Wound management technology projections

{Below is a summary of the products and technologies addressed in MedMarket Diligence report #S247, "Worldwide Wound Management, 2008-2017: Established and Emerging Products, Technologies and Markets in the U.S., Europe, Japan and Rest of World."}

Wound management technologies are comprised of a remarkably diverse range of product types.  Dressings alone can be divided into multiple types, including film dressings, hydrocolloids, foam dressings, alginate dressings, hydrogels, non-adherent dressings, and antimicrobial dressings. Other wound products include cleansing and debridement products, tissue engineered products, pharmacological products, (including pain control, antibiotics, growth factors, non-growth factor modulators, gene therapy, and scarring modulators), physical treatments (like pressure devices, hydrotherapy, electrical stimulation, electromagnetic stimulation, ultraviolet therapy, hyperbaric oxygen therapy, mechanically assisted wound closure devices, ultrasound, laser and information systems. Some of these product categories are well established; others are in development.

Film Dressings. Film dressings are a vital segment of the advanced wound management market. The potential for film dressings in moist wound healing is a concept that is now over 20 years old. Due to the age of many of the strong brands in this segment, key patents on technologies and the delivery/application systems are expiring. This will erode premium prices, which have been maintained by creating new and differentiating application systems and the strong branding that is associated with them. Companies with strong know-how coupled with highly integrated low-cost manufacturing, and strong brand awareness will retain share in the marketplace.

Overall, despite increased competition and price pressure, this market segment will continue to demonstrate positive growth resulting from continued adoption of moist wound healing principles and switching from general non-occlusive dressings to advanced products such as films. The market for transparent film dressings is mature, and although individual products may provide a number of separate features, such as different moisture vapor transmission rates (MVTRs), they are purchased as commodities by buying groups. Given acceptable delivery systems, films compete on price. Global sales of film dressings are significant, but relatively stable, with price competition limiting sales growth to around 5% per year.

Hydrocolloid Dressings. The market for hydrocolloids grew rapidly in the 1980s and 1990s due to the products’ convenience and the fact that they can be left on some wounds for up to five days, together with widespread experience in their use, significant clinical support, and intensive marketing, that have helped grow sales volume over the years. Clinician customers developed a high awareness of these hydrocolloid brands and effectively substituted them for traditional fabric dressings once they had adopted the rationale for advanced wound care using moist wound healing. Major players in this segment of the market encouraged the use of hydrocolloids for all moist wound healing applications.

Hydrocolloids are used extensively in long-term care sites where wear time and ease of use are determining factors in dressing selection and in hospitals where they are popular with opinion leaders. However, hydrocolloids are now starting to lose ground in the face of competition from newer types of dressings with superior benefits. Sales of hydrocolloids are growing at a modest rate, but will nonetheless reach well over $1 billion by the year 2017. ConvaTec, Coloplast, and other strong players will find it increasingly difficult to defend these brands from advancing generic hydrocolloid equivalents produced by lower cost manufacturers with generic cost bases. In addition, there is a growing customer recognition that hydrocolloids have been superseded by other technologies (for example, foam dressings) for some wounds.

Foam Dressings. The ability to outperform hydrocolloids in highly exuding wounds, lack of dressing debris, and moderate cost have made foam dressings one of the fastest growing segments in the advanced wound care market. Foams are expected to maintain an aggressive market growth rate into the immediate future as these products take share from hydrocolloids due to their superior handling characteristics, and as they erode traditional gauze dressing usage. 

Alginate Dressings. Alginate dressings are popular in the home care and extended care markets where high absorption capacity is used to reduce the number and expense of skilled visits. In deeper wounds, alginates conform to the wound bed and contain exudates better than foam dressings. As with other advanced wound dressings, the alginate market is experiencing pricing pressure due to the continued cost consciousness of many individual country’s health care systems, and the generic nature of these materials and lack of proprietary intellectual property. Use of alginate dressings is especially common on moderate-to-highly exuding wounds. Alginates were quickly categorized as devices and reimbursed in the USA, UK, France and Germany, leading to strong growth in these countries. The relatively strong support for these products by expert wound care clinicians and the need for management of highly exudative wounds led to high sales growth in the mid 1990s. The alginate dressings market segment will grow at a healthy annual compound annual growth rate through 2017; in 2008, companies generated more than a half billion dollars from alginate dressings sales.

