Whether sales growth arises by a preferred adoption of one technology over another or by better than average economic conditions — or both, sales of wound management products are driven by technology adoption rates that vary by country, clinical practice patterns, reimbursement and other variables.
We assessed current and forecast sales for the following products:
Traditional Adhesive Dressings
Negative Pressure Wound Therapy
Bioengineered Skin & Skin Substitutes
For all product segments but the traditional adhesive, gauze, and non-adherent wound care products (which were assessed only at the global level), we assessed growth in each of the following countries/regions: Americas (USA, Rest of North America, Latin America), Europe (United Kingdom, Germany, Italy, France, Spain, Rest of Europe), Asia/Pacific (Japan, Korea, Rest of Asia/Pacific), and Rest of World.
From our examination (report #S251) of the global market for wound management products, below are the top product-country cohorts in terms of projected compounded sales growth from 2015 to 2024.
See the newest global wound management market report (published December 2012), 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.”
In results presented in a poster session at the 24th Annual Clinical Symposium on Advances in Skin and Wound Care (San Antonio, TX), the Advanced Wound Management Division of Smith & Nephew highlighted that gauze-based negative pressure wound therapy (NPWT) can achieve the same treatment goals as foam-based NPWT, which are a reduction in wound dimension, exudate, and improvement in granulation tissue.
One of the most dramatic, and perhaps surprising, recent developments in the advanced wound management sector has been the meteoric rise of negative pressure wound therapy (NPWT) technology, spearheaded by the V.A.C. approach developed by Kinetic Concepts Inc. (KCI). This has driven growth in the “physical treatment” market segment to exceed $1.2 billion. In 1989, Mark Chariker and Katherine Jeter developed a technique utilizing standard surgical dressings and wall suction to create a “vacuum” that aided in wound healing. In 1997, Dr. Michael Morykwas and Dr. Lewis Argenta studied the use of suction applied to polyurethane foam in wounds. Shortly after, KCI launched its product, the V.A.C.® and later received Medicare B approval. In early September 2009, Kinetic Concepts received Japanese regulatory approval to begin selling the V.A.C. device in that country. The company expects sales to commence in the first half of 2010.
Further innovations into the use of closed wound suction were made by BlueSky Medical with the Versatile One® System. Then in 2007, Smith & Nephew acquired BlueSky Medical and brought all that company’s products under the Smith & Nephew umbrella. Since the purchase of BlueSky, S&N has devoted considerable resources to contest KCI’s hold on the lion’s share of the market for NPWT devices.
More details on the study and its results from Smith & Nephew are given here. The trial was a prospective, multi-center clinical evaluation assessed 131 non-grafted patients at 21 centers in the United States, Canada, United Kingdom, Saudi Arabia and the United Arab Emirates.
Products and technologies used in advanced wound management have found varying degrees of success in global markets, stemming from differences in clinical practices, cultures, sensitivities, demographics and other geographically-driven differences. At the macro view, the size of the advanced wound management market by countries falls in a typical pattern based on the relative size of the populations and healthcare markets:
The differences between these markets in their relative adoption and use of advanced wound management technologies is illustrated in the graph below, showing the percent of each country's total market that is represented by each wound product type.
The size of the wound care market is ultimately determined by the clinical need for advanced wound management products. That need is most clearly reflected in the prevalence of chronic wounds and burns. Current estimates put the total annual incidence of chronic wounds at almost 9 million worldwide, and there are 177 million cases of diabetes worldwide; 10%–15% of diabetic patients will develop ulcers at some point. The market for products used in the management of specific wound types are, in decreasing size, venous stasis (as in chronic venous ulcers) decubitus ulcer (e.g., bedsores), diabetic foot ulcers and lastly (despite their acute nature) burn wonds.
It should be noted that a large proportion of wound product sales are accounted for by traditional types of wound management products. It has been estimated that two-thirds of the world’s physicians are not making routine use of advanced wound management products. Perhaps surprisingly, U.S. physicians are much more conservative in their approach to advanced wound healing technologies than their European counterparts. For this reason, the European share of the AWC market is significantly higher than the U.S. share.
