Cerebral thrombectomy procedures worldwide

In 2014, approximately 33.7 thousand cerebral thrombectomy procedures were performed worldwide, of which United States and largest European states accounted for roughly 46% and 37%, largest Asian states contributed 10.4% and the rest of the world added remaining 6.5%.

The 2014 global cerebral thrombectomy system sales were estimated at approximately $166 million, of which the United States accounted for about $79.1 million (or ~47.7%), followed by the largest Western European states with $59.4 million (or 35.8%), major Asian states with $17 million (or 10.2%) and the rest-of-the-world with $10.5 million (or 6.3% of the total).

In the view of the industry insiders and practicing neurointerventional radiologists, relatively modest volume of life-saving cerebral thrombectomy procedures and corresponding product sales appear to reflect still insufficient body of favorable clinical data and inhibiting impact of the published dubious findings from the major IMS-III study.

The latter compared first-generation cerebral thrombectomy techniques with standard medical (and tPA) therapy and asserted that endovascular clot retrieval interventions did not result in visible improvement in patient outcomes. The cited conclusions clearly contradict results of numerous randomized trials with available second-generation cerebral revascularization systems, which appear to documented superiority of the latter system in management of acute ischemic stroke caseloads.

It is generally assumed that the situation with end-user adoption is likely to improve dramatically in two-three years from now, when results of the ongoing major U.S. and international trials with novel cerebral thrombectomy devices become available.

Based on these assumptions, the cumulative worldwide volume of cerebral thrombectomy procedures is projected to experience accelerated growth to the end of the forecast period resulting in 10.8% overall average annual expansion of corresponding interventions in the forthcoming five years to an estimated 56.2 thousand total procedures worldwide in 2019.

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From: “Emerging Global Market for Neurointerventional Technologies in Stroke, 2014-2019”, Report #C310.

The worldwide market for cerebral clot retrieval systems is forecast to grow at a slightly slower pace expanding on average 10.1% per annum to about $268.4 million in the year 2019. Price pressure will keep sales growth lower than procedure volume gains.

The largest absolute dollar gains can be expected in the U.S. market (which is projected to add $55.9 million in corresponding device revenues), followed by the West European marketplace (+ $30.6 million), major Asian state business (+ $11.2 million) and the rest-of-the-world (+ $4.7 million).

Cerebral thrombectomy systems

Selected Cerebral Thrombectomy Systems on the U.S. and International Markets

From the 2015 report, “Emerging Global Market for Neurointerventional Technologies in Stroke, 2014-2019”.

CompanyDeviceFeaturesVessel RangeDevice Sizes (D/L)Regulatory Status
AcandisAperioSelf-expanding nitinol stent-based device with hybrid cell design and adaptable working length1.5 to 5.5 mm3.5, 4.5, 6.0 mm / 28, 30 or 40 mmCE Marked
BALTCatch+ Mini/, Catch+, Catch+ Maxi, Catch+ MegaSelf-expanding 16-wire nitinol baskets with tapering cell size design, closed distal tip and 3 distal-1 proximal radiopaque markers2.0 to 7.0 mm3.0, 4.0, 6.0, 9.0 mm / 15, 20, 30, 55 mmCE Marked
Codman /DePuyRevive SESelf-expanding nitinol basket with hybrid cell design, closed distal tip, and 3 radiopaque markers1.5 to 5.5 mm2.5, 3.0, 3.5, 4.0, 5.0, 6.0 mm / 20, 30, 40 mmCE Marked, Approved in China, South Korea, and Taiwan
CovidienSolitaire FRSelf-expanding nitinol stent-based device with Parametric design (for multiple planes of clot contact to enhance capture). Features 3 or 4 distal and 1 proximal markers2.0 to 5.5 mm4.0, 6.0 mm /26, 31, 42 mmCE Marked, FDA approved
NeuraviEmbotrapSelf-expanding nitinol stent-based device with open cell design, closed distal tip, and 3 radiopaque markers. Features dilating inner channel for rapid flow restoration and integrated distal and side branch protection2.0 to 5.5 mm3.0, 4.0, 6.0 mm / 15, 20, 30, 55 mmCE Marked
PenumbraPenumbra SystemAspiration based system comprised of vacuum pump, specialty clot capture & retrieval catheters, and Separator> 3 mm3.0, 4.0, 5.0 mm / 26 mmCE Marked, FDA approved, available in Asia, Australia, and South America
PhenoxpREsetSelf-expanding nitinol stent-based tapering device with closed ring design, and stable proximal opening2.0 to 4.0 mm4.0, 6.0 mm / 30, 45 mmCE Marked
StrykerTrevo Pro, Trevo View, Trevo XPLine of self-expanding nitinol stent-based devices (standard, all radiopaque, oversized) with spiral cell design and soft, guidewire-like closed distal tip1.5 to 4.0 mm4.0, 5.0, 6.0 mm / 20, 30, 40 mmCE Marked, FDA approved

