Category Archives: cancer

topic about cancer diagnostics or therapeutics, with therapeutics to include any type of treatment (e.g., drug, device, etc.)

Projected global wound prevalence by wound types

MedMarket Diligence’s Report #S249, “Worldwide Wound Management, Forecast to 2020: Established and Emerging Products, Technologies and Markets in the Americas, Europe, Asia/Pacific and Rest of World”, is currently available (order directly from link).


Products in wound management (current and potential) are targeted at wounds of a wide variety of types that present varying degrees of challenge to heal, require different types of clinical approaches and are growing at variable rates globally and in specific geographic areas.

The main types of wounds include the following:

  • Surgical wounds
  • Traumatic wounds
  • Lacerations
  • Burn wounds (outpatient)
  • Burn wounds (medically treated)
  • Burn wounds (hospitalized)
  • Pressure ulcers
  • Venous ulcers
  • Diabetic ulcers
  • Amputations
  • Carcinomas
  • Melanomas
  • Complicated skin cancers

The most significant volume of wounds (and, in many cases, the easiest to address) are surgically created wounds for the purpose of addressing a disease state requiring surgical intervention.  Considered in the same category of these are trauma and the more minor lacerations, since there are no additional conditions that complicate the wound.  Below is illustrated the worldwide trend in these wound types.
wound-preval-surgery

Source: MedMarket Diligence, LLC; Report #S249.

Burn wounds represent another category of wound types with their own unique demands to be clinically addressed.  Medically treated wounds are the most prevalent, followed by those that can be treated on an outpatient basis. Depending upon the severity, there are a range of clinical and technology options. Below is their projected prevalence worldwide.

prevalence-burns

Source: MedMarket Diligence, LLC; Report #S249.

Representing only modest numbers (by comparison to surgical/traumatic wounds), chronic wounds present the most challenging and high-cost type of wound to address clinically. (As an illustration of the challenge, clinician reported data on “time to heal” is usually left blank.) These wounds, due the potentially life-threatening challenges they present, as well as their inherently higher costs, are a major target of medical technology development.  Below is illustrated their global prevalence, which is noteworthy for the fact that, due to their correlation with a rapidly aging population, represent among the highest growth rates in prevalence among all wound types.

prevalence-chronic

Source: MedMarket Diligence, LLC; Report #S249.

The last group of wound types is various forms of cancer, whose treatment as “wounds” is overshadowed by their treatment as cancer.  Prevalence in cancer, particularly as a subset of wound types, is not projected to be growing at a high rate (annual growth rates are barely 3%). (Also included in this category is amputations, which may or may not be related to cancer, but raised similar clinical challenges.) Below is the projected worldwide prevalence of cancer-related and amputation wounds.

wound-preval-other

Source: MedMarket Diligence, LLC; Report #S249.

 

Technologies at Recently Identified Medtech Startups

It was a robust month for medtech startups being founded (or at least getting on our radar) with a wide range of technologies under development. Below is a list of technologies under development by these companies:

  • Device to assist in early detection of melanoma.
  • Small molecules for skeletal tissue regeneration.
  • Intubation device.
  • Device for the point-of-care treatment of chronic central pain.
  • Technologies for detection of perforated bowel.
  • Prosthetic heart valve technology.
  • Catheter-based approach to carotid body modulation for treatment of sympathetic nervous system-mediated disease.
  • Sheaths, snares and other devices in interventional cardiology.
  • Device for non-invasive and reversible treatment of presbyopia.
  • Drill device to reduce complications in orthpedic and spine surgery.
  • System for evacuation of surgical smoke.
  • Minimally invasive technologies for the treatment of stroke.
  • Surgical device technology.
  • Robotic system for use in spine surgery.

The companies are included with all available details in our Medtech Startups Database.

Tissue engineering & cell therapy markets, 2012 and 2018

The varied technologies underpinning the market for “tissue engineering & cell therapy” are diverse — even more so than people in the industry often recognize.  Frequently, both tissue engineering and cell therapy are presumed to be purely developmental in current “markets”, a far cry from when such technologies will be so advanced as to make organ replacement a retail market.  The truth is that, on the one hand, tissue engineering has become a very routine part of clinical practice (as in skin grafts and orthopedic tissue grafts) and, on the other hand, while cell therapy still has vastly more clinical (and commercial) potential than it has as yet demonstrated, it has nonetheless demonstrated sufficient advance that several obstacles to cell therapy benefits have been greatly diminished: (1) the issue of the Bush-era ban on federally-funded embryonic stem cell research was promptly lifted by the Obama administration and (2) advances in the use of adult stem cells and the reversion of cells from a differentiated to undifferentiated state (i.e., creation of pluripotent cells) have made limitations on embryonic stem cells largely moot.

