Embed Size (px)
Citation preview
1
Orthopaedics Medical Device Industry Overview
Market Analysis and Future Trends
November 2016
Marco BerizziChief Financial Officer
e-mail [email protected] mobile +39 342 9204033
Objective
• Historical perspective of Medical Device Macro
Sector and Orthopaedics Medical Device
Industry in terms of Market Size and
Competitive Landscape
• Focus on Factors driving Orthopaedics Medical
Device Industry Evolution
• Presentation of Orthopaedics Medical Device
Industry Market Size Trend
2
Agenda
• Historical perspective of Medical Device
Macro Sector and Orthopaedics Medical
Device Industry
• Business Drivers underlying Orthopaedics
Medical Device Industry Evolution
• Orthopaedics Medical Device Industry Market
Size Trend
3
In ’10 Implant Mkt accounts for ca. 25% of Medical Device Mkt with Orthopaedics having the Highest Share
4
[email protected] Note: Medical devices market data does not include Dental & Aesthetics. Cardiovascular does not include general cardiac surgerySource: Researches by health care information providers, investment banks and other analysts
Global Medical Device Market SizeGlobal Medical Device Market Size(2010;B$)
z
Orthopaedic
Cardiovascular
Opthalmic
Neurological
Pheripheral vascular
ElectrophysiologyElectrophysiology
Wound care
Surgical instruments
Infection control
Syringes
Vascular acc.Vascular acc.
Gravity adminGravity admin
Beds and transport
tools
Surgical fixt.Surgical fixt.
OtherOther
Urology and Urology and nephrology
Endoscopy
Patient monitoring
Patient monitoring
VentilationVentilation
Infusion
Hernia rep.Hernia rep.
AnestesiaAnestesia
Imaging
Energy and radiotherapy
Radio-pharma
Contrast agent
X-ray filmX-ray film
Tradiotional in vitro
diagnostics (IVD)
Point of care IVD
Molecular IVD
Non electrical diagnostic
Other
Hearing Hearing tools
Home respir.
Medical Medical non
wovens
Blood donat.
$71B
Procedural Instruments and
Devices
Imaging and Radiology
$57B
IVD and Non electrical
Diagnostics
$54B
Surgical Instrumentsand Medical
Supplies
$49B
Equipment
$44B
Other
$27B
0%
100%
50%
Tot. ca. $300B
Focus of next slides
Focus of next slides
In ’10 Orthopaedics Market is moderately Fragmented with a Few Number of Players covering All Segments
5
[email protected] Note: With exception of top player n° 4 focused only on “Spine and Biologics” therapeutic segmentSource: Researches by health care information providers, investment banks and other analysts
Mkt ShareMkt Share(2010;%)
Market Share by Therapeutic SegmentMarket Share by Therapeutic Segment(2010;B$;%)
• First 4 players represents ca. 50% of the market covering major* part of segments
• Small and medium size players are focused on specific segments
100%
Market Leader
Medium Player n°5
Top Player n°2
Top Player n°3
Top Player n°4
Medium Player n°6
Medium Player n°7
$11.9B
T3
ML
T2
M7
M6
OtherOther
$8.5B
T4
ML
M5
T2T2
S8S8
M6M6
S8S8
T3T3M7M7
Other
$4.0B
M5
ML
T2
M6
M7M7
T3T3
Other
$3.3B
M6
ML
S8
T2
M7M7
Other
S8
$1B
M5
M5
T2
T2
ML
ML
M7
M7
Oth
Oth
$1B
ML
ML
S8
S8
M5
M5
T3
T3
M7
M7
Oth
er
Oth
er
Hips and Knees Spine and Biologics Trauma Sport Medicine
Extrem-ities
Craniomaxilllo-
facial
0%
100%
50%
Tot. $29.6B
Other
Small Player[s] n°8Small Player[s] n°8
“Like-for-like” data treating M&A deals as if occurred 1st Jan 2010
Concentration of Orthopaedics Market through M&A deals occurs in ’10-’15 time interval
6
[email protected]: Researches by health care information providers, investment banks and other analysts
Mkt ShareMkt Share(2010;%)
Market Share by Therapeutic SegmentMarket Share by Therapeutic Segment(2010;B$;%)
• M&A deals concentrate almost 50% of the market in the hands of 2 players
• Concentration is particularly relevant in Hips/Knees and Spine/Biologics segments
100%
Top Player n°2
Top Player n°4
Medium Player n°6
$11.9B
ML α
T2
M6
OtherOther
$8.5B
T4
T2T2
S8S8M6M6
S8S8
Other
$4.0B
T2
M6
Other
$3.3B
M6
ML α
S8
T2
T βT β
Other
S8
$1B
T2
T2
Tβ
Tβ
Oth
Oth
$1B
S8
S8
Oth
er
Oth
er
Hips and Knees Spine and Biologics Trauma Sport Medicine
Extre-mities
Craniomaxilllo-
facial
0%
100%
50%
Tot. $29.6B
Other
Small Players n°8Small Players n°8
Market Leader α[Market leader +
Medium Player n°5]*
Medium
Top Player β[Top player 3 + Medium
Player n°7]*
T β
ML α
T βT β
ML α
T β
ML
αM
Lα
Tβ
Tβ
ML
αM
Lα
Note: * See categorization shown in previous slide
Concentration impact due to
M&A deals
Orthopaedics Demand is driven by Americas and Spine / Knees / Hips / Trauma Therapeutic Segments
7
Orthopaedics Medical Device Market SizeOrthopaedics Medical Device Market Size(2010;B$;%)
Macro Business Driver
Macro Business Driver
Spine
Knees
Hips
Trauma
ExtremiteCMF
Sports med
Biologics
Americas
Europe
Asia-pacific
