Tag Archives: ultrasound

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

 

Growth of modalities in tissue ablation

An examination of the future markets for technologies used in therapeutic ablation has support for a general and sustained growth in ablation technology revenues:

Ablation-modality-growth-revenues

Source: Report #A145

However, when considering the relative growth of each of the modalities in tissue ablation, it is clear that some modalities are growing more aggressively than others:

Ablation-modality-growth-shares

Source: Report #A145

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.

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Tissue ablation is predominantly cancer therapy

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:

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

Source: Report #A145, "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities."

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.

Growth in the Asia/Pacific Market for Ablation Technologies

 

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.

Asia-pacific-ablation

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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Shifting caseload and markets in tissue ablation

Technologies to therapeutically ablate tissue (via destruction and/or removal of abnormal tissue or creation of a therapeutic lesion as in blocking errant electrical pathways in arrhythmia) represent a remarkably diverse set of tools despite their fundamentally common capability of tissue ablation.

Spanning electrical, radiation, light/laser, radiofrequency, ultrasound, cryotherapy, thermal therapy, microwave and hydromechanical and embodied in a wide range of medical devices and equipment, all ablation types simply destroy tissue.  The differences lie in respect to the specificity of each modality in targeting disease tissue and in respect to their capacity to be integrated in different types of instruments that may match the demands of specific clinical practices.

The recent history of ablation technology market developments reveals that, despite the specialization of modalities to specific tissues, or the efforts by manufacturers to carve out clinician or disease-state niches for specific modalities, growth in different ablation procedure types and clinical practice patterns has changed steadily but not always predictably.  Recent clinical results, new ablation device innovations and other developments have had the propensity to drive shifts in patient caseload between alternative ablation types.  Given the development and manufacturing costs, have largely and unsurprisingly maintained focus in typically one modality type, seeking to provide innovations in devices and equipment that accentuate benefits for there specific modality in specific clinical applications.

Below is illustrated the worldwide market for ablation technologies in 2009 and forecast 2019.

Source: "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities." Report #A145.

Ablation technology markets

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.

Source: "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities" (MedMarket Diligence Report #A145)

Evolution of ablation technologies and migration of caseload

Technologies to therapeutically ablate tissue (via destruction and/or removal of abnormal tissue or creation of a therapeutic lesion as in blocking errant electrical pathways in arrhythmia) represent a remarkably diverse set of tools despite their fundamentally common capability of tissue ablation.

Spanning electrical, radiation, light/laser, radiofrequency, ultrasound, cryotherapy, thermal therapy, microwave and hydromechanical and embodied in a wide range of medical devices and equipment, all ablation types simply destroy tissue.  The differences lie in respect to the specificity of each modality in targeting disease tissue and in respect to their capacity to be integrated in different types of instruments that may match the demands of specific clinical practices.

The recent history of ablation technology market developments reveals that, despite the specialization of modalities to specific tissues, or the efforts by manufacturers to carve out clinician or disease-state niches for specific modalities, growth in different ablation procedure types and clinical practice patterns has changed steadily but not always predictably.  Recent clinical results, new ablation device innovations and other developments have had the propensity to drive shifts in patient caseload between alternative ablation types.  Given the development and manufacturing costs, have largely and unsurprisingly maintained focus in typically one modality type, seeking to provide innovations in devices and equipment that accentuate benefits for there specific modality in specific clinical applications.

Below is illustrated the worldwide market for ablation technologies in 2009 and forecast 2019.

Source: "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities." Report #A145.

Ablation technologies proliferate from their many clinical benefits

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.

ablation-bubbles

Source:  MedMarket Diligence, LLC; Report #A125, "Ablation Technologies Worldwide:  Products, Technologies, Markets, Companies and Opportunities."

 

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.

High growth applications of ultrasonic surgical systems

Ultrasonic surgical systems deliver vibrational energy to ablate tissue and affect hemostasis. Unlike radiofrequency (RF) and laser systems that achieve coagulation through thermal welding, ultrasonic energy is not reliant upon heat to seal tissue. The popularity of ultrasonic systems is being driven by several inherent advantages. The absence of smoke, which improves the visual field and eliminates the need for smoke evacuation, improves intraoperative visualization. Further, these instruments combine grasping, cutting and coagulation into one integrated tool set that reduces cost and time consuming, intraoperative instrument exchanges. Patient safety is enhanced as there is an absence of electrical current passing through a patient’s body and lateral tissue damage is therefore minimized. The procedures that benefit most from the inherent advantages of ultrasonic surgical systems are advanced laparoscopic procedures.

Below are illustrated the procedures with the highest growth in the application of ultrasonic surgical systems. Over the 2003-2008 timeframe, each of these demonstrated double-digit growth, with growth in gastric bypass (bariatrics, obesity) and prostatectomy outpacing all others.  Over the next five years, these procedures will demonstrate comparable growth.

ultrasound-surgical-apps

Source:  Report #A125, "Ablation Technologies Worldwide Market, 2008-2017."