Consequently, the great struggle for anyone seeking to assess the “commercial potential” in tissue engineering and stem cell therapy is overcoming the presumption that these technologies are still a long way off from attaining any level near their potential commercial success.

The solution has been to track actual company revenues especially, but not limited to, readily verified SEC 10(K) company reports on revenues generated from these technologies.  This has been our experience in characterizing worldwide markets for tissue engineering and cell therapy in our Report #S520.

The aggregate worldwide market for tissue engineering and cell therapies, representing an already stunning range of clinical applications, stands at roughly $12 billion in 2012.  This market, through commercial introduction of new products and expanded applications of approved products, will reach almost $32 billion by 2018. See our 2012 and 2018 estimates, below.

Source: “Tissue Engineering, Cell Therapy and Transplantation: Products, Technologies & Market Opportunities, Worldwide, 2009-2018″, Report #S520.

Ablation technology regional growth to 2019

In our analysis of the global market for the spectrum of ablation technologies – Electrical, Radiation, Light, Radiofrequency, Ultrasound, Cryotherapy, Thermal (other than cryo), Microwave, and Hydromechanical — we assessed the size and growth of sales of these technologies with specificity to a large number of regions and countries:

  • U.S.A.
  • Canada
  • Brazil
  • Mexico
  • Germany
  • United Kingdom
  • France
  • Italy
  • Spain
  • BeNeLux
  • Japan
  • China
  • India
  • Australia
  • Rest of World

Below, we illustrate, ranked from low to high, the compound annual growth rates of each geography/technology combination.  This data reflects the strong trends that exist for clinical adoption and sales growth of specific technologies, driven by the unique combination of country-specific and technology-specific forces.

Source: Report #A145, MedMarket Diligence, LLC.

Follow the Need: The Global Fight Against Obesity

A recent Bank of America Merrill Lynch Global Research report called, “Globesity – The Global Fight Against Obesity”, examines the subject of obesity as a global need driving business across a range of sectors. As opportunistic and “exploitive” this may be, one need recognize that, in free market economies, businesses are compelled to focus on unmet need.

“Global obesity is a mega-investment theme for the next 25 years and beyond. Obesity may be the most pressing health challenge facing the world today and efforts to tackle it will shape thinking by policy makers and in boardrooms around the world,” said Sarbjit Nahal, equity strategist at BofA Merrill Lynch Global Research. (See link.)

The “need” associated with obesity can be viewed from a broad standpoint as any type of demand for products and services stemming from the growing incidence and prevalence of obesity, from products that enable that demand (fast food and other high caloric foods) to the clinical management of obesity and its sequellae (i.e., diabetes, heart disease, etc.).

(The Merrill Lynch report focuses on obesity as a business investment focus with medium and long term potential, considering the major categories of Pharmaceuticals and Health Care, Food, Commercial Weight Loss, Diet Management and Nutrition, and Sports Apparel and Equipment.)

From a clinical perspective, obesity is a major opportunity for new treatments due to the direct and indirect costs it creates.  The indirect costs arise from the health-related complications of obesity, often referred to as “co-morbidities”:

Obesity Co-Morbidities

    • Metabolic syndrome
    • Immune system effects
    • Type 2 diabetes
    • Hypertension
    • Cardiovascular disease
    • Dyslipidemia
    • Depression
    • Gastroesophageal reflux disease (GERD)
    • Osteoarthritis
    • Non-alcoholic fatty liver disease
    • Cancer

Source: MedMarket Diligence Report #S835.

It is the mandate of the medical product industry to develop, introduce and market products that may competitively address healthcare need to the benefit of company shareholders. As an economic driver, obesity can be clearly seen one of the most compelling for the fact that obesity prevalence is increasing dramatically and the evidence that obesity’s costs, both direct and indirect, are rising steadily at a time when healthcare costs are already under intense scrutiny.

The allure of the industry’s interest in obesity is bluntly reflected in the business of managing obesity (see Report #S835):

“The global market for treatment of obesity is predicted to reach $5,159.6 million by 2019, exhibiting a compound annual growth rate (CAGR) for 2010-2019 of 17.4% The largest sector in revenue terms by 2019 is likely to be combination drugs, reaching $1,844.0 million in global revenues. Almost all device- and drug-based treatment categories will reach strong double-digit CAGRs by 2019.”

One might argue, at least from the cost standpoint, that by pursuing advanced medical technology solutions (complex new devices and drugs) the obesity management industry is simply exacerbating the problem.  Looked at narrowly, this argument is easy to defend.  However, a fundamental force underlying medical technology development is that new products that offer the defensible (i.e., marketable) potential to reduce the costly complications of healthcare conditions will be met by support in the payer side of healthcare.


MedMarket Diligence has published “Products, Technologies and Markets Worldwide for the Clinical Management of Obesity, 2011-2019″, Report #S835.