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Therapeutic Segments Geo Area
$29.6B $29.6B
• Americas and in particular US territory have driven and willlead evolution of orthopaedics medical device market …
• … Next chapter articulates business drivers defining orthopaedics market with special focus onUS territory
Main focus
of next
chapter
Main focus
of next
chapter
Source: Researches by health care information providers, life science information providers and other analysts
Agenda
• Historical perspective of Medical Device Macro
Sector and Orthopaedics Medical Device Industry
• Business Drivers underlying Orthopaedics
Medical Device Industry Evolution
• Orthopaedics Medical Device Industry Market
Size Trend
8
Specific Business Drivers determine Orthopaedics Medical Device Industry Evolution
9
People Aging
Obesity
Activity and Inactivity
Product Innovation
Advertising
1
2
3
4
5
Public Health System Constraints
6
Hospital and Health Providers new Role
7
++++++++ --------= Positive Impact on Market Size
= Negative Impact on Market Size
++++++++
++++++++
++++++++
++++++++
++++++++
--------
--------
Orthopaedics Medical Device Industry Business Drivers
Almost 30% of US Population will be over 60 years old by ’45…
10
[email protected] Source: United Nations – Population Division – Department of Economic and Social Affairs – August 2016
1
US Demographic Trend by Age ClusterUS Demographic Trend by Age Cluster(2015-2045;%)
Over 60 years
20.7% 23.1% 25.2% 26.1% 26.8% 26.9% 27.4%
25% 25% 25% 24% 24% 24% 24%
60% 58% 57% 55% 54% 54% 55%
15% 17% 19% 21% 21% 22% 22%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2015 2020 2025 2030 2035 2040 2045
Over 65 years
20 - 64 years
0 - 19 years
100% 100% 100% 100% 100% 100% 100%
12%8%
38%
29%
29%
38%
22% 24%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1996-1998 2009-2011
Over 65 years
45 - 64 years
18 - 44 years
Under 18 years
…and People Aging will increment the Demand for Reconstructive Procedures
11
[email protected] Source: The Burden of Musculoskeletal Diseases in the United States – 2014 Report
1
Persons with Musculoskeletal Diseases by Age Cluster in USPersons with Musculoskeletal Diseases by Age Cluster in US(1996-1998 and 2009-2011;%)
100% 100%
Obesity is a rising Phenomenon which will affect more than 40% of US Population by ’30
12
Source: 2012 Elesevier – Am J Prev Med – “Obesity and Severe Obesity Forecasts Through 2030”
2
12.7%
22.1%
28.6%
30.9%
34.5%
37.4%
39.9%
42.2%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
1990 2000 2008 2010 2015 2020 2025 2030
0.9%2.6%
4.1%4.9%
6.4%7.9%
9.5%11.1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
1990 2000 2008 2010 2015 2020 2025 2030
Obesity incidence on US Pop. ≥
Obesity incidence on US Pop. (1990-2030;%;BMI ≥30)
Severe Obesity incid. on US Pop. ≥ 4
Severe Obesity incid. on US Pop. (1990-2030;%;BMI ≥ 40)
Note: Study conducted in 2009 and 2010 with data from 1990 to 2008, sampling non pregnant adults aged ≥ 18 years and using non linear regression model
Major Part of Hip and Knee Surgeries is put in place for Obese and Overweight People
13
2
Joint Replacement Surgeries by Weight Cluster – US exampleJoint Replacement Surgeries by Weight Cluster – US example(2002-2004;%)
11%5%
30%
12%
59%
83%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Hip replacement Knee replacement
Obese
Overweight
Normal
Source: 2006 Springer Verlag – International Orthopaedics – “Obesity increases the likelihood of total joint replacement surgery among younger adults”
Note: Study conducted in 2006 on non elderly total joint replacement surgeries on 305 patients at MeritCareMedical Center in Fargo, ND or in the outreach facilities of Bemidji and Detroit Lakes, MN
100% 100%
Almost 50% of US Population get less Basic Exercises than Recommended…
14
[email protected]: Early Release of Selected Estimates Based on Data From the National Health Interview Survey, 2014
3
Persons respecting US Aerobic Activity (AA) Guidelines (GL)
Persons respecting US Aerobic Activity (AA) Guidelines (GL)
Persons respecting US AA GL and Muscle-strengthening GuidelinesPersons respecting US AA GL and Muscle-strengthening Guidelines
48% 50% 49% 49%
52% 51% 51% 51%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2011 2012 2013 2014
Not respect ofguide lines
Respect ofguide lines
21% 20% 20% 21%
80% 80% 80% 79%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2011 2012 2013 2014
Not respect ofguide lines
Respect ofguide lines
Note: Data are based on household interviews of a sample of the civilian noninstitutionalized population elder than 18. Estimates in this figure are limited to leisure-time physical activity only.
