Category Archives: medtech

topic is about medical technology of different types, describing specific products under development, the market for them or their impact on healthcare

Wound prevalence by types, worldwide

The bulk of wound types driving the use of products for wound sealing, closure, hemostasis and anti-adhesion are surgical incisions made for the purpose of treating disease. While this figure is over 100 million annually on a global basis, its significance as a force for the use of wound closure and related technologies must be tempered by the fact that surgical incisions are intentionally made and therefore are made by surgeons and other clinicians with advanced expectation of how the wound will be closed.  By contrast, wounds of other types offer a degree of complexity and unpredictability that, even in their lower numbers, represent a markedly bigger challenge for clinicians to manage.  Indeed, the most significant costs in wound management ensue from chronic wounds, which arise as a result of inadequate circulation, excess pressure, infection, complicating disease or conditions (e.g., diabetes, obesity) and other factors.

Below is illustrated the global distribution of wound prevalence by type of wound (2011).

wound-prevalence-pie

Source: MedMarket Diligence, LLC; Report #S190 and Report #S249.

Types and Uses of Wound Care Products

Wound care products take many forms based on the type of function provided by the product, the wound type and its severity.  Excluding for the moment the emerging array of physical wound healing systems (e.g., NPWT, hyperbaric oxygen, etc.), there are quite a number of combinations, and as new materials emerge, such as types of media or means to deliver wound care, the combinations are expected to multiply.

Below is illustrated a representation of wound product types, forms and applications.  This now includes the rapidly growing field of growth factors in wound care, which may be delivered by many different methods, including carrier or media types.

Types and Uses of Wound Care Products

woundcare-product-types

Sources: Murphy, P.S. et al. Plastic Surgery International Volume 2012 (2012), Article ID 190436, 8 pagesdoi:10.1155/2012/190436; MedMarket Diligence, LLC, Report #S249.

Medtech fundings for April 2013

Fundings for medical technology during April 2013 totaled $422 million. Top fundings included:

  • $40 million for electroCore Medical, LLC (non-invasive vagal nerve stimulation therapeutic devices)
  • $39.3 million for Celator Pharmaceuticals (nanoparticle-based drug delivery in cancer)
  • $33 million for Esperion Therapeutics (LDL-lowering therapies)
  • $32.2 million for Watermark Medical, Inc. (sleep apnea diagnostics)
  • $29 million for Vaportherm (treatment for COPD, other respiratory)
  • $25.5 million for Solta Medical (medical aesthetics)
  • $25 million for Topera, Inc. (electrophysiology mapping systems)
  • $22.6 million in an IPO for InspireMD (vascular stents)
  • $20 million for Avinger (intravascular imaging)

For the complete list of fundings for April 2013 see link.

Growth versus current share in global wound management products

Sales of products in global markets for wound management are in a fairly dynamic state of flux, especially for the very large, well established market that it is.  Traditional wound management products — dressings and bandages that do little more than keep debris out of wounds — are being challenged aggressively by products playing a considerably more active role in accelerating wound healing and preventing the complications and costs inherent in chronic wounds.

The market for even commodity-like dressings products continues to grow, driven by increased prevalence of many wound types and supported by these products’ ease of use and low cost.  However, the markets for more advanced products are growing at substantially higher rates as a result of the ability of these products (or the perception) to provide faster, less costly or otherwise better wound healing.  The net effect is that all segments of wound management product sales are growing (see Exhibit 1), although a variable rates, resulting in considerable shifts in each segment’s share of the total wound market (see Exhibit 2).

Exhibit 1

3013-03-27-CAGRs

Source: MedMarket Diligence, LLC; Report #S249.

Exhibit 2

3013-03-27-wound

Source: MedMarket Diligence, LLC; Report #S249.

Consequently, the rapid growth in sales of advanced products is shifting the balance of sales away from traditional products.

As rapid as the growth of advanced wound product sales is, there is still a long competitive battle to wrest control of a large share of wound management from traditional bandages and dressings (see Exhibit 3).

