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Transcript of Understanding the Peripheral Vascular Toolkit: An Analysis of Trends, Strategies and Opportunities...
Understanding the Peripheral Vascular Toolkit:
An Analysis of Trends, Strategies and
Opportunities in the U.S. Peripheral Intervention Market
Teri MinorSenior Industry Analyst, Medical Devices
HealthcareFrost & Sullivan
September 29, 2009
2
� Peripheral Vascular Disease overview
� Types of treatments for Peripheral Vascular Disease
� Shifts in types of procedures and physician specialties
� Future technologies and products
Focus Points
39/29/2009
3
Peripheral Vascular Disease Still Growing in the U.S.
•In 2008 the Peripheral Vascular Disease Market was growing from 5% to 10% from historical growth rates of 15%.
•Patients are delaying visits for screening, causing a delay in diagnosis.
•In 2008 there were approximately 3.6 million interventional procedures for the diagnosis and treatment of Peripheral Vascular Disease.
•The American Hospital Association states that Peripheral Vascular disease significantly increases the risk of stroke or heart attack.
49/29/2009
Growing Rate of Peripheral Vascular Disease in the U.S.
Comorbidity for
Peripheral Vascular
Disease is high with
lower survival rates
than some forms of
cancer
Peripheral Vascular
Disease
significantly under-
diagnosed; less
than 1 in 3 patients
An estimated 30% of
individuals in the U.S.
afflicted with
Peripheral Vascular
Disease die within 5
years.
10 million people in U.S.
with Peripheral Vascular
Disease growing 5% - 10%
Peripheral Vascular Disease
59/29/2009
Treating Peripheral Vascular Disease
Disease Treatment
• Surgical procedures Saphenous Vein or ePTFE Grafts
• Drug Therapy Advancements in treatment of obesity, diabetes, and vascular
disease
• Interventional Treatments
• Stents
• Atherectomy Devices
• PTA Balloon Catheters
• Stent Grafts
• Thrombectomy
69/29/2009
Growth and Strategy – Peripheral Vascular Key Segments
Changing Market Landscape:
•Over 100,000 lower limb amputations
• In 2008 stents represented 41% of treatment
•On-going active efforts to improve screening and awareness
•Endovascular interventions increased more than threefold while bypass decreased -4%
•Wide range of treatment options available: balloon angioplasty; atherectomy; thrombectomy; stenting; vascular compression;
venous ablation
Peripheral Vascular Key Segments
Peripheral
Stents
41%
Atherectomy
13%Thrombectomy
10%
Stent-Graft SFA
12%
PTA Balloon
Catheters
15%
Surgical Grafts
9%
Peripheral Stents
Atherectomy
Thrombectomy
Stent-Graft SFA
PTA Balloon Catheters
Surgical Grafts
79/29/2009
Key Interventional Treatment Segments
Company Stenting Angioplasty
Advanced
Baloon Thrombectomy Atherectomy
Carotid
Stent
Embolic
Protection
Abbott Laboratories X X X X
Angioscore X
Boston Scientific X X X X X X
Cardiovascular Systems X
Cordis- J&J X X X X
CR Bard X X
Edwards Lifesciences X X
ev3 X X X X X X
Idev X
Medtronic X X X X
Pathway medical
Possis X
Spectranetics X
89/29/2009
2008 Peripheral Stent Market Key Indications
•The Market for peripheral vascular stents has not yet become standardized or saturated
•Stent placements account for over 35% of all peripheral vascular interventions in 2008
•High Fracture Rates and CMS reimbursement has limited growth
Peripheral Stent Market Overview
2008 PERIPHERAL STENTS BY INDICATION
Illiac
37%
Femoral-
Popliteal
27%
Renal
23%
Carotid
13%Illiac
Femoral-Popliteal
Renal
Carotid
99/29/2009
Open Surgical Procedures Marketing Losing to MIT
As with other sectors, open surgical procedures for peripheral vascular
disease treatment is being replaced by interventional treatments.
• Open surgical options include ePTFE vascular grafts and saphenous
vein bypass.
• Peripheral Interventions have quicker recovery and are less invasive.
• Patient awareness increases as more physicians adopt minimally
invasive technologies.
• FDA approval of SFA treatment will shift the market.
• Better technologies in stents, and athrectomy devices increase
adoption.
109/29/2009
Shift in Treatment Segments for Peripheral Vascular
•There has been a tremendous shift over the past 5 years in treatment
of peripheral vascular disease, from surgical to interventional
procedures.
•Due to the associated risks open surgical treatment is considered a
last resort, and the market is looking for safer alternatives.
•Open surgical device sales of ePTFE grafts declining rapidly.
•High restenosis rates often perceived as justifiable compared to
surgery.
119/29/2009
Device and Treatment Shifts Drive Shifts in Surgeon Specialty
• The success of interventional treatment for peripheral vascular disease has driven a shift in physician specialty performing procedures.
• Vascular surgeons who traditionally treated Peripheral Vascular Disease, were slow to adopt losing cases to cardiologists, interventional radiologists, radiologists, and interventional cardiologists.