Source: MedMarket Diligence, LLC; Report #C310.

Potential for neurological applications of sealants, hemostasis and closure treatments

neuro-sealantsThere is potential for new sealant, hemostasis and closure treatments designed to facilitate surgical treatments of neurological disorders; most existing alternative treatments are pharmological therapies limited to reducing symptoms and few cures exist. An important driver in this market segment is the increasing aging population, with a consequent growing prevalence of age-related disorders. Also, new improved systems for diagnosis promise the possibility of earlier intervention.

The major indications that will benefit from new sealant, hemostasis and closure products in neural tissue surgery are procedures to treat chronic stroke, spinal cord trauma, neurovascular defects, and brain tumor treatments.

There are an estimated 5.6 million Americans who may benefit from the use of closure and securement products for neurological disorders in 2008.
 


Excerpt from "Worldwide Surgical Sealants, Glues and Wound Closure, 2009-2013," report #S175, published by MedMarket Diligence, LLC.

Obesity’s costs high and rising

Obesity puts a burden on so many aspects of life that the socioeconomic cost is almost inevitably enormous—as well as very difficult to accurately pin down. At the individual level, there is the lower quality of life, days missed from work, decreased wages, premature retirement, potentially unemployment, and the medical costs of related illnesses, which may include depression, cardiovascular disease, joint and arthritic problems, diabetes, stroke, etc. At the societal level, there is the mounting healthcare bill, as well as the increased costs falling upon employers due to missed work days. The healthcare bill would increase even if no one in the US was obese, because of the wave of aging baby boomers. But add to this wave the additional costs of treating the co-morbidities of obesity, and the magnitude of the wave increases significantly.

Direct costs are commonly defined as the costs of treating obesity and the diseases that can be associated with it. This includes but is not limited to the relative portion of the costs of treating hypertension, depression, cardiovascular disease, several types of cancer and osteoarthritis which can be attributed directly to obesity; prescription drugs for weight loss; and bariatric surgery. It also includes the cost of visits to physicians and clinics, hospital admissions and outpatient treatments.

Indirect costs include the cost of earnings lost due to absence from work because of illness associated with obesity. Indirect costs also include the cost of premature mortality. As can be imagined, these costs are much more difficult to estimate, as the methodologies and the statistics may vary from country to country, and, within a country, from agency to agency and from year to year. Of course, it is impossible to put a price on the loss of a life, but statistics allow an approximation of various ‘business’ aspects of the cost. For example, if someone dies from obesity before the age of retirement, then the cost of lost years of employment should also be factored in.

 

Difficulty of Calculating Costs and Morbidity
In 2004, the media reported that the annual cost of all treatments of obesity in the US tipped the scales at $117 billion, and that over 400,000 people died every year from causes directly related to obesity. These numbers appeared everywhere, and took on an air of veracity due both to the solid reputation of the source (the Centers for Disease Control and Prevention) and the repetition. Unfortunately, these numbers were wrong.