Medical technology platforms with high growth potential

Specific technologies and broad technology platforms have tremendous potential for market growth based on combinations of recent technology advancement, changes in clinical practice, current forces in the market and other criterial. 

  • Biotech solutions to traditional medical device technologies.  The thrust of medical technology is, and has been for a long time, to make it as effective as possible while being the least possible invasive.  Taken to the extreme, instead of implanting a device, such as a suture or a staple, the almost perfect solution would to be to close wounds with no device at all.  Hence, surgical sealants, fibrin glues and other medical/surgical adhesives, hemostats and related biologicals (and even non-biologicals like cyanoacrylates), having proven themselves clinically and offering very low adoption hurdles, represent a huge opportunity in the medtech market.
     
  • Ablation and other high energy technologies.  What used to be handled by scalpel when my father did general surgery, is now increasingly being accomplished using energy-driven modalities that provide other tissue effects that a sharp metal blade alone could never do.  These technologies are therefore growing in both the penetration of traditional surgical procedures and their expansion to new clinical applications.
     
  • Nanotech and microelectromechanical systems (MEMS).  It is actually a gross oversimplification to use a word like "nanotech" and imply that you are talking about one type of technology.  The only thing common to nanotech is size; every manner of material, construction, function and clinical benefit is part of this area.  The pace of development is striking.
     
  • Drug-device hybrids.  Just a few of the applications of combining drugs and devices in a single device include localized drug-delivery that avoids toxic, systemic dosages and vastly improved biocompatibility of existing devices. These two options alone represent multiple enormous markets.  Now, naked metal (or other) implants seem almost barbaric.
     
  • Bioresorbable materials.   Polymer and other materials technologies are enabling the development of implants and other devices that conveniently go away when they are no longer needed.  Already a significant market force in areas like bone growth in orthopedics, bioresorbable stents and other implants are proving their worth in cardiology and urology. 
     
  • Atherosclerotic plaque-reversing drugs.  When Pfizer divested itself of Esperion Therapeutics, it did not bode the end of this striking new drug approach to atherosclerosis, it simply illustrated the persistent challenge of drug development.  Here, it should be kept in mind that, the bigger the potential payout, based on huge clinical need (e.g., drug solution to the device intensive treatment of coronary artery disease), the more likely it is only a matter of time before the product reaches the market.  The jury is out on the "when" part, not the "if".
     
  • Rational therapeutics.  This is the holy grail thinking behind the development of many, many biotech products.  If one can develop a cure — a direct resolution of the underlying biological defect or deficiency in disease — and not just the symptoms, then one has changed the market in paradigm ways.  The hurdle and the payoffs are huge.
     
  • Tissue engineering technologies.  We have begun to be able to develop tissue engineered organs of increasing complexity — skin, bladders and rudimentary pancreases — and the benefits of these are in applications too numerous to mention..
     
  • RFID.  There is little, really, that is sophisticated about radiofrequency identification devices,  but their rapid integration into medical technologies of a wide range (tagging surgical instruments so they don’t get left behind, implants that enable external identification or even status, other types) will extend the utility and value of medical devices.
     
  • Noninvasive glucose monitoring.  Optimizing care for diabetes means, at a minimum, very frequent (5-10) checks per day of blood glucose.  This many finger pricks per year by the total number of diabetics globally (a rapidly growing number at that) who clearly would benefit from noninvasive monitoring reveals the value of this opportunity.  Capturing that opportunity means the combined success of both technology and cost.
     
  • Infection control.  This area is a top area, not for the sigificant technologies that have been developed, but the enormous demand for them.  Between rapidly emerging problems like methicillin-resistant staph aureus (MRSA), the resurgence of tuberculosis, the enormous costs of nosocomial infections and other infection-related challenges, infection control is an enormous, global opportunity.
     
  • Spine surgery.   The nature of the human spine, constructed of bone that needs to be both flexible and strong, demands device-intensive solutions.  The growing patient population of active, older adults is ratcheting the pressure on technologies to be less invasive, provide greater range of motion, last longer, cost less — all of which drives innovation in spine surgical technologies.
     
  • Obesity treatment technologies.  Technology solutions to the increasingly prevalant problem of obesity are imperfect, but still are frequently better solutions for the obese than an alternative that may ultimately also encompass heart disease, diabetes, stroke and other problems.  Diverse drug and device alternatives have been developed and the trend in obesity incidence will simply drive their continued development. 

Other forces are at work driving the above technologieis including, of course, cost containment, the integration of information technologies in both medical product and development process and the globalized economy.

(While the above list  is separately a White Paper that I have written, and periodically re-write to reflect new stuff being developed, I find it interesting and worthwhile to revisit frequently and discuss in this blog.)


The above topics are covered in various MedMarket Diligence reports.  See our list of titles.