100% 100% 100% 100% 100% 100% 100% 100%
… while more Active Lifestyles are leading to an Increase in Injuries
15
3
“For America's baby boomers […] too much of a good thing has consequences. Encouraged by doctors to continue to exercise three to five times a week for their health, a legion of running, swimming and biking boomers are flouting the conventional limits of the middle-aged body's abilities and filling the nation's operating roomsand orthopedists' offices in the process. They need knee and hip replacements, surgery for cartilage and ligament damage, and treatment for tendinitis, arthritis, bursitis and stress fractures. The phenomenon even has a name in medical circles: boomeritis.”
The New York Times
“In the U.S. about 30 million children and teens participate in some form of organized sports and more than 3.5 million injuries each year which cause some loss of time of participation, are experienced by the participants. Almost one-third of all injuries incurred in childhood are sports-related injuries. By far the most common injuries are sprains and strains”
Standford Children’s Health
“Ever since the advent of the "X Games" in the mid-1990s, Americans have embraced so-called extreme sports such as mountain biking, skateboarding and snowboarding. But experts are warning that the fun can quickly turn to tragedy when amateurs try to mimic stunts they've seen on television. A new analysis finds that extreme sports have been linked to more than 4 million injuries since 2000, and now cause more than 40,000 head and neck injuries annually” Health Day News
Long-lasting Products and Less Invasive Surgery drive Use earlier in Life
16
[email protected] Source: *Arthritis Care Res (Hoboken) - 2014 June – “Time trends in the Characteristics of Patients Undergoing Primary Total Knee Arthroplasty”;^NCHS Data Brief n.° 186 – February 2015 - Hospitalization for Total Hip Replacement Among Inpatients Aged 45 and Over: United States, 2000–2010
4
Total Knee Replacement by Age Cluster in US*
Total Knee Replacement by Age Cluster in US*
Total Hip Replacement by Age Cluster in US^
Total Hip Replacement by Age Cluster in US^
2.9% 5.2%
19.5%
26.7%
67.2%
58.1%
10.4% 10.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1993-1995 2002-2005
Over 80 years
65 - 79 years
50 - 64 years
Under 50 years
12.0%17.0%
24.0%
29.0%
34.0%
28.0%
30.0%26.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2000 2010
Over 75 years
65 - 74 years
55 - 64 years
45 - 54 years
100% 100% 100% 100%
Consumer-Focused Advertising drives Patient-Led Demand
5
“Some manufacturers of orthopedic medical devices have launched new websites which first ask if you are a patient, surgeon or investor and then take the visitor to a separate site geared for the answer provided. A producer has launched several websites for patients describing specific products including mobile bearing kneesand the agility ankle”
Health care investor industry news
“An implant manufacturer has begun to air its television spot for its mobile bearing knee and another one has run TV advertisements in selected regions / cities on the US territory” Orthopaedic industry news
“Given changing patient demographics and the information revolution, the effects of Direct-to-consumer Advertising (DTCM) likely will continue to grow”
Orthopaedic scientific news
“Now medical device companies are directly contacting consumers but not necessarily through the traditional television airways. The above companies have patient education websites advertised on social media to deliver information about their products”
Spine and Orthopaedic industry news
“A medical device company websitefeatures patient stories about back pain and managing chronic pain issues. The websitehas a "doctor discussion guide" to optimize appointments and a tool to connect with back pain specialists”
Spine and Orthopaedic industry news
17
Public Health System Constraints affect Orthopaedics Expenditure
18
6
• Public health systems - in US and all around the world - are increasingly required to contain and rationalize expenditure
• Increased pricing pressure may be the norm in orthopaedics implant segment going forward
Public Health System Impact
• New reimbursement schemes are supposed to reward quality and efficiency
