Ali MADANIPhone: + 33 1 47 78 46 [email protected]
2
TUTORIAL Orthopaedics Market
June 2016
Table of contents
Worldwide orthopaedic market: dynamics, competition, drivers, limiters, … Worldwide orthopaedic markets in 2015: hip, knee, trauma, spine, others…Worldwide orthopaedic Market: products, innovations, growth, competition & trendsMarket drivers, market limitersForecasts by 2020
European orthopaedic market: market share, new products in details, heavy trends, …
European orthopaedic markets in 2015: market share for hip, knee & shoulderEuropean orthopaedic Market: new products, trends…Forecasts by 2020
Summaries
I
II
III
http://www.implants-event.com/program/presentations-2016/
Password: biarritz_2016
To download the presentations:
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
3
TUTORIAL Orthopaedics Market
June 2016
Hip segmentation
Cemented Cementless Hybrid
Monobloc Modular ResurfacingShorter stem
& mini hipStandard With bipolar
shell
Total PartialRevision
Dual mobilitycup
Primary
Revision
HIP
Anterior approachsurgery
Postero/lateralapproach surgery
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
4
TUTORIAL Orthopaedics Market
June 2016
Bear
ings
Fixa
tions
Total Hip
Cemented(Stem & cup
are cemented)
Cementless(Stem & cup
are cementless)
Hybrid(Stem is
cemented, cup is cementless)
Cemented
Metal / Polyethylene
Ceramic / Polyethylene
Cementless
Metal / Polyethylene
Ceramic / Polyethylene
Ceramic / Ceramic
Hybrid
Metal / Polyethylene
Ceramic / Polyethylene
Metal / Metal
Hip segmentation by fixations & bearings
Ceramic / Ceramic
Metal / Metal
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
5
TUTORIAL Orthopaedics Market
June 2016
Knee segmentation
KNEE
FIXED MOBILE UNICONDYLAR FEMORO PATELAR
TOTAL Partial Revision
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
6
TUTORIAL Orthopaedics Market
June 2016
Fixe
d Vs
. Mob
ile k
nee
bear
ings
& F
ixat
ions
Post
erio
r sta
biliz
ed V
s. C
ruci
ate
Reta
inin
g To
tal k
nee
TOTAL
Posterior stabilized
Cruciateretaining
Knee segmentation: Fixed Vs. Mobile knee bearings, Fixations, Posterior stabilized Vs. Cruciate Retaining Total knees
FIXED MOBILE
Cemented
Cementless
Hybrid
Cemented
Cementless
Hybrid
TOTAL
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
7
TUTORIAL Orthopaedics Market
June 2016
Shoulder segmentation
Shoulder
Total Partial Revision Resurfacing
Standard Reversed
Cemented Cemented
Cementless Cementless
Hybrid Hybrid
Mini shoulder
Universal stems
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8
TUTORIAL Orthopaedics Market
June 2016
Spine segmentation
Spine Instrumentations
Fusion
Cervical devicesLumbar &
Thoraco-lumbarcages
Universalsystems
Trauma & Tumor
Degenerative
Deformity
Non fusion
Cervical discs Lumbar discs Extradiscaldynamic
Interspinous
Posterior
VCF
Kyphoplasty
VertebroplastyCages
ALIFPLIF TLIFXLIF
Raw materials
Pure Peek
Peek + Ti coating
Peek + Trabecular layer
Additive Manufacturing
Titanium
Carbon
Others
….
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
9
TUTORIAL Orthopaedics Market
June 2016
19%
5%2%
17%23%
13%
21%
Worldwide orthopaedic* markets in 2015:~39 BUS$ (+4.3%)
Source: Avicenne research & analysis 2016
HIPKNEE
EXTREMITIES
SPINE
TRAUMA
ORTHO-BIOLOGICS
OTHERS
KNEE8.9 B$
+4.5%
Hip6.5 B$
+2.1%
SPINE8.3 B$
+2.9%
• Extremities: Shoulder, Elbow, Ankle, Foot, hand,… (excluding trauma)• Orthobiologics: Allograft, Xenograft, Synthetic Bone, Cement, BMP, others, Cell based Product, Auto repair product, Anti Adhesion product, Hyaluronic Acid,…• Other: Navigation, ortho. Equipment, etc..
