DEFINING THE LANDSCAPE FOR NEUROMODULATION
2020or
20/20
Dana Mead12/6/2012
KPCB Confidential
Over 350,000 jobsMore than US $650 billion market cap
Company and Market Building Since 1972
KPCB Confidential
Innovation Markets
Information Technology• Smartphones + tablets à PCs + laptops
• Third Wave of Innovation
Health Care & Life Sciences• Targeted therapeutics • “Digital” Health • Medical Devices
New Energy Technology• Science of small à enormous markets
• Speed and scale
KPCB Confidential
Life Sciences PortfolioDIAGNOSTICS THERAPEUTICS TOOLS/SERVICESDEVICES
KPCB Confidential
Presentation Pathway: 2012 2020
Therapies/IndicationsTechnologyCare ContinuumHealthcare EconomicsMarketsA Healthy Ecosystem ?
KPCB Confidential
Neuromodulation Therapies 2012 2020
• Foundation of therapies across pain, spasticity, movement disorders, incontinence, epilepsy, sensory deficits
• Therapy efficacy is mixed despite trial step (SCS)
Expanding therapies to more complex neurodegenerative diseases
2020
• Expanded indications• Enhanced efficacy• Less invasive implant procedures• Improved efficacy, eliminate trial (SCS)2012
KPCB Confidential
Traditional SCS: Trial Success Rates*
*Success defined as >50% VAS score improvementSource: Leerink Swann, Physician survey (n=50) and SMI prospective/retrospective data
Pelvic/Groin (37%)
Foot (59%)
Arms (49%)
Chest (31%)
Leg (75%)
Back (50%)
Hand (44%)
KPCB Confidential
Neuromodulation Therapies: Current & Future
Parkinson’s Disease
Hearing Disorders
Vision Disorders
Urinary & Fecal Incontinence
Spasticity
Malignant Pain
Gastroparesis
Chronic Pain
Obsessive Compulsive Disorder
Dystonia
Essential Tremor
Depression
Pelvic Floor Disorders
Bowel Disorders
Heart Failure
Neurodegenerative Diseases Alzheimer’s Parkinson’s Huntington’s ALS
Migraine/Headache
Epilepsy
Sleep Apnea
COPD/Asthma
Dry Eye
KPCB Confidential
Neuromodulation Technology2012 2020
• Complex programming• Intense patient involvement, subpar UI’s• Poor connectivity (EHR & provider)• High patient burden (size, stimulation, no MRI)
• Closed loop (sensing & therapy)• Therapy less intrusive for patient (stim perception,
passive recharging, no MRI restrictions)• Device data flow provides for remote Dx, EHR, etc.• MEMS/NANO/Next Gen Power Supplies/Wireless
Approaching next phase of technology innovation
2020
2012
KPCB Confidential
Neuromodulation Care Continuum 2012 2020
• Disjointed care• Best practices undefined or concentrated with leaders• Role/sequence of therapy; devices, medication, & other
pain therapies remains unclear• Neuromodulation often a last-resort therapy
• Standard protocols for managing pain & other neuro conditions emerge
• Treatment paths well-defined and adopted• Quality outcomes defined, enforced & measured• Neuromodulational moving up the care
continuum
Moving from modest adoption to standard of care 2020
2012
KPCB Confidential
Neuromodulation Healthcare Economics (US)2012 2020
• Primarily fee for service• Rewards treatment vs. outcome• Incentives don’t support ACO model• $20-25K ASP with mixed outcomes
• Expanded patient coverage WW• Value= quality outcomes/costs• Comparative effectiveness filter for de novo therapies • ASP pressure for legacy therapies• Accountable, at risk care
Industry must quantifiably demonstrate therapy value
2012
2020
KPCB Confidential
Worldwide Neuromodulation Market2012 2020
2012
2020
New therapies, new indications and market penetration drive WW growth
• $2.87B WW• $1.41B SCS• 80% U.S./14% EU• 10% CAGR
• $6.2B WW• $3B SCS• 70-80% US; Asia?• 10% CAGR
Source: Analyst reports. Includes SCS, OBS, SNM, VNS, TDD
Optogenetics: What does it do?
Optogenetics: Potential for Therapeutic and Cellular Specificity
• Target specific phenotypes• Induce suppression or activation• Affect specific neuroanatomies• Combined genetic and device therapy
Brain-Machine Interfacing
• Progress in tissue-machine interfacing and coupling can provide advanced methodologies to develop neural-based therapies
• Nanoscafolding and other microfabrication techniques may contribute to providing the ability to control specific neural networks
KPCB Confidential
A Healthy Neuromodulation Ecosystem - 2020
• Invest in the clinical trials to support efficacy/safety, indication expansion and cost-effectiveness
• Design “product” for emerging markets• Develop closed-loop devices (sensing & therapy)• Reduce programming requirements and need for follow-
up visits• Enhance connectivity (e.g., remote Dx, EHR interface)• Make the therapy non-invasive (e.g., reduce size, volume,
weight, subcutaneous, etc.)• Demonstrate clear value to the system