• Health care providers are strongly pushed to be accountable for resource use and for efficiency achievement
• Relevant impact on orthopaedics implant pricing and volumes is supposed to occur
Increased Grip on Sourcing by Hospitals and HC Providers affects Orthopaedics Expenditure
7
• Hospitals are progressively regulating interactions of physicians with med tech suppliers
• Physicians disintermediation allows sourcing centralization and standardization with relevant impact on orthopaedics implant pricing and volumes
• Improvement of sourcing practice in terms of new processes, resource quality and sound competences inside health care provider hospital procurement departments allows significant expenditure saving with relevant impact on orthopaedics implant pricing and volumes
Hospitals and Health Care Providers Role
Ph
ysic
ian
A
ffilia
tio
n
• Physician affiliation as hospital employees allows sourcing centralization and standardization with relevant impact on orthopaedics implant pricing and volumes
Agenda
• Historical perspective of Medical Device Macro
Sector and Orthopaedics Medical Device Industry
• Business Drivers underlying Orthopaedics
Medical Device Industry Evolution
• Orthopaedics Medical Device Industry
Market Size Trend
20
z
Orthopaedics Mkt in ’07-’20 is dominated by Americas with Asia Pacific registering Highest Growth Rate
21
Orthopaedics Medical Device Mkt Size Trend by Geo AreaOrthopaedics Medical Device Mkt Size Trend by Geo Area(2007-2020;B$;%)
18.021.3
22.8 23.7 24.5 25.429.0
4.2
5.35.8
6.16.4
6.8
8.5
2.1
3.1
3.84.1
4.54.9
6.5
24.3
29.6
32.433.8
35.437.0
44.0
0
5
10
15
20
25
30
35
40
45
2007 2010 2013 2014 2015 2016 2020
Asia-pacific
Europe
Americas
Total
Source: Researches by health care information providers, life science information providers and other analysts coupled with forecasting simulations
CAGR 07-13
CAGR 13-16
CAGR 16-20
10.1% 9.3% 7.2%
5.3% 5.4% 5.8%
4.1% 3.6% 3.4%
4.9% 4.6% 4.4%
z
Orthopaedics Mkt Trend in ’16-’20 period is driven by Knees, Hips and Trauma Therapeutic Segments
22
Orthopaedics Medical Device Mkt Size Trend by Therapeutic SegmentOrthopaedics Medical Device Mkt Size Trend by Therapeutic Segment(2007-2020;B$;%)
5.8 6.7 7.1 7.3 7.6 7.8 8.8
5.76.7 7.1 7.5 7.9 8.4
10.44.3
5.25.5
5.86.2
6.5
8.1
3.3
4.04.6
4.85.0
5.3
6.3
1.0
1.31.6
1.71.8
1.9
2.3
0.6
0.7
0.80.8
0.90.9
1.0
2.4
3.3
3.83.9
4.14.2
4.8
1.3
1.8
1.81.9
1.92.0
2.2
24.3
29.6
32.433.8
35.437.0
44.0
0
5
10
15
20
25
30
35
40
45
2007 2010 2013 2014 2015 2016 2020
Biologics
Sports med
CMF
Extremite
Trauma
Hips
Knees
Spine
Total ex dental
CAGR 07-13
CAGR 13-16
CAGR 16-20
5.5% 3.4% 3.0%
7.9% 3.6% 3.4%
6.3% 3.8% 3.6%
9.3% 4.7% 4.5%
5.7% 4.6% 4.4%
4.0% 5.9% 5.6%
3.9% 5.7% 5.5%
3.4% 3.3% 3.0%
4.9% 4.6% 4.4%
Source: Researches by health care information providers, life science information providers and other analysts coupled with forecasting simulations
DisclaimerDisclaimerDisclaimerDisclaimer
23
• This document (“Document”) has been prepared by the author (“Author”) solely forinformational purposes
• The Author shall not have liability for the contents of, for any representation (expressed orimplied) contained in, or for omissions from, this Document or any other written or oralcommunication
• The information contained herein is being made as of the date of this Document, unlessanother time is specified, and the Author has no obligation to update such information
• Reference to other authors (“Other Authors”) publications, analysis, economic model orformula is made solely for communication or informational purposes and it does not implyany linkage between Other Authors and content presented within this Document in termsof accuracy and completeness of information conveyed
• This Document does not contain any data or confidential information concerning thebusiness, contractual arrangements, deals, transactions or particular affairs of theCompany or his affiliates for which the Author had or currently has an employmentagreement
AuthorAuthorAuthorAuthor
24
Marco BerizziChief Financial Officer
e-mail [email protected] mobile +39 342 9204033linkedin https://ch.linkedin.com/in/marco-berizzi-6957bb12
MSc in Probability and Application (spec. Probability and Finance) UPMC - Pierre et Marie Curie University (Paris VI University), Paris
MSc and BSc in Economics L. Bocconi University, Milan
