The “traditional” types of tissue ablation — electrosurgery and radiation therapy — are losing relative share as new modalities are able to penetrate caseload of other modalities, or even tap previously untreated patients and increase the aggregate caseload. In particular, radiofrequency and cryotherapy will demonstrate the highest growth over the 2011 to 2019 period.
Tissue ablation is defined as the “removal of a body part or the destruction of its function, as by surgery, disease, or a noxious substance.” Put more simply, ablation is considered to be a therapeutic destruction and sealing of tissue.
The technologies representing the majority of physical (rather than chemical) ablation are comprised of the following:
The largest share of the market for energy-based ablation devices is used in cancer therapy, primarily using the radiation therapy modality. Following that is general surgery with its use of electrocautery and electrosurgical devices, RF ablation, cryotherapy, etc. Cardiovascular is thought to be third, even though cardiovascular is making the most noise in the medical press with RF and cryoablation of atrial fibrillation, this segment is thought to be third in share order. The remaining applications are relatively small and fall in line behind the three leading sectors.
The Asia-Pacific market for ablation technologies looks quite different from the Americas and European Union. Here, at present, the largest market is Japan, which accounts for the majority of the market, although by population and current growth rates, the People’s Republic of China has the greatest potential. Its greater than 1.3 billion population and, more importantly, the healthcare infrastructure that the government is putting into place ensure that China will continue to comprise an ever greater share of this market.
Data in the exhibit is drawn from MedMarket Diligence report #A145, "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities."
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Ablation technologies are used to destroy ("ablate") diseased or traumatized tissue for therapeutic benefit. This includes destruction of cancerous tumors, ablation of endometrial tissue associated with endometriosis or abnormal uterine bleeding, creation of myocardial lesions to block the errant electrical signals in arrhythmia, and numerous others.
The largest share of the market for energy-based ablation devices is used in cancer therapy, primarily using the radiation therapy modality. Following that is general surgery with its use of electrocautery and electrosurgical devices, RF ablation, cryotherapy, etc. Cardiovascular applications are growing, particularly for cryoablation and radiofrequency ablation for arrhythmia, and now represent hold the third largest clinical area of ablation. The remaining applications are relatively small and fall in line behind the three leading sectors.
In the aggregate (i.e., for each modality worldwide), the largest segment is radiation-based ablation technologies, based to a large degree on the cost of the systems and their well-established use in clinical practice.
Below is a chart of the 2011 markets for ablation technologies by modality, with their projected compound annual growth rates (CAGRs) from 2011 to 2019.
Surgical management of soft tissues via "ablation" therapies, in which alternative energy types (radiation, electrosurgcal, ultrasound, etc.) are applied to excise, destroy, or otherwise produce a therapeutic effect at the tissue level has undergone a proliferation in development with all of these alternatives vying for caseload in clinical applications as diverse as tumor ablation, arrhythmia ablation, endometrial ablation for treatment of endometriosis, ophthalmic procedures for vision and disease treatment, cosmetic, and many others.
The alternatives run the gamut from well established, high volume, low growth procedures like conventional x-ray to emerging, relatively low volume, high growth procedures like microwave ablation in cancer and arrhythmia ablation, and every other type of procedure in between.
Below illustrates the growth versus market size distribution of ablation technology alternatives.
Select technologies in ablation are among the most dynamic growth markets in the entire medtech sector. The therapeutic and other benefits with these technologies included that they are typically less invasive than traditional surgery and are generally employed without the need for an implant. The therapies can be precisely metered and can be repeated. Emerging energy modalities therefore have the potential to grow at significant, double-digit rates over the next decade as delivery systems evolve.
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.
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.
A cursory review of data in the recent MedMarket Dilgence report #A125 reveals the countries with the highest expected growth rates in markets for ablation technologies.
Based on the growth in the ablation modality segments (e.g., radiofrequency, microwave, cryosurgery, thermal, ultrasound, etc.) that comprise each country’s total ablation market, the countries with the highest ablation market growth are India and China. The high growth in these countries ensues from how nascent these markets are, since potential application of ablation in these countires have yet to be tapped to any significant extent (the current market for ablation in India is $190 million compared to the U.S. market at $12.9 billion).
Ablation Technologies Market by Country Compound Growth Rate 2008 to 2017
[Insight: One of the more fascinating aspects of medical technology development is the penchant in the industry for finding different ways to accomplish traditional tasks in medical and surgical care. While certainly some technologies can be oversold for their putative clinical benefits — driving up healthcare costs and giving the industry a bad rap — some medtech advances indeed provide clinically better outcomes that few can legitimately argue, IMHO, as not being cost effective. These include major technology paradigm shifts like laparoscopic surgery. Another area that has shown a progressive set of changes to medical and, especially, surgical care, has been ablation technologies, the use of energy-based and other technologies to accomplish the dissection of tissue, the destruction of cancerous and other lesions and other functional alternation of tissue (e.g., in arrhythmia ablation) that was in most cases previously accomplished by, for the most part, a scalpel only (OK, a little simplified, but you get the idea). These ablation technologies now represent a pretty strong market or collection of market segments that are changing the way surgeons manipulate tissue. Below are some highlights of how the market breaks down by different modality. We also present some of the recent M&A activity in this industry. For additional details on ablation technologies, see the tag or category of "ablation" (or any of the separate modalities) in this blog. – Patrick Driscoll, Founder, MedMarket Diligence]
The worldwide high energy therapies market represents a $25 billion opportunity in 2008. The category consists of therapeutic devices and equipment that deliver the controlled application of one or more modalities of energy to tissue.
Global Ablation and Other Energy-Based Therapies Market Share and Compound Annual Growth Rate by Modality
The field of energy-based companies is well populated, partly because there are several different categories of energy application in clincial medicine, and because companies tend to be focused on single or tightly-focused energy applications. Thus there are companies specialising in cryoablation, thermal ablation, electrosurgery, brachytherapy and so on. Many companies have entered this field offering a new technology in one particular form of energy application.
A growing tendency in recent years has been the acquisition by larger, multifunctional medical device companies of smaller and often newer energy-based companies, as a means of adding a new technology to their portfolio. The past five years have seen many mergers and acquisitions of this kind involving energy-based companies. Exhibit 4-1 shows some examples of M&A activity from the past three years.
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.
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.