 

Clinical Applications of $11.5 Billion Ablation Technologies Market Mapped

The performance of surgery has undergone a steady evolution over the past 40 years, moving from procedures employing scalpels and sutures to procedures employing a dizzying number of product types — reusables/disposables, devices/biologics/hybrids, percutaneous/endo-laparoscopic, real-time MRI and other image-guidance and the whole spectrum of devices and equipment in the $11.5 billion ablation technology market.  This last field harnesses the capabilities of instruments differentiated largely by energy type to therapeutically treat tissue by destruction, excision, sealing and other means.

For reference, a dictionary definition of tissue ablation is “the removal of a body part or the destruction of its function, as by surgery, disease, or a noxious substance.” From a device/instrumentation standpoint (as opposed to, for example, chemically-based ablation), ablation is the therapeutic destruction and sealing of tissue or creation of other therapeutic effect in tissue. The predominant forms of device-based ablation technologies include:

  • Electrical
  • Radiation
  • Light
  • Radiofrequency
  • Ultrasound
  • Cryotherapy
  • Thermal (other than cryotherapy)
  • Microwave
  • Hydromechanical

While the tissue effects produced by these different modalities have potential for use in virtually all clinical applications, their emerging use is concentrated in a fairly well defined but detailed list.  The largest share of the market for energy-based ablation devices, driven to a significant extent by its long history in clinical practice, is in cancer therapy, primarily via radiation therapy. General surgical applications represent the next most common use of ablation technologies, especially those using electrocautery and electrosurgical devices, radiofrequency ablation and cryotherapy, etc. Cardiovascular applications then represent the next most active area of ablation technologies, especially given the often acute nature of cardiovascular disease.

Most of the universe of ablation technology clinical applications is illustrated in the map, below.

Source: MedMarket Diligence, LLC (Report #A145)

Ablation technologies in cancer

Cancer represents a major target of the clinical applications of ablation technologies, as illustrated by the share of each modality’s 2011 revenues that are used in cancer:

Source: Report #A145, “Ablation Technologies Worldwide Market 2009-2019″, MedMarket Diligence, LLC.

Considering the utility of the different ablation types for treatment of cancer, it’s not surprising that radiation is the dominant source of ablation technology revenues for cancer in 2011.

Share of All Ablation Revenues in Cancer, by Modality, 2011

Source: Report #A145, “Ablation Technologies Worldwide Market 2009-2019″, MedMarket Diligence, LLC.

Underestimating obesity

Obesity Co-Morbidities

  • Cardiometabolic syndrome
  • Type 2 diabetes
  • Hypertension
  • Dyslipidemia
  • Coronary heart disease
  • Osteoarthritis
  • Stroke
  • Gall bladder disease
  • Obstructive sleep apnea
  • Gastroesophageal reflux disease (GERD)
  • Some cancers (endometrial, breast, and colon)

Current estimates of obesity prevalence in the U.S. are based on body mass index (BMI) and account for  20% obesity rate in the 50 states, with 12 states having rates of over 30%, according to the CDC.  However, recent research carried out by researchers at New York University School of Medicine and other institutions have indicated the imprecision of BMI is resulting in a high number of false negatives for obesity.  In the research studying a sampling of men and women and comparing BMI to an alternative method for determining obesity by employing specific biomarkers and duel-energy x-ray absorptiometry (DXA), the BMI measurement concluded that 26% of the subjects were obese, while DXA concluded that 64% of the patients were obese.

Body mass index has previously been challenged as a measure of obesity due to its inability to effectively differentiate between body types regarding obesity. Whether the DXA ultimately becomes a more reliable standard measure for obesity remains to be seen, but what is clear is that any measure that results in higher counts of the obese will be met by healthcare (and the medical product industry) as justification for increased spending in the treatment of obesity. Further research, of course, will be necessary to evaluate the relationship between the increased sensitivity to detection of obesity and the identification of associated morbidity or, as is often the case with obesity, the co-morbidities of diabetes, heart disease and other expensive healthcare challenges.


For further information on obesity drugs and devices, see the 2011 MedMarket Diligence report #S835, "Products, Technologies and Markets Worldwide for the Clinical Management of Obesity, 2011-2019".

Competition, investment and markets in cell therapy, tissue engineering

Competition in the field of tissue engineering and cell therapy is intense, whether it be attracting top scientists, obtaining licenses to university-owned patents, being the first to reach market with a particular technology, obtaining coveted investment funding, or gaining the attention of larger companies with deeper pockets.