• * Not included : Power tools, Arthroscopy & soft tissue repair, sport Medicine, Neuro-stimulation
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
10
TUTORIAL Orthopaedics Market
June 2016
The Worldwide orthopaedics market: Growth
2000 - 2010 CAGR
Source: Avicenne research & analysis 2016
2010 - 2012 CAGR 2012 - 2015 CAGR
11,3%
1,9%
4,9%
2,5%
4,35%
0% 5% 10% 15%
EXTREMITIES
HIP
KNEE
SPINE
AVERAGE TotalOrtho
14,0%
2,3%
4,7%
2,0%
4,25%
0% 5% 10% 15%
EXTREMITIES
HIP
KNEE
SPINE
AVERAGE TotalOrtho
10,4%
13,3%
11,5%
11,4%
0% 5% 10% 15%
HIP
KNEE
SPINE
AVERAGE TotalOrtho
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11
TUTORIAL Orthopaedics Market
June 2016
Worldwide implants market in 2015 in value (B$)
Market value (B$)
Source: Avicenne research & analysis 2016
8,9
6,58,3
3456789
10
Knee Hip Spine
56%19%
25%
Row USA
Europe
46%
23%
31%
Row USA
Europe
64%18%
18%
Row
USA
Europe
+4,5%
+2.1%
+2.9%
% Growth 2014-2015
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
12
TUTORIAL Orthopaedics Market
June 2016
Worldwide implants & Orthobiologics marketin 2015 in value (B$)Market value (B$)
Source: Avicenne research & analysis 2016
7,35,3
2,00
2
4
6
8
Trauma & CMF Orthobiologics Extremities
45%
25%
30%
Row USA
Europe
70%21%
9%Row
USA
Europe 60%24%
16%
RowUSA
Europe
+5.2%
+5.4%
+10.5%
% Growth 2014-2015
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
13
TUTORIAL Orthopaedics Market
June 2016
The countries taken into account in Europe are the 17 strongest economies
France65
Germany82
Italy61
UK64
Spain47
27 600
30 400
30 200
22 80020 200
Inhabitants in Million
GDP per capita in US $
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
14
TUTORIAL Orthopaedics Market
June 2016
The countries taken into account in Europe are the 17 strongest economies
Belgium11.1
29 600
5.6
37 300 Denmark
5.4
30 900Finland
9.5
Sweden35 300
4.6
Ireland36 400
Netherlands16.7
32 700
8.4
Austria 32 2000,5
Luxembourg
Greece11.1
62 600
14 900
Portugal 11.1
14 3008
Switzerland44 600
5
Norway52 800
Inhabitants in Million
GDP per capita in US $
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
15
TUTORIAL Orthopaedics Market
June 2016
Worldwide orthopaedic market in 2015: competition2015 Worldwide Orthopaedic Market
Source: Avicenne research & analysis 2016
2015 revenues of the Major Orthopaedic Companies (B$)
Depuy-Synthes
20%
Zimmer Biomet
16%Stryker
13%Medtronic
8%
Smith & Nephew
5%
Other38%
2,0
3
5
6,3
8
0 10 20 30
Smith & Nephew
Medtronic
Stryker
Zimmer Biomet
Depuy-Synthes
Ortho products
Other Medical devices
2015: Zimmer acquired Biomet for 13.4 B USD
2012: Depuyacquired Synthes
for 21.3 B USD
33,3%
34,8%
37,9%
30% 35% 40%
2013
2014
2015
OtherMarket share
2015: Medtronic acquired Covidien for
50 B USD
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
16
TUTORIAL Orthopaedics Market
June 2016
Worldwide competition by product in 2015: Market share
Source: Avicenne research & analysis 2016
Others
HipTop 5: 75%
KneeTop 5: 84%
SpineTop 5: 71%
Trauma & CMF
Top 5: 67%
Total Ortho
Top 6: 65%
20%
17%
22%
35%
21%
19%
16%
9%
13%
13%
30%
32%
5%
8%
16%
0%
0%
30%
0%
8%
9%
10%
0%
7%
5%
21%
25%
35%
38%
35%
Worldwide
=100%
=100%
=100%
=100%
=100%
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
17
TUTORIAL Orthopaedics Market
June 2016
The challengers gained market share continuously
Source: Avicenne research & analysis 2016
2013challengers
2014challengers
Hip
Knee
Spine
Trauma & CMF
Total Ortho
15%
19%
29%
32%
33% 35%
17%
21%
30%
33%
2015challengers
38%
21%
25%
35%
38%
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
18
TUTORIAL Orthopaedics Market
June 2016
26% 21%
19%
26%
15% 13%
12%12%13%
10%
8% 8%9%
9% 8% 8%
5,6% 7,7%
32%
39%
46% 47%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
2008 2012 2014 2015
Zimmer Depuy Stryker Smith & Nephew Biomet Challengers
Challengers
Hip Europe market share 2008-2015
Hip Europe market share
Source: Avicenne analysis 2016
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
19
TUTORIAL Orthopaedics Market
June 2016
Knee Europe market share 2008-2015
Knee Europe market share
24%20%
19%
28%
20% 17%
19%18%
12%
11% 10% 10%11%
14%
12%12%
8%
12%
11%
25%
27% 30%32%
0%
5%
10%
15%
20%
25%
30%
35%
2008 2012 2014 2015
Zimmer Depuy Stryker Smith & Nephew Biomet Challengers
Challengers
Source: Avicenne analysis 2016
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
Worldwide orthopaedic Contract Manufacturing
market report 2015-2020
&Top 100 player profiles
Majors Vs Challengers: Majors saved their margins & Challengers got the growth!