The implication is that there is significant market potential, if barriers such as cost and entrenched attitudes can be overcome. It is not yet widely appreciated, even in some parts of the developed world, that the relatively high initial cost of managing hard-to-heal wounds with advanced techniques is more than offset by the savings achieved with shorter treatment periods and reduction in the demand for skilled medical attention.
Prior to the late 1970s it was thought that wounds needed to dry out to prevent infection, form a scab, and subsequently heal well underneath the scab. In the late 1970s new work on occlusive film materials demonstrated that wounds heal better if a moist environment is maintained. A number of transparent film dressings are now commercialized under brand names such as Bioclusive, Opsite, and Tegaderm. Transparent film dressings can be made to have moisture vapor transmission levels from zero g/24h/m2 (occlusive) to levels beyond 3000 g/24h/m2 (semi-occlusive). If the speed of exudates production by the wound exceeds the moisture vapor permeability (MVP), then the film dressing effectively proves an occlusive barrier, although technically the dressing is still semi-occlusive. Indeed, gases will still be transmitted across the wound dressing. All film dressings provide a covering that is impermeable to microbes and therefore they protect the wound from infectious agents such as bacteria, viruses and fungi.
Transparent films that create a moist wound environment provide a semi-occlusive barrier that allows active wound fluid and cells to function in a physiological environment. Film dressings prevent scab formation, isolate the wound from contamination by microbes, and allow more rapid granulation and epithelialization of the wound surface. Film dressings are used to protect from friction and shear, and can serve as barriers to moisture. They are also useful as retention dressings and provide the proper environment for autolytic debridement. Film dressings in larger sizes serve as surgical drapes during surgery or in smaller sizes as I.V. catheter retention dressings. These applications for film dressings are designed to prevent movement of microbes from surrounding skin to the injury site. This is important because many microbes have an almost commensal relationship with normal skin. To remove them completely often requires injury to the skin, and yet if they are allowed to grow in wounds they can reach concentrations that become pathologic.
Companies in the Films Dressings Wound Management Market
3M Health Care
Advanced Medical Solutions
Lohmann & Rauscher
Smith & Nephew
Swiss American Products/Elta
Systagenix Wound Management*
Most film dressings on the market today are made of polyurethane film with acrylic adhesives and a disposable support or application system integrated into the design. The support function may provide a secondary function such as serving as a wound-tracing device for record keeping. Films differ in MVTR and extensibility or elasticity. Wound dressings generally provide a low to moderate MVTR (500 to 2,000 gm/24h/m2), whereas film dressings with MVTRs greater than 3000 gm/24h/m2 are produced for specialty applications such as surgical drapes or catheter retention dressings. These dressings are specially designed to allow all moisture at the surface of the skin to escape from the skin surface, to keep infectious agents out of the site, and to prevent the natural skin flora from infecting the wound site.
While the huge $5 billion global market for wound management technologies may not suggest it, many of its products are designed to target the high cost of wound healing. Chronic wounds and non-healing wounds. See the 2009 MedMarket Diligence report.
FOOTHILL RANCH, CA — Advanced wound management technologies — those used in the clinical management of wounds (not OTC) — represent a $5 billion global market that will triple in the next ten years. These technologies have continued to evolve beyond simple dressings and bandages to be able to accelerate wound healing, improve clinical outcomes and, in particular, attempt to reduce the cost of managing wound types like arterial, venous, diabetic and stasis ulcers.
The distribution of the advanced wound care market across these different wound care types has continued to shift, especially with the development and application of more expensive wound care technologies, which have been incentivized by the high cost of chronic wounds. Physical therapies, which include negative pressure devices, positive pressure devices, mechanically assisted wound closure, hydrotherapy, electrical stimulation, ultraviolet therapy and others, are demonstrating the largest relative growth.
The MedMarket Diligence report, "Worldwide Wound Management, 2009: Established and Emerging Products, Technologies and Markets in the U.S., Europe, Japan and Rest of World," published September 2009, details the complete range of products and technologies used in wound management and wound care, from dressings, bandages, hydrogels, tissue engineered products, physical treatments and others. The report details current clinical and technology developments in this huge worldwide market with high growth sectors, with data on products in development and on the market; market size and forecast; competitor market shares; competitor profiles; and market opportunity. The report provides full year (actual) 2008 market size and share data, with forecast market data to 2017, for the U.S., Europe, Asia/Pacific and Rest of World.
