Growth of Ablation Technologies, Applications, Worldwide

The growth in sales of a medical technology is dictated by a unique combination of a specific technology in a specific clinical application in a specific geographic market.

In the Smithers Apex report, The Future of Tissue Ablation Products to 2020, the markets for the different ablation technology types were assessed per application in each of the major world geographies. See the groupings, below:

Ablation Types and Clinical Applications:

  • Electrosurgical/radiofrequency
    • Cardiac
    • Surgical
  • Microwave
    • Oncologic
    • Urologic
  • Laser
    • Aesthetic
    • Ophthalmic
    • Surgical
  • External Beam Radiation Therapy (EBRT)
    • LINAC Systems
    • Cobalt-60
  • Cryoablation
    • Cardiac & Vascular
    • Oncologic Surgery
    • GYN Surgery
    • Dermal/Cutaneous Surgical
  • Ultrasound
    • Ophthalmic (Cataract) Surgical
    • Multipurpose Surgical
    • Urologic Surgical
    • Multipurpose High Intensity Focused Ultrasound (HIFU)

Geographic Areas:

  • United States & Other Americas
  • Largest Western & European States
  • Major Asian States
  • Rest of World

The Smithers Apex report contains the detailed assessment of ablation technology sales in each combination of technology, geography and clinical application. Below is illustrated graphically, sorted by compound annual growth rate in sales, each of the combinations.

Growth of Ablation Technologies by Clinical Application and Geography, 2014-2020

image001

Source: Smithers Apex

 

Ablation technologies and their variable penetration of clinical applications

Ablation technologies of different types have in common their ability to produce a therapeutic effect on human tissue.  Beyond this common ground, however, there are stark differences in the modalities.  Consequently, ablation technologies have variable penetration of clinical applications, with use of specific modalities for specific clinical applications driven by factors such as the tissue effect produced, likelihood of collateral tissue damage, the designs of manufacturers’ specific systems in meeting clinicians needs, cost, and other considerations. 

Cancer treatment is a good example, with a few modalities having significant shares of their worldwide ablation revenuesin cancer, while other modalities are little used in these areas. 

cancer-ablation

Source: MedMarket Diligence, LLC; Report #A125, "Worldwide Ablation Technologies."

 

 

Ablation Technologies Worldwide Market, 2008-2017

Ablation Technologies Worldwide Market, 2008-2017: Products, Technologies, Markets, Companies and Opportunities

· 264 pages · 70 Exhibits · 61 Company Profiles · September 2008 · Report #A125

This report is a detailed market and technology assessment and forecast of the products and technologies in the ablation market for treatment of soft tissues via energy-based modalities, including electrosurgery, radiosurgery, gamma knife, brachytherapy, cryogenic therapy, fluidjet therapy (hydrotherapy), microwave ablation, radiofrequency ablation, laser, thermal ablation, and ultrasonic ablation.

The complete report description, table of contents and list of the exhibits for this report is here.  The report may be ordered online or via order form

NOTE:  We recently added the option, when ordering online, to purchase only the 70 tables, charts and other exhibits in the report.  See the online ordering option.

High-intensity focused ultrasound (HIFU) among treatment alternatives for prostate cancer

Following up on my post yesterday regarding ablation treatments for prostate cancer, one of the ablation modalities noted was HIFU, or high-intensity focused ultrasound. Unlike lasers, RF, microwave or cryotherapy, ultrasound offers superior control of energy output. 3D control and directionality of the energy delivered provides the ability to treat a prescribed target volume and shape which is critical for tumor ablation and increased energy penetration into the target tissue enables the treatment of larger tumor volumes and reduces treatment times.

As is frequently the case with new technologies, initial enthusiasm is eventually tempered (to varying degrees) by long term outcomes data. A review of 2-year data on HIFU for prostate cancer (published in UroToday) presented a less than enthusiastic view of HIFU, indicating that there is inadequate data yet on its efficacy and safety in prostate cancer.

HIFU has indeed yet to demonstrate its efficacy in a number of clinical applications, but while the authors of the UroToday article are justifiably prudent in advising clinicians to view HIFU with some caution, one would be equally prudent to not accept at face value statements like, "companies … have invested heavily in these new technologies and often market them aggressively, irresponsibly and unwisely with immature data."

Energy-based technologies, by virtue of having effects that are not as evident as those of a traditional scalpel, should indeed be evaluated for those effects (positively and negatively), but neither HIFU nor any other ablative technology should be so summarily dismissed.


See Report #A125, "Ablation Technologies Worldwide: Products, Technologies, Markets, Companies and Opportunities."