0%
5%
10%
15%
20%
25%
30%
35%
-10% -5% 0% 5% 10% 15% 20% 25%
WW
Ort
ho 2
014
mar
kets
hare
(%)
Revenues CAGR 2011-2014 (%)
20
Source: Avicenne , annual reports and companies June 2015
ChallengersLegende
Market share
Revenues growth
1 BUS$
Challengers
CAGR 2011-2014 Ortho revenues
Company CAGR Main drivers
LDR 24,5% Spine/USA
Wright 18% Extremities
LIMA 11,8% Hip/ export*Shoulder/USA
Amplitude 11% Knee, hip/export
Mathys 8,6% Hip, knee/export
* export: apart from their home country
Challengers CAGR average 16,2%
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
21
TUTORIAL Orthopaedics Market
June 2016
Challengers growing Vs Majors
Source: Avicenne research & analysis 2016
Majors Challengers
Product standardization Multiplication of customized
Product range reduction Product range Extension
Sale channels cost cutting Attracting new sale forces
More centralized services Local and high level services
Focus on surgeons with high activity Focus on all the surgeons
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
22
TUTORIAL Orthopaedics Market
June 2016
Market Drivers
Source: Avicenne research & analysis 2016
Demographic& Economic
Impact 1: Population
Impact 2: Inhabitants 65+ years
Impact 3: Health expenses
Impact 4: Obesity
New products& innovationand revision
Impact 1: Product mix impact
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
23
TUTORIAL Orthopaedics Market
June 2016
Global population growth 1950-2050and people over 65
Source: United Nations – World Population Prospects, The 2012 Revision, Smith & Nephew annual report 2014
0
2
4
6
8
10
12
1950 2000 2050
In b
illio
n
5%
51%
44%
2.5 billion people 6 billion people 10 billion people
0-19
20-64
65+
0-19
20-64
65+ 7%
54%
39%0-19
20-64
65+ 16%
56%
28%
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24
TUTORIAL Orthopaedics Market
June 2016
The market drivers: Demographic & Economic
Obesity in developed countries % of inhabitants
Health expenses % of GDP
15%
23%
31%34% 37%
4% 6%9%
13%17%
7%
14%
23%26% 28%
0%
10%
20%
30%
40%
1980 1990 2000 2010 2020
USA France UK
Source : OCDE
6%8%
10%
13%
15%
5%6%
8%10%
11%
4%
6%
6%7%
8%
0%
10%
20%
1980 1990 2000 2010 2020
USA France UK
Source : OCDE
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
Worldwide orthopaedic Contract Manufacturing
market report 2015-2020
&Top 100 player profiles
Innovation and new products pull the market
New products launch is at the core of the dynamic company development:
Innovations are boosting the marketThey capture innovative surgeons
Mature implants are becoming generic products and are attacking emerging country markets. Some standard products are re-boosted by minor or significant innovations.
The most relevant innovations for the last two decades have been: cementless products, ceramic for hips, reversed shoulder, trabecular products, etc.
Innovation, new surgical approach, new ancillaries and instruments … are the keys to capture new surgeons and to increase the average price. The most relevant innovations for the last two decades have been: cementlessproducts, ceramic for hips, reversed shoulder, Trabecular products, etc.