The source of the numbers was a 1999 report in the Journal of the American Medical Association by David B. Allison and others. Allison apparently made unreasonably huge extrapolations from a relatively small sample of actual measurements, and concluded that some 300,000 deaths per year could be attributed to obesity. Then in March 2004, the CDC produced a paper which put this number even higher, to over 400,000. Scientists who had criticized the Allison results became even more vociferous after publication of the CDC paper; under a storm of criticism, the CDC finally revised their study nearly a year later (January 2005), bringing the number of annual deaths down to 365,000. The debate continues, though, as different analysts and scientists use different sets of numbers; the current ‘guestimate’ for the number of deaths attributable to obesity ranges from 7,000 to around 122,000 per year.

There is also the argument, put forth by groups such as the Center for Consumer Freedom (CCF) in the US, which says that the entire so-called ‘obesity epidemic’ is being grossly over inflated. They accuse pharmaceutical and medical device companies of catastrophizing the situation so as to incite the government to improve insurance coverage for treatment drugs and devices.

Real Costs, Real Morbidity
The costs and the morbidity from obesity are real, though. One medical journal, Obesity Research, estimates that US obesity treatments, which may range from clinic visits ($10-$50 per visit) to gastric bypass operations ($20,000-$35,000), cost each adult in the US about $350 per year. Over 50% of this cost is borne by taxpayers through the Medicare and Medicaid programs. The World Bank has estimated that the cost of obesity in the US is about 12% of the US national healthcare budget, or about $70 billion—per year. Whatever the exact figures, it is apparent that, left unchecked, there will be costs hitting many healthcare systems worldwide which most are ill prepared to absorb.

Impact on Businesses/Economies
Much research continues to take place into the theoretical and real costs of obesity and how these costs impact national economies. The obvious implication is that the greater the costs, the greater the negative impact on the national economy, and the more urgent the need to address the issue earlier rather than later. The exhibit below shows estimates of annual costs for several major economies.  Even given the caveat that calculations of estimates vary by country, year and data used, the picture does not look encouraging. The majority of the studies of the economic impact of obesity has been conducted using the US population; hence, much of the data which follows looks at the US information.

 Examples of Annual National Costs of Obesity (US$ Millions)

Country

Estimated number of premature deaths due to obesity

Estimated Direct Cost of Obesity

Estimated Indirect Cost of Obesity

Total

United States

122,000-400,000

$70,000-75,000

$56,000

$126,000-131,000

United Kingdom

30,000

$900

$3,600

$4,500

France

11,000

$1,629

No estimates
available

>$1,629

Germany

16,700

$13,080

No estimates
available

>$13,080

Australia

5,800

$1,330

$272

$1,602

 Source:  MedMarket Diligence, LLC


Drawn from Report #S825, "Worldwide Market for the Clinical Management of Obesity, 2007-2015." Published by MedMarket Diligence.

Technologies at new medtech companies (startups)

New medical technologies represented in specific companies recently added (September 2008) to the Medtech Startups Database:

  • Recombinant proteins and cells for intervertebral disc cell regeneration
  • Non-hydrogel polymer used to stimulate tissue growth in dental/orthopedic applications
  • Biomaterials and biologics for repair of bone and cartilage
  • Portable endoscopic imaging
  • Device treatments for restless leg syndrome (RLS)
  • Disposable steerable surgical instrumentation for arthroscopy
  • Technologies to restore spinal disc function
  • Embolic protection system 

For details on the Medtech Startups Database, see link.  


Also from MedMarket Diligence: 

  • New!  Ablation Technologies 2008:  “Worldwide Ablation Technologies, 2008-2017.”  See link.
  • Spine Surgery 2008: Spine Surgery: Products, Technologies, Markets & Opportunities, Worldwide, 2008-2017.  See link. 
  • Wound Management 2007-2016: Wound Management: Established and Emerging Products, Technologies and Markets in the US, Europe, Japan and Rest of World.  See link. 

For additional details on Reports or the Medtech Startups Database, contact Patrick Driscoll at +1-949-859-3401 or patrick(at)mediligence(dot)com.