisation costs for dengue patients are regularly studied, and are typically in the range of US$220–820 in low and middle income countries (LMICs), and significantly higher in private markets, such as the U.S., where treatment can cost around US$7,000. These figures are for routine, non-ICU hospitalisations; costs are much higher if intensive care is needed. [10]

Potential antiviral price:

Although it is too early in the development process to accurately price our products, we need to settle on a number, or numbers, to calculate a market value. Once again there’s no ‘one price fits all’ - rather it’s likely there’ll be differential pricing across a variety of markets, influenced by factors such as local income levels, subsidisation, public health funding, and the perceived risk of Dengue.

By way of comparison, during the Covid-19 pandemic, the U.S. government paid US$529 for a course of Paxlovid, and the same drug was later priced by Pfizer for ongoing commercial sale at US$1,390. [11] Paxlovid is currently sold in New Zealand for around NZ$2,000, but fully subsidised by the government if you meet certain criteria. Another Covid antiviral, Remdesivir, was initially priced at around US$3,000 per course in wealthy counties, while Molnupiravir was priced at US$700 per course in the U.S., but sold for about US$200–300 in LMICs.

At this stage, we will use a cost of US$360 per course (one dose per course). This price point is justified by health economics, and falls well below the average cost of hospitalisation and supportive care in LMICs. It is also in line with antiviral pricing globally yet can be adjusted for low-income endemic countries if needed, via government subsidies or differential pricing strategies.

Base Dengue market size estimate:

At US$360 per antiviral dose, even treating a small fraction of clinical cases yields substantial annual market value. (Here we also add a mid-range figure)

• 5% of clinical cases (lower end) 1.25 million x $360 = US$450 million

• 5% of clinical cases (mid-range) 3.75 million x $360 = US$1.35 billion

• 5% of clinical cases (higher end 6.25 million) x $360 = US$2.25 billion

Other factors to consider:

Protective administration multiples the market size
In outbreak settings, one person with confirmed Dengue infection means there’s likely to be 3 others with asymptomatic infection - all acting as a reservoir to spread the disease. A protective administration of our antiviral to close contacts (i.e. family members) or even entire neighbourhoods would serve to limit infections and flatten the outbreak trajectory. This scenario could result in a market multiplier of anywhere from three times to upwards of ten times.

Stockpiling for pandemic preparedness

Assuming storage and stability requirements are met, antivirals can be stockpiled for seasonal preparedness in high risk areas. More than half the world’s population is currently at risk from dengue, which is spreading into new areas, and stockpiling would allow a more rapid response to outbreaks, reducing infection rates and hospitalisations.

Antiviral stockpiling is commonplace already. During the Covid pandemic, the Australian government stockpiled around 1.8 million doses of covid antivirals. The New Zealand government amassed 1.3 million doses of flu antivirals during the 2009 H1N1 pandemic, and the U.S. government has a target of 81 million courses of antivirals for their Strategic National Stockpile.

4. Market size validation

The economic burden of Dengue has been well studied, and a comprehensive analysis published in The Lancet Infectious Diseases (2016), estimated the total annual global economic burden of Dengue at US$8.9 billion (falling within a range of US$3.7–19.7 billion). [12]

Hospital admissions account for 18% of this burden, which equates to about US$1.6 billion (range: $666 million–$3.5 billion). Another report suggest the current market for treatment (including both vaccines and hospital-delivered supportive care) was around US$2.1 billion in 2024 and growing rapidly (11.6% CAGR). [13]

These figures provide a useful comparison to our estimates for the reach and market value of a new antiviral treatment.

5. Forecast market growth

Changing climate and weather patterns, urbanisation, rising global case numbers, and expanding at-risk populations could drive market growth well beyond initial adoption rates.

Rapid and unplanned urban expansion is creating ideal breeding conditions for Aedes mosquitoes, leading to higher dengue transmission in newly urbanised areas, particularly those with poor infrastructure, high population density, and inadequate water management. [14]

In fact, urbanisation is a robust driver of dengue outbreaks across Latin America, Asia, and Africa, and climate change further increases transmission potential by extending mosquito habitats and altering seasonal disease patterns.

In recent years, the Asian tiger mosquito (Aedes albopictus), a key dengue vector, has expanded rapidly across Europe, and is now established in multiple regions, including southern, central, and western Europe. Local outbreaks are becoming more frequent and intense with climate change accelerating mosquito survival and viral transmission. [15]

This convergence of factors has produced persistent outbreaks and record-breaking dengue incidence in recent years around the globe, reinforcing the market’s growth trajectory.

Conclusion:

The above workings, although still subject to important uncertainties, present a robust and defendable estimate of the addressable market. While the urgent medical need is undeniable, this market size analysis points to the commercial opportunity necessary to attract the investment required to advance an effective dengue antiviral.

At Kimer Med, we remain deeply committed to this mission, with the goal of saving lives and reducing suffering for millions of dengue patients worldwide.

References

[1] https://www.worldmosquitoprogram.org/en/news-stories/stories/explainer-dengues-deadly-impact-children and https://pmc.ncbi.nlm.nih.gov/articles/PMC11925280/

[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC11175482/

[3] https://academic.oup.com/jtm/article/31/2/taae009/7571403 and https://pmc.ncbi.nlm.nih.gov/articles/PMC11149719/

[4] https://tdr.who.int/publications/m/item/2009-10-01-dengue-guidelines-for-diagnosis-treatment-prevention-and-control

[5] https://www.nature.com/articles/nature12060

[6] https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

[7] https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00554-6/fulltext

[8] https://ghdx.healthdata.org/gbd-2021

[9] https://pmc.ncbi.nlm.nih.gov/articles/PMC11925280/

[10] https://www.sciencedirect.com/science/article/pii/S1201971219300979 and https://journals.plos.org/plosntds/article?id=10.1371%2Fjournal.pntd.0012718 and https://pmc.ncbi.nlm.nih.gov/articles/PMC9112532/

[11] https://www.cnbc.com/2023/10/18/pfizer-to-price-covid-drug-paxlovid-at-1390-per-course-.html