"The intense focus of healthcare reform on the cost of medical technologies might examine wound management as a cost driver, but the reality of products and development in this area is that the high cost of chronic or non-healing wounds is the prime target of the wound management industry’s efforts," says Patrick Driscoll of MedMarket Diligence, publisher of the 2009 Worldwide Wound Management Market report. According to Driscoll, the high direct and indirect costs of chronic wounds have created an economic opportunity that sustains advanced technology development. This does not make wound care exempt from the focus of healthcare reform, but does weaken the argument against the "high costs" of advanced technology development.
The U.S. market for wound management products, like many markets, towers over all other country markets, but outside the U.S., the largest markets for wound management technologies are Germany and Japan, and these two markets are remarkably similar in size and growth, if not in cultural or economic drivers.
It is estimated that more than 1 million people in Japan are treated for wounds every day. There are roughly 5,500 new cases of diabetes every year. There are now roughly 8.2 million Japanese suffering from diabetes with a total 18.7 million people including pre-diabetic subjects, according to The Japan Diabetes Society.
The potential market opportunity offered by the caseload of decubitus ulcers may be gauged from the fact that the total of infirm elderly is expected to be 3.5 million in 2010. Among elderly individuals who are bedridden, 75% have been in this situation for more than one year and 53% for more than three years.
Patients in Germany have free access to physicians and this means that patient preference influences prescribing, so “patient-friendly” products have an advantage. There is a tendency to favor the longer-established products in the AWM category in order to control costs; thus hydrocolloids are growing at around 5% per annum while films and hydrogels are growing only slowly, while alginate and foam products have seen vigorous sales growth.
Wound healing agents have the biggest share of the German non-prescription medical market. The aggregate German advanced wound care market is estimated to grow at over 12% per year from a value of $592.1 million in 2008.
Below are the major non-U.S. markets for wound management, mapped by size and growth (CAGR 2008-2017).
See also the 2013 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”.
Wound management encompasses a wide range of products: fabric dressings, first aid dressings, dressings and internal wound management products for surgery, advanced wound management products, active pharmaceutical wound care products, tissue engineering, physical therapies for wound care, and pressure relief products and skin treatments, for preventative wound management.
MedMarket Diligence is finalizing its analysis (publication September 2009) of the global market for wound management products (Report #S247). Following is an excerpt from the 2007 analysis (provided as a point of reference only; more current data is under review).
Surgical wounds account for the vast majority of skin injuries. We estimate that there are over 100 million surgical incisions a year requiring some wound management treatment. Approximately 80% of these wounds use some form of closure product (sutures, staples, and tapes). Many employ hemostasis products, and use fabric bandages and surgical dressings.
Surgical wounds are projected to increase in number at an annual rate of 3.1%, but overall the severity and size of surgical wounds will continue to decrease over the next ten years as a result of the continuing trend toward minimally invasive surgery.
Surgical procedures generate a preponderance of acute wounds with uneventful healing and a lower number of chronic wounds, such as those generated by wound dehiscence or post-operative infection. Surgical wounds are most often closed by primary intention, using products such as sutures, staples, or glues, where the two sides across the incision line are brought close and mechanically held together. Surgical wounds that involve substantial tissue loss or may be infected are allowed to heal by secondary intention where the wound is left open under dressings and allowed to fill by granulation and close by epithelialization. Some surgical wounds may be closed through delayed primary intention where they are left open until such time as it is felt it is safe to suture or glue the wound closed.
A significant feature of all wounds is the likelihood of pathological infection occurring. Surgical wounds are no exception, and average levels of infection of surgical wounds are 7 to 10 percent dependent on the procedure. These infections can be prevented by appropriate cleanliness, surgical discipline and skill, wound care therapy, and antibiotic prophylaxis. Infections usually lead to more extensive wound care time, the use of more expensive products and drugs, significantly increased therapist time, and increased morbidity and rehabilitation time. A large number of wounds will also be sutured to accelerate closure, and a proportion of these will undergo dehiscence and require aftercare for healing to occur.