Hydrogels. Hydrogels are often promoted by referring to their aesthetic cooling effects, which help to reduce wound pain. Hydrogels are now perceived by clinicians as effective in encouraging autolytic debridement, and encouraging the healing of dry or minimally exuding wounds. Amorphous hydrogels and gauze-stabilized formats provide a real advantage in wound packing, and these products have been readily adopted by clinicians. In addition, hydrogels have good potential to serve as delivery systems for active agents. Competitors are actively introducing new hydrogel products to the market, and targeting alternate and home care markets. Thus, hydrogel sales are projected to grow at roughly 5% per annum from 2008 to 2017.

Approximately 50% of amorphous hydrogel products are used by clinicians to re-hydrate black necrosis or yellow slough for purposes of debridement. The other 50% of amorphous hydrogels are sold for use as a general hydration material for controlling moisture to aid moist wound healing.

Non-Adherent Dressings. Non-adherents are a vital part of the advanced wound management market. Products are used to permit less frequent changes of dressings and to allow the use of dressings that manage higher quantities of exudates but reduce the potential for these dressings to stick to the wound. They are also used in combination with traditional dressings as an alternative to more expensive advanced wound dressings. These dressings are also used as the primary contact layer for compression bandaging systems (although we have excluded sales due to this usage from our market estimates). Thus, non-adherent sales are projected to continue to grow at little better than 3% per annum through 2017.

Anti-Microbial Dressings. Anti-microbial dressings are used to manage the effects of microbial colonization and growth. Bacterial infection of wounds is a significant complication of wound repair. There is a growing concern regarding the use of antibiotic products in the wound care environment, and there are few “non-resistant-microbe-forming” antibiotic technologies on the horizon that offer potential to be launched within the next five years. In contrast to this, antimicrobial technologies are being pursued by all wound management companies, to enhance existing brands, and to address the recognized need in this area. Topical antiseptics are one option to treat patients with infected wounds; they act rapidly and locally to destroy microbes. Products fall into a number of categories, which tend to overlap with other categories of wound care products due to the product base technology used for the dressing category that inspired them. For example, Tulle Gras delivery systems have been used for some antibacterial products such as Inadine, Bactigras, and generic antibiotic impregnated products. Sales are projected to continue to grow at under 5% per annum from 2008 to 2017.

Wound Cleansers and Debriding Agents. The wound cleanser and debridement market is expected to grow at well over 5% annually, from over $400 million in 2010. The enzymatic debridement subsegment of this market is driven by the increase in the elderly population with the corresponding increase in nursing home populations and in-home health care environments where chronic wounds are prevalent. The increasing prevalence of diabetic ulcers contributes to the market potential for these agents.

Skin Replacements and Substitutes. Skin replacements and substitutes compete in the severe burn market, venous leg ulcers market, and the diabetic foot ulcer markets where their high cost is offset by their ability to save lives and/or save limbs from amputation. These products have taken some time to demonstrate clinical effectiveness and to be approved for use to heal wounds faster than alternative treatments. In addition, these products are currently significantly more expensive than alternative therapies, and publicly funded health care schemes around the world have found it difficult to accept these costs despite strong cost-effectiveness claims. It is highly likely that these products will take some time to be widely adopted. The move towards cost- effectiveness procurement practice is likely to increase uptake of these products as purchasers advance from decisions based on unit product cost towards outcomes assessments and data. In addition, manufacturers are developing alternative manufacturing and lower cost product designs that should enhance the cost effectiveness of these products over the next few years.