Ablation and other energy-based technologies with multiple clinical applications

Manufacturers of ablation and other energy-base therapeutics are both witnessing and driving a steady evolution of multiple technologies with potential to produce therapeutic (or, in some cases, simply cosmetic) tissue effects, with different energy types competing head-on for caseload.  These innovators have continued to improve their understanding of the nature of each energy type’s impact on the target tissue(s) and have optimized the delivery to improve outcome, improve ease of use and minimize adverse collateral tissue effects or other complications.

To illustrate the breadth of applications for energy-based technologies, see the excerpt below from the table of contents to the MedMarket Diligence report #A125, "Ablation Technologies Worldwide Market, 2008-2017: Products, Technologies, Markets, Companies and Opportunities." 

 

SECTION 1:  ENERGY-BASED THERAPIES BY DISEASE STATE AND TECHNOLOGY
1.1  Cancer
1.1.1  Brachytherapy
1.1.2  Cryotherapy
1.1.3  Microwave Ablation
1.1.4  Radiation Therapy
1.1.5  Radiofrequency Ablation
1.1.6  Stereotactic Surgery
1.1.7  Laser Ablation
1.1.8  Photodynamic Therapy
1.1.9  Ultrasonic Ablation
1.2  Cardiovascular Disease
1.2.1  Angina Pectoris
1.2.2  Atrial arrhythmias
1.2.2.1  Cryoablation
1.2.2.2  Electrical Cardioversion
1.2.2.3  Microwave Ablation
1.2.2.4  RF Ablation
1.2.2.5  Temperature Controlled
1.2.2.6  Fluid Cooled
1.2.3  Bradycardia
1.2.4  Critical Ischemia
1.2.5  Vascular Occlusive Disease
1.2.6  Ventricular Arrhythmias
1.2.6.1  About ICD, CRT and CRT-D
1.2.7  Wolf-Parkinson-White Disease
1.3  Elective Surgery
1.3.1  Cosmetic Surgery
1.3.1.1  Laser Hair Removal
1.3.1.2  Port Wine Stains
1.3.1.3  Psoriasis
1.3.1.4  Varicose Veins
1.4  Ophthalmic Surgery
1.4.1  Capsulotomy Surgery
1.4.2  Laser In-Situ Keratomileusis (LASIK)
1.4.3  Laser Epithelial Keratomileusis (LASEK)
1.5  General Surgery
1.5.1  Fecal Incontinence
1.5.2  Gastroesophageal Reflux Disease (GERD)
1.6  Gynecological Applications
1.6.1  Hysterectomy
1.6.2  Menorrhagia
1.6.3  Fibroids
1.6.4  Bladder Neck Suspension
1.7  Urological Applications
1.7.1  Urinary Tract Stones
1.7.2  Benign Prostatic Hypertrophy
1.7.2.1  TUMT
1.7.2.2  TUNA
1.7.2.3  Photoselective Vaporisation of the prostate (PVP)
1.7.2.4  HoLAP
1.7.2.5  CoreTherm
1.7.2.6  TMX 3000
1.7.2.7  Prolieve
1.7.2.8  Prostiva RF Therapy
1.7.2.9  Water-Induced Thermotherapy
1.8  Tonsillectomy
1.9  Orthopedic Applications
1.9.1  Capsular Shrinkage
1.9.2  Carpal Tunnel Syndrome
1.9.3  Chondroplasty
1.9.4  Debridement
1.9.5  Epicondylitis and Tendinitis
1.9.6  Inflammatory Conditions
1.9.6.1  Nucleoplasty
 
See the report’s complete description, table of contents, and list of exhibits here.

 

Ablation and other energy-based medical technologies worldwide

The world market for energy-based devices was well in excess of $25 billion in 2008. This represents almost 14% of the total medical device market; however, the share varies from country to country, since ablation therapy is high-technology and fairly high-cost; in poorer economies low-cost medical products such as syringes and consumables account for a relatively higher share of the medical market.

Analyses of the medical market by product category typically divide it into a small number of broad product classes such as electromedical equipment; syringes, needles and catheters; medical consumables; etc. The products included in "energy-based therapies" are divided among several of these categories.

Energy-based devices are of nine main categories, and the market share by category.

Worldwide Ablation and Other Energy-based Device Market by Product Category

ablation-segments

Source:  MedMarket Diligence, LLC; Report #A125, "Ablation Technologies Worldwide Market, 2008."
 