With new companies being founded every day, competition is intense among these new enterprises to obtain these coveted prizes. Meanwhile, most large medical device and pharmaceutical companies are still choosing to cautiously evaluate which companies, if any, they might acquire or partner with.
Licensing a patented academic technology for further development is one way biotechnology companies can expand their intellectual portfolio. It is also a way to defend one’s turf by preventing a competitor from using that patented information. Thorough networking can work to the company’s advantage here, because it can yield insights about research progress, about who to contact for licensing discussions, and what other companies may be sniffing around for a good licensing opportunity.

If a company is considering licensing, then it should examine the quality of the patent (whether it is both broad enough and defensible), how much access the company will have to the inventors, rights to publish further research and the rights to sublicense out the work. The company must decide if the technology could form the basis for a new company or if it is an assistive technology that may broaden core strengths the company already possesses. The technology should also be examined to see how far from market an end product likely is. Of course, the details of dividing up any monetary awards must also be addressed. Licensing involves fees, which may include upfront fees, fees or royalties to be paid on a milestone or quarterly basis, and annual maintenance fees. The patent holder naturally expects value for licensing out the patent, whether that value is harvested at the beginning of the relationship or at the end.

Industry Focus. The majority of biotech companies involved in this industry are focusing on disease areas that have the most patients and the largest unmet needs. These include cancer therapies, diabetes, orthopedics and cardiovascular products. Some companies are taking a different approach, attempting to carve out a niche for themselves in a disease state with a smaller population and a less crowded playing field, such as Alzheimer’s, ophthalmology or central nervous system disorders.

Investment Levels. As the debate on health care reform nears resolution, the market will likely see a modest increase in mergers and acquisitions among pharmaceutical, medical device and biotechnology companies.

In terms of investment dollars, the stock market crash of 2008 had a major impact on the amount of investment dollars available to fledgling businesses. In the case of biopharmaceuticals, the typical drug development process for drug candidates that make it to market can take more than 12 years and $1.2 billion. Unfortunately, nearly 90% of drug candidates will fail in development.

Typically, venture capitalists provide five to eight years of equity to start-ups who may or may not amount to a successful enterprise. Because of downturns in financial markets for the last two years or so, venture capitalists and investment banks have increasingly been choosing to fund their prior investments rather than new start-ups.

Investor Returns. Primarily because of the lengthy and costly rigorous clinical trial process required, biomedical companies require great deals of capital to support them until their innovative product reaches market. Biotechnology companies may need as much as $1 billion to allow it to survive a 10–12 year time span to reach market. Because of the tightening of financial markets, less money has been available for new companies, forcing some either to license to larger companies future rights to their technologies or to sell their technology outright. Others less fortunate have been forced to close their doors.

Investing in biomedical enterprises has always been risky as only a small percentage ever make good on the investment. In the face of a global recession, investors are only getting more difficult to find and many new companies are struggling to stay afloat. For instance, in California, 334 biotechnology companies with an aggregated market cap of $352.1 billion were traded publicly on major U.S. markets in the third quarter of 2009, according to PricewaterhouseCoopers. Of these, 135 had less than one year of cash remaining and 42% had less than six months of funding left.

Below is illustrated the 2009 to 2018 forecast for the global markets in tissue engineering, cell therapy and transplantation, by clinical area.

Source: MedMarket Diligence, LLC, Report #S520, "Tissue Engineering, Cell Therapy and Transplantation: Products, Technologies & Market Opportunities, Worldwide, 2009-2018."

Bariatric surgery linked to reduced risk of cardiovascular death

In the January 4, 2012, edition of JAMA, researchers at the University of Gothenburg in Sweden determined that bariatric surgery is associated with reduced risk of cardiovascular deaths and events such as heart attack and stroke in obese individuals.  As the researchers note, "this is the first prospective, controlled intervention to our knowledge reporting that bariatric surgery is associated with reduced incidence of cardiovascular deaths and cardiovascular events."

The correlation between obesity and the presence of "co-morbidities" such as type 2 diabetes, hypertension and other conditions has been supported by clinical data, there has been a notable absence of direct data on the association between bariatric surgery and improvements in overall health that reduce the risk of death.  The Gothenburg study confirmed this specifically by studying 2,010 obese patients who underwent bariatric surgery contrasted to a control group of 2,037 obese individuals receiving standard care.

The authors were careful to note that the reduction in risk only correlated with modest weight loss from bariatric surgery and that subsequent, greater weight loss did not further reduce risk.  The authors also note that additional research is needed on any possible correlation between weight loss other than by bariatric surgery and reduction in risk of death.

Below is illustrated the market for various obesity treatment options, with expected product revenues in 2013 and growth to 2019.

 

Worldwide Obesity Treatment Market Size (2013) and Growth (to 2019) by Treatment Option

[Note: The size of the bubbles and their horizontal position on the graph reflect the market size. The vertical position reflects the projected market growth.]

Source: MedMarket Diligence, LLC; Report #S835