Pharmacological Products. In the field of wound management there are a large number of companies commercializing technologies in the pharmacological field. These technologies include recombinant growth factors and growth factor mixtures, gene therapy, chemical cell stimulants, natural plant extracts and other pharmaceuticals including analgesics, antibiotics, scar reduction products etc. Advanced wound care practices and dressings have focused on removal of the underlying cause of the wound, altering the physical environment, and provision of a moist wound healing environment. These efforts have greatly improved wound care by facilitating wound repair by supporting the body’s own repair and regenerative processes. Recent interest and efforts have been directed to evolving products and procedures designed to actively manipulate the wound healing process. In addition, antibiotics and analgesics have direct and beneficial application in the treatment of wounds in specific cases.

Physical Therapies. Physical modalities have been used in the attempt to encourage wound healing for centuries. Passive compression is a popular approach for the treatment of venous stasis ulcers and many of the current passive compression products have their roots in traditional practices (e.g., paste bandages). Passive compression addresses the underlying etiology of chronic venous insufficiency.

Alternatively there is a market for devices designed to remove pressure from wounds that have been caused by extended pressure on the skin surface, and this market segment has shown astronomical growth within the past 3-4 years, driven by the demonstrated ability of application of negative (i.e., sub-atmospheric) pressure to speed up and improve the healing of chronic wounds.

There are also a great number of devices that are designed to immobilize limbs to avoid weight-bearing behavior, and sophisticated footwear and devices for diagnosing neuropathy. In addition, devices exist to manipulate pressure around limbs to maintain and improve venous blood flow. There are devices designed to accelerate healing through the use of physical treatments including ultrasound, electrical, magnetic, hyperbaric, and pressure relief.

Taken together, these physicial treatment modalities commanded sales almost $2 billion in 2010 and annual growth at double digits for the period 2008–2017.

Tissue Engineered Products. Skin replacements are designed to replace missing skin, including the skin’s structures and biologic functions. Skin replacements may be from the patient’s own skin, from a human cadaver, or from an alternate species; or the skin replacement may be made from biomaterials or biodegradable synthetic materials with or without cells grown as tissue engineered constructs in culture. These tissue engineered products provide the matrix alone, epidermal tissue equivalent, dermal tissue equivalent, or a multi-layer human skin equivalent that includes both dermal and epidermal tissues. In addition this category includes some emergency burn cover products that are synthetic and biosynthetic dressings. These products have been used for some time as a temporary covering for severely burnt patients when insufficient graft material is available and the patient will otherwise die if the burns are not covered to reduce fluid loss and prevent infection. When skin for autografting is available, the temporary dressing is removed and graft is performed. This skin replacement category of products is receiving considerable R&D attention as biotechnology companies strive to develop replacement engineered skin to repair chronic wounds.

MedMarket Diligence report #S247:

The report details the current and projected market for wound management products, including dressings, closure devices, debridement, pharmacological products, tissue engineered products and others. Particular emphasis is placed on advanced and leading edge developments (i.e., those approaching wound management from novel perspective) such as growth factors, stem cells, gene therapy and other approaches, while baseline data (current and forecast market size and current competitor market shares) is provided for established segments — multiple dressings types (film, foam, alginate, antibacterial, non-adherent), hydrogels, hydrocolloids, pharmaceuticals, and physical treatments. The report details the clinical and technology developments underlying the huge and evolving worldwide wound care market, with data on products in development and on the market; market size and forecast; competitor market shares; competitor profiles; and market opportunity. Separate size, growth and competitor data are presented for the U.S., leading western European countries, Japan and the Rest of World category. The report profiles leading and emerging companies, with data on products, technologies and positions in the advanced wound care market. The report establishes the current worldwide market size for major technology segments as a baseline for and projecting growth in the market over a ten-year forecast and assesses and projects the composition of the market as technologies gain or lose relative market performance over this period.

Se also the related report $S180, "Worldwide Surgical Sealants, Glues, Wound Closure and Anti-Adhesion Markets, 2010-2015."

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