Ultrasonic energy offers superior control of energy output. 3D control and directionality of the energy delivered provides the ability to treat a prescribed target volume and shape which is critical for tumor ablation as increased energy penetration into the target tissue enables the treatment of larger tumor volumes and reduces treatment times. Peripheral and coronary vascular occlusive conditions that afflict tens of millions of people worldwide are now being treated with technologies that enable the delivery of ultrasonic energy over the active length of a small diameter guidewire-like device in an occluded blood vessel. The popularity of ultrasonic surgical systems is being driven by their inherent advantages. These systems control bleeding by coaptive coagulation at low temperatures ranging from 50ºC to 100ºC. Coagulation occurs by means of protein denaturation as opposed to thermal welding and the absence of smoke improves the visual field.

Cryogenic energy or the extreme absence of heat is very attractive as it is highly containable and thus localized. Cryoablation can be safely employed adjacent to delicate tissue and structures such as certain vasculature. Cryoablation may eliminate many of the problems seen in treating complex arrhythmias such as pulmonary vein stenosis. Cooling freezes tissue and does not seem to cause extracellular matrix changes or damage to the endocardium, which may lower clot-related complications. Thanks largely to advances in ultrasound, which allows physicians to target diseased tissue with pinpoint accuracy, and temperature control, which allows physicians to destroy the diseased tissue without harming the surrounding healthy tissue, cryoablation has become the fastest growing minimally invasive option for prostate cancer patients.

Microwave energy offers the inherent advantage of accommodating parallel delivery points. An increased treatment area can be treated with microwave energy very efficiently. Microwave probes are ideally suited for a full spectrum of cardiac ablation procedure from simple pulmonary vein isolation in paroxysmal AF to a full Maze for permanent AF. Energy delivery times are short, on the order of 25 to 60 seconds, and the unidirectionality of the microwave ensures the protection of surrounding tissues during epicardial application–a significant requirement for beating-heart application. Microwave energy is also being used as a transurethral therapy to treat BPH.

Light energy is being harnessed and focused for a variety of therapeutic applications. CO2 lasers are being used to revascularize injured myocardial tissue while excimer lasers are being adapted to atherectomy catheters that can clear thrombosis and reperfuse vessels. Over 2 million individuals seek the therapeutic benefits of laser vision correction each year; low level “cold” lasers are being employed to treat chronic pain relief for debilitating conditions like carpal tunnel syndrome–a leading cause of lost workdays. Intense pulsed light (IPL) that affects subtle changes in collagen is being used to treat vascular and pigmentation irregularities.

Hydromechanical energy systems that jet streams of saline only five one-thousandths of an inch in diameter — about the thickness of a human hair–can precisely dissect tissue, sparing vessels and nerves, and are being employed for hepatic resection and nerve-sparing retropubic radical prostatectomy. This modality does not cause thermal damage to tissue and can sculpt, ablate and cauterize bleeders.

Radiation energy using focused arrays of intersecting beams of gamma radiation is being used to treat lesions within the brain. Radiosurgery devices that can ablate otherwise untreatable tumors and malformations when directed by computers are finding otherwise untreatable lesions.

Thermal energy is employed successfully to treat menorrhagia due to benign causes in premenopausal women. When tissue is heated above 46°C, cellular protein denatures and the cell dies. Thermal uterine balloon therapy offers a less-invasive option that allows women to preserve their uterus. Thermal therapy is also being employed for breast and prostate cancer. Implants made of ferromagnetic material that can be “turned-on” when placed within an electromagnetic field and heated in situ offer a high degree of specificity with respect to the treated tissue area.

Electrical energy delivered by small implants can deliver a life saving jolt of electricity to shock a patient’s heart back to normal when rhythmic disturbances of the lower heart chambers that can cause sudden cardiac death are detected. Similar devices deliver electrical energy to speed up a heart beating too slowly. Image-guided radiofrequency ablation which uses heat to destroy diseased tissue can preserve kidney function and avoid kidney dialysis for patients with solid renal tumors who are not surgical candidates.

Radiofrequency energy is gaining widespread use in the field of sports medicine surgery for the thermal modification of soft tissue structures within the joint. The use of radiofrequency energy for thermal chondroplasty has gained tremendous popularity because of the quality of the therapy. Radiofrequency surgical systems have the inherent ability to seal large vessels as a result of the tremendous temperatures the energy can generate.
 

Energy-based therapeutics markets by clinical application

Energy-based therapeutics include technologies to effect the destruction or treatment of tissues to remove pathology or otherwise modify tissue (e.g., for creating lesions that block the aberrant signals in arrhythmia).  These technologies include radiofrequency, microwave, laser/light, microwave, cryo, hydromechanical, ultrasound and thermal.