Exhibit 3

3013 03 27 wound pie

Source: MedMarket Diligence, LLC; Report #S249.

Future Wound Management: More Equipment, Biotech; Less Lowtech

The history of wound management has been dominated by a simple premise of getting wounds closed, keeping them covered and letting the body heal itself.  But the demand to accelerate the wound healing process, especially for a growing caseload of chronic wounds (driven by increased diabetes prevalence, aging population, and others) is driving a shift way from a passive role in wound management to one where materials are used to draw away exudate, kill bacteria, and maintain healing-optimized moisture levels; equipment is used to also remove exudate and otherwise stimulate the healing process; natural and bioengineered grafts are used to intervene for extreme wound types; growth factors and other biologicals are used to supplement the natural cascade of wound healing.  In short, wound healing is moved from being eminently passive to decidedly active, with considerably more medtech and biotech, with less “low-tech” (e.g., simple bandages and dressings).

The resulting balance of the overall wound care market distributed across multiple product and technology types will represent markedly different pictures between now and the next decade.

Below is illustrated the shift in wound care technologies, from a percentage of total basis and absolute share of product revenues basis:

WoundShareWithGF

Source: MedMarket Diligence Report #S249, “Wound Management, Worldwide Market and Forecast to 2021: Established and Emerging Products, Technologies and Markets in the Americas, Europe, Asia/Pacific and Rest of World.”  Published March 2013.

WoundRevenuesWithGF

Source: MedMarket Diligence Report #S249

 

 

Growth factors in wound management

MedMarket Diligence has expanded its global wound care market analysis to address the current market and forecast outlook for growth factors developed and applied to accelerating wound care.

Extensive research has demonstrated that wound fluid is rich in growth factors. Growth factors are naturally occurring proteins found primarily in platelets and macrophages. They are needed for normal wound healing to promote growth and migration of fibroblasts, endothelial cells and keratinocytes.

For this reason, growth factors have been heavily studied and already have demonstrated their potential to advance wound care.

Report #S249, “Wound Management, Worldwide Market and Forecast to 2021: Established and Emerging Products, Technologies and Markets in the Americas, Europe, Asia/Pacific and Rest of World,” provides detailed global, regional and country-specific data on growth factors in wound care.

Harsh questions for complex medtech

robotic_or_scalpelOn the one hand, as I track medical device technology development, I see the increasing trend toward a reduction in the complexity of approaches to accomplish therapeutic ends. The underlying force seems to be, “healthcare technology is expensive, so let’s minimize the technological complexity, minimize the invasiveness, reduce collateral damage, make treatments more specific to the resolution of symptoms and/or disease…” The result is that, for example, endoscopic surgery leads to laparoscopic surgery, which leads to single port laparoscopic surgery, which leads to natural orifice transluminal endoscopic surgery, potentially competing in its minimally invasiveness against alternatives like transcatheter interventional procedures — even for procedures like cardiac valve repair or replacement or coronary artery bypass grafting.

Then, on the other hand, I see technological development moving in the entirely opposite direction of increasing complexity with developments like robotic surgical systems, intraoperative imaging and others, all of which raise the question as to whether we are simply developing technologies for technology’s sake. Do these increasingly complex technologies provide a clinical endpoint not achievable with alternative technologies, or more importantly, procedural approaches? Certainly, I think that technologies that enable a surgeon to perform a procedure that he otherwise simply could not perform, such as those involving the use of intraoperative imaging technologies that enable the surgeon to see healthy versus pathological tissues and differentiate his actions accordingly can arguably result in a better clinical outcome. And as part of this process, one must consider the cost of the accompanying technology such as imaging systems.