• As the market for coronary interventions matures, cardiologists will be looking for work in the peripheral field. This trend is already occurring in the U.S. and expected to accelerate.
Key Users2005 2008
Interventional Cardiologists 35% 50%
Vascular Surgeons 25% 35%
Interventional Radiologists 40% 15%
129/29/2009
Physician Specialties Performing Peripheral Interventions
Vascular
SurgeonsVascular
Surgeons
CardiologistsCardiologists
RadiologistsRadiologists
Interventional
CardiologistsInterventional
Cardiologists
Peripheral Vascular
Interventions
139/29/2009
Trends for the Future
-Market Trends
• High growth areas are Carotid stents, Lower Limb, and Atherectomy.
• The stent market is poised to take off; however, there continue to be
regulatory issues and confidence from providers which hold the market from
reaching the full potential.
• Interventional procedures continue to take away from surgical procedures
-New Devices – Increase Usage – Improve Outcomes
• Cook Medical clinical trial of Zilver PTX-Blockages in Femoropopliteal Artery
paclitaxel-coated stent use for outside the heart
• Ev3 enrolling trail for SFA indication for its EverFlex stent
• New Atherectomy devices hitting the market
149/29/2009
Conclusion
FDA approval for peripheral stents could increase usage by 50%
Peripheral Vascular is a hot opportunity
Research of new technologies such as drug-eluting stents are still to be played out
Alternative treatments such as atherectomy will drive revenues
Peripheral Vascular Outlook
There has still been no “gold standard” to emerge
159/29/2009
Voice of the Clinician: Understanding the PV Intervention Toolkit End User Analysis
Frost & Sullivan is currently conducting a project seeking to trend the current and near term market for
peripheral intervention products – based on data from ~150 clinical specialists, including vascular
surgeons, interventional cardiologists, and interventional radiologists:
Objectives:
• Evaluate behavior analytics and probe for unmet needs of interventionalists and vascular surgeons
pertaining to their practice
• Uncover adoption trends, treatment selection criteria and prevalence of off-label usage of stents,
• Assess levels of patient awareness, and trends related to screening and diagnosis.
• Understand purchasing structure and other institutional factors impacting utilization
• This study would also probe patient pathways, awareness/access to newer technologies, current and
expected patient demographics, product preferences, access to care, and other dynamics that can shape
overall market projections.
28%
26%
15%
18%
23%
15%
28%
26%
15%
18%
23%
33%
10%
21%
21%
15%
21%
33%
10%
21%
21%
15%
10%
18%
31%
26%
15%
10%
36%
3%
3%
8%
15%
18%
3%
3%
3%
8%
15%
18%
18%
31%
26%
15%
26%
36%
31%
36%
38%
36%
21%
36%
38%
31%
21%Cordis J&J
Medtronic
Boston Scientific
Abbott Vascular
ev3
Cook Medical
Foxhollow (ev3)
Pathway Medical
Cardiovascular Systems
Spectranetics
Boston Scientific
Currently using Have used in the past Have seen demo or tested Have heard of Was not aware of
SAM
PLE
Early Adopters
Most receptive to new
technologies and forms of treatments.
Risk Averse
Certain clinicians who are well set in their practice, are sometimes more resistant to change. They require higher levels of scrutiny and evaluation of new technologies before they are
willing to adopt or consider incorporating those treatments into their practice.
Evidence-BasedThe result of clinical tests and the experience of peers is this segment’s top concern.
22%
32%
46%
Early Adopters
Most receptive to new
technologies and forms of treatments.
Risk Averse
Certain clinicians who are well set in their practice, are sometimes more resistant to change. They require higher levels of scrutiny and evaluation of new technologies before they are
willing to adopt or consider incorporating those treatments into their practice.
Evidence-BasedThe result of clinical tests and the experience of peers is this segment’s top concern.
22%
32%
46%
SAMPLE
169/29/2009
Next Steps
Request a proposal for a Growth Partnership Service to support you and
your team to accelerate the growth of your company.
1-877-GoFrost (1-877-463-7678)
Register for the next Chairman’s Series on Growth:
The Growth Excellence Model: Competitive Benchmarking & Growth
Investing (October 6th) (http://www.frost.com/growth)
Register for Frost & Sullivan’s Growth Opportunity Newsletters and keep
abreast of innovative growth opportunities.
(www.frost.com/news)
179/29/2009
Your Feedback is Important to Us
Growth Forecasts?
Competitive Structure?
Emerging Trends?
Strategic Recommendations?
Other?Please inform us by taking our survey.
What would you like to see from Frost & Sullivan?
189/29/2009
For Additional Information
For Additional Information
Teri Minor
Industry Analyst, Medical Devices
Healthcare & Life Sciences Research
901-270-0399
Carol Skloss
Director of Sales
Healthcare & Life Sciences
210-247-3810
Venkat Rajan
Industry Manager, Medical Devices
Healthcare & Life Sciences Research
210-247-2427