There are estimated to be 1.5 million cases of traumatic wounding every year. These wounds required cleansing and treatment with low adherent dressings to cover them, prevent infection, and allow healing by primary intention. Lacerations are a specific type of trauma wound that are generally more minor in nature and require cleansing and dressing for a shorter period of healing. Lacerations occur frequently (approximately 19 million cases a year) as a result of cuts and grazes and can usually be treated within the doctor’s surgery and outpatient medical center and hospital accident and emergency department.
Burn wounds can be divided into minor burns, medically treated, and hospitalized cases. Out-patient burn wounds are often treated at home, at the doctor’s surgery, or at outpatient clinics. As a result a large number of these wounds never enter the formal health service system. We estimate that approximately 3.3 million burns in this category do enter the outpatient health service system and receive some level of medical attention. These burns use hydrogels and advanced wound care products, and may even be treated with consumer based products for wound healing. Medically treated burn wounds usually get more informed care to remove heat from the tissue, maintain hydration, and prevent infection. Advanced wound care products are used on these wounds. Approximately 6.3 million burns like this are treated medically every year. Hospitalized burn wounds are rarer and require more advanced and expensive care. These victims require significant care, nutrition, debridement, tissue grafting and often tissue engineering where available. They also require significant aftercare and rehabilitation to mobilize new tissue, and physiotherapy to address changes in physiology.
Chronic wounds generally take longer to heal and care is enormously variable, as is the time to healing. There are approximately 7.4 million pressure ulcers in the world that require treatment every year. Many chronic wounds around the world are treated sub-optimally with general wound care products designed to cover and absorb some exudate. The optimal treatment for these wounds is to receive advanced wound management products and appropriate care to address the underlying defect that has caused the chronic wound; in the case of pressure ulcers the causal effect is pressure and a number of advanced devices exist to reduce pressure for patients. There are approximately 11 million venous ulcers, and 11.3 million diabetic ulcers in the world requiring treatment. Chronic wounds are growing in incidence due to the growing age of the population, and due mostly to awareness and improved diagnosis. At present these factors are contributing to growth of this pool of patients faster than the new technologies are reducing the incidence of wounds by healing them.
Wound management products are also used for a number of other conditions including amputations, carcinomas, melanomas, and other complicated skin cancers, which are all on the increase.
Below is a report from MedMarket Diligence on the worldwide wound management market. The report is described in detail here.
Worldwide Wound Management, 2007-2016: Established and Emerging Products, Technologies and Markets in the U.S., Europe, Japan and Rest of World
· 256 pages · 64 Exhibits · 69 Company Profiles · Report #S245 · Published Nov. 2007
This report details the complete range of products and technologies used in wound management and wound care, from dressings, bandages, hydrogels, tissue engineered products, physical treatments and others. The report details current clinical and technology developments in this huge worldwide market with high growth sectors, with data on products in development and on the market; market size and forecast; competitor market shares; competitor profiles; and market opportunity.
This report details the current and projected market for wound management products, including dressings, closure devices, debridement, pharmacological products, tissue engineered products and others. Particular emphasis is placed on advanced and leading edge developments (i.e., those approaching wound management from novel perspective) such as growth factors, stem cells, gene therapy and other approaches, while baseline data (current and forecast market size and current competitor market shares) is provided for established segments — multiple dressings types (film, foam, alginate, antibacterial, non-adherent), hydrogels, hydrocolloids, pharmaceuticals, and physical treatments. The report details the clinical and technology developments underlying the huge and evolving worldwide wound care market, with data on products in development and on the market; market size and forecast; competitor market shares; competitor profiles; and market opportunity. Separate size, growth and competitor data are presented for the U.S., leading western European countries, Japan and the Rest of World category. The report profiles leading and emerging companies, with profiles providing detailed profile information on major competitors, brief profiles of companies with less sizeable current or potential positions in the market, and additional profiles of companies with novel or advanced wound care research activities in the market.
The report establishes the current worldwide market size for major technology segments as a baseline for and projecting growth in the market over a ten-year forecast and assesses and projects the composition of the market as technologies gain or lose relative market performance over this period.
(For more information, see link or contact Patrick Driscoll, patrick at mediligence dot com, or tel: 949-859-3401.)