Some sectors of the energy-based market are growing steadily, others more rapidly. RF ablation is seeing lively growth, as are cryotherapy and microwave therapy. Overall, the market is estimated to be increasing at more than 11% per annum, which is significantly higher than growth of the medical device market overall. The buoyancy in the energy-based sector is due partly to increased uptake of these technologies and partly due to introduction of technology refinements, which in turn lead to increased usage. There is also the demographic factor; many of the conditions for which ablation products are used are commoner among older than younger patients, and lengthening life expectancy makes its own contribution to market growth.

Certain clinical sectors demonstrate a more significant share of the ablation market due to the prevalence of diseases and disorders that are amenable to these treatments.  See the current segmentation of the ablation market by clinical application.

energy-by-applicatoins

Source:  MedMarket Diligence report #A125, "Worldwide Ablation Technologies Market."

Cardiovascular applications represent the most significant application, due to the existing caseload and the adoption of ablation technologies, especially in arrhythmia management.  Secondarily, but perhaps with an even greater upside potential, is cancer therapeutics.  

Below see the current distribution of ablation therapy markets across different solid tumor types.

solid-cancers-ablation

Source:  MedMarket Diligence report #A125, "Worldwide Ablation Technologies Market."

 

European Ablation Markets, by Segment and Country

The major national markets in Western Europe for ablation technologies account for almost 12% of the global ablation market. Their share of the total medical device market is around 30%. Healthcare spending per capita is broadly similar across all the countries for which an example forecast (France) is provided below, ranging from approximately one-quarter to half of the equivalent expenditure in the USA. Apart from this variance, the inter-country differences in ablation market size are mainly a factor of different population sizes.

Source: MedMarket Diligence Report #A125
Source: MedMarket Diligence Report #A125

Below is a description of the MedMarket Diligence report #A125:

This report is a detailed market and technology assessment and forecast of the products and technologies in the ablation market for treatment of soft tissues via energy-based modalities, including electrosurgery, radiosurgery, gamma knife, brachytherapy, cryogenic therapy, fluidjet therapy (hydrotherapy), microwave ablation, radiofrequency ablation, laser, thermal ablation, and ultrasonic ablation.

The report describes alternative energy-based technologies and the nature of their effect on soft tissue, the underlying basis of the technology, the requisite systems for their use (including capital equipment, devices and disposables), and their strengths and weaknesses for specific clinical applications. The report details current and anticipated target applications and assesses the current and forecast caseload for each energy-based therapeutic considering competition from any and all alternative energy-based or other therapeutics, with current and worldwide market forecasts (2008-2017) segmented by technology type and specific clinical segment. The report provides segmentation of the worldwide ablation market by both ablation technology and region/country: Americas (USA, Canada, Mexico, Brazil), Europe (Germany, United Kingdom, France, Italy, Spain, BeNeLux), Asia/Pacific (Japan, China, India, Australia) and Rest of World. The report details the current and emerging products, technologies and markets for each energy-based therapy. The report profiles over 60 key companies in this industry detailing their current products, current market position and products under development.


The Report #A125, “Ablation Technologies Worldwide Market, 2008-2017: Products, Technologies, Markets, Companies and Opportunities,” is described in full at link. The report may be order for immediate download online or my be purchased via Google Checkout below.


























Key Ablation Technology Companies

The energy-based medical device industry is led by a diverse group of companies, including small-to-medium pure-play companies specializing in ablation therapies and large multinationals whose interests encompass other classes of medical devices as well as ablation products.  Key companies include Medtronic, St. Jude Medical, Varian Medical Systems, Boston Scientific (including Guidant),  and Getinge.

In terms of ablation therapies, different market contenders make their appearance.  Covidien claims a key share of this market; Valleylab, a division of Covidien, is a leader in the field of RF ablation for general surgery. In the arrhythmia ablation segment, the Johnson & Johnson company Biosense Webster has a significant share, competing with CryoCath Technologies, AtriCure, Getinge and St. Jude Medical.

The exhibit below gives details of selected companies with their areas of energy-related product specialisation (with 2007-2008 annual revenues given in the full Ablation report). 

Source: MedMarket Diligence report #A125 (market shares deleted, ranking changed to alphabetical), “Worldwide Ablation Technologies,” published September 2008. 

 


See link for complete details. This report may be purchased online for immediate download at link or may be purchased via Google Checkout, below.

 

Radiofrequency Ablation Products Available and in Development

 
From Report #A125, “Ablation Technologies Worldwide, 2008-2017”, published September 2008. See link.

Below are selected radiofrequency ablation products, their applications and their status of regulatory approval.
 

[Table=11]

 


For additional information on Report #A125, see link. The report may be purchased online or via Google Checkout, below.