Accordingly, when one considers the range of different complex robotic surgical technologies on the market or under development, one has to ask whether these systems truly allow the performance of procedures that the average, well-trained surgeon could not perform without that technology. Certainly, there are complex surgical procedures, such as delicate neuro procedures that, if not performed with extremely precise accuracy, might result in serious collateral damage. But hernia repair? Appendectomy? Colon resection? Hysterectomy? Some of these fairly high-volume procedures have indeed been presented as justification for the enormous expenditure needed to acquire robotic surgical systems.

Forgive me for stating the obvious, but it seems incumbent upon healthcare systems to critically evaluate the cost/benefit of new technology, given the limited resources in healthcare.

For this reason, it does not surprise me in the least that recent reports of complications or, in the least, device problems associated with the use of Intuitive Surgical’s robotic systems have promptly led to a precipitous decline in that company’s stock value. If a technology can’t enable the performance of a procedure that otherwise could not be performed, then its value is in question. Further, if the technology cannot perform a procedure flawlessly, and without complication or error that can arguably be performed without that technology, then its value is seriously in question.

Wound management markets globally in modest to aggressive growth

The global markets for wound management range from basic to advanced products, from gauze to bioengineered skin. By product type, traditional bandages remain the largest volume of sales, and this will persist through 2020.  The fastest growing segments, however, vary by region, with the highest growth alternately coming from sales of alginate dressings or bioengineered skin.

Geographically, sales in North America, in particular the USA, will remain the dominant share of wound management products.  However, the greatest growth will come from markets in Asia/Pacific as economic strength in the region (including China) contributes to deeper penetration of the large potential caseload.

Below is illustrated the worldwide wound management market by product type and geographic region for 2012, and, presented on the same scale for comparative purposes, the market for these products in 2020.

Wound2012

Source: MedMarket Diligence, LLC; Report #S249, “Wound Management, Worldwide Market and Forecast to 2020: Established and Emerging Products, Technologies and Markets in the Americas, Europe, Asia/Pacific and Rest of World.”

Wound2020

 Source: MedMarket Diligence, LLC; Report #S249.

Spine surgery worldwide market, sales growth rates of products

Demonstrating a very wide range of clinical approaches and technologies, products used in spine surgery range from the very well established to products demonstrating considerably more potential than actual, current sales.

The products in spine surgery include:

  • Posterior Pedicle Screw Fusion Systems
  • Anterior Cervical Plate Systems Anterior Thoracolumbar Systems
  • Anterior Lumbar Interbody Fusion
  • Thoracolumbar Interbody Fusion
  • Posterior Lumbar Interbody Fusion
  • Axial Lumbar Interbody Fusion
  • Interspinous Process Spacers
  • Cervical Artificial Discs
  • Lumbar Artificial Discs
  • Vertebroplasty
  • Balloon Kyphoplasty
  • Allografts
  • Demineralized Bone Matrices
  • Bone Morphogenic Proteins

Spine fusion systems represent the most well established products in spine surgery.  Novel and/or emerging technologies include artificial discs, vertebroplasty and kyphoplasty.  The more novel use of allografts, demineralized bone matrices and bone morphogenic proteins offer considerable promise, but clinical challenges have limited their more rapid growth.

Below are illustrated the relative growth rates (comparing CAGR from 2012 to 2020) of spine surgery products. (We are providing the growth rates represented graphically with the absolute values of the growth rates not shown on the x-axis to simply illustrate the relative growth rates.)

CAGRs-relative

 

Source: MedMarket Diligence, LLC, Report #M520, “Worldwide Spine Surgery: Products, Technologies, Markets & Opportunities, 2010-2020.”  This data is also represented in the Data Forecast, #M520X, “Worldwide Spine Surgery Data Forecast 2010-2020.”

Medtech Funding Average Deal Size Trend

Tracking medtech fundings by month, we have compiled several years of data and here present the trending in the average deal size by month, which indicates a relatively volatile pattern but does nonetheless also indicate a modest but still upward trend.

deal-size-trend

 

Source: Compiled by MedMarket Diligence, LLC.  Data shown at link.

The burst this month is a bit overstated due to several large fundings in a month that is only one week old.