New products
Hip
StandardHips:
Charnley, Corail, Zweymuller
Standardknees:
Nexgen, LCS,
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Innovative surgeons are looking for new products. They are lured by new orthopaedic projects. Conservative surgeons mainly use standard products with decades of clinical evidences
25%40%
40%
40%
35%20%
Latin countries Evidence basedcountries
Conservatives Followers Innovatives
% of the surgeons by category in each type of country
26
Sources: AVICENNE analysis
Conservativesurgeons
Innovativesurgeons
Followersurgeons
New products
Hip
StandardHips:
Charnley, Corail, Zweymuller
Standardknees:
Nexgen, LCS, TUTORIAL
Orthopaedics MarketJune 2015
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
27
TUTORIAL Orthopaedics Market
June 2016
Product Mix pulls the marketTotal hip trends 2006-2020 (in volume)
Cemented, Cementless, Hybrid
Cemented, Cementless & Hybrid ratio(% of Total hip)
Source: Interviews & Avicenne Research & Analysis 2016
25%19% 17%
54%60% 60%
21% 21% 24%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%20
06
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Hybrid
Cementless
Cemented
Europe
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28
TUTORIAL Orthopaedics Market
June 2016
The revision driver: more and more people have more than one implant in their lifeHip implant trends 2006-2020 (in volume)
Total, Partial & Revision hip, mini hip Ratio (% of the global market)
Source: Interviews & Avicenne Research & Analysis 2016
66%60% 56%
18%15%
14%
12%16%
18%
4%1%
1%
8% 12%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Mini hip
Resurfacing
Revision
Partial
Total
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
29
TUTORIAL Orthopaedics Market
June 2016
The market limiters (1/8)
Source: Avicenne research & analysis 2016
ReimbursementImpact 1: Price decrease
Impact 2: Longer Time to market
Buying Groups
Impact 1: Price decrease
Impact 2: More Low-end products demand
RegulatoryImpact 1: Time to market
Impact 2: Higher development Cost
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
30
TUTORIAL Orthopaedics Market
June 2016
The market limiters (2/8)Reimbursement and pricing regulation
USA Germany UK Sweden Italy Belgium Switzerland France
Launch date & extension 1983 2003-2010 2002-2007 1992-1994 1994-1998 1984 2002 2003-2012
Classification system DRG
G-DRG (derivate
from Australian)
system
HRG (derivate from US system)
NordicDRG
ROD (derivate from US system)
APR-DRG (derivate from US system)
DRG (US system)
GHM (derivate from US system)
Targets
Coverage of all
Medicare budgets
75% of C-DRG in 2007
Target of 100% HRG
in 2006
Coexistence 50% DRG, 30% global
dotation& 20% de reimburse
ment
Coexistenceof 80%-
90% ROD, 6-7%
planifica-tion funds ,
& 3-14% extra funds
Main application: every day expenses
Invest-ments
supported by the
“cantons”
50% T2A in public
hospitals & 100% in
private and public in
2012
For more than 20 years, a general concern for controlling health expenses has started in the developing countries with the introduction of the DRG type systems
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
The market limiters (3/8)HIP average price* trend in Europe
1 000
1 100
1 200
1 300
1 400
1 500
1 600
1 700
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Aver
age
pric
e* in
Eur
ope
in €
France
Germany
UK
Italy
Europe
After many years of constant average price growth due to product mix effect, with an increasing volume, European countries are trying to curtail the ballooning expenses. They used reimbursement price regulation to stabilize their spending.
31
Source: Avicenne European Orthoaedic market report 2015-2020
2004 Germany*** DRG reimbursement decreased
Italy, UK prices decrease due to worldwide crisis
UK Growth highly impacted by Product Mix between 2003 &2009 **
2013 France reimbursement
decreased
* Average price in Europe in € = Total country market in value / total market in units, the average price is highly impacted by Product Mix effect** In 2003 in UK, the cementless hip was the lowest rate in Europe : 17% in UK, Vs 53% in France, 4% in Germany.This figure, 17%, increased drastically!*** In Germany, ancillaries are billed separately by orthopaedic companies and not included in this average price
TUTORIALOrthopaedics Market
June 2015
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
32
TUTORIAL Orthopaedics Market
June 20160,2%
0,6%0,8%
-0,1%0,5%
-0,8%-1,1%-2,1%
-1,8%-1,1%-1,1%-1,1%
-1,5%-1,5%-1,5%
-3,0% -2,0% -1,0% 0,0% 1,0%
200620072008200920102011201220132014201520162017201820192020
Price trends (4/8)
Average sales price trendper year for hips
Source: Interviews & Avicenne Research & Analysis 2016
Example of price decrease for each product (Euros)Average forecasted price decrease/year from 2013 to 2020: -1.3 %
664 €
899 €
1 642 €
298 €
661 €
0
500
1 000
1 500
2 000
2 500
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
M/PE cemented
Ce/PE cemented
Ce/Ce cementless
Partial standard
Partial with Bipolar shell
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
33
TUTORIAL Orthopaedics Market
June 2016
Price trends (5/8)
Average sales price trendper year for knees
Source: Interviews & Avicenne Research & Analysis 2016
Example of price decrease for each product (in Euros)Average forecasted price decrease/year from 2013 to 2020: -1.9 %
-3,7%-1,5%-1,5%
-2,0%-1,8%
-1,9%-2,6%
-3,2%-2,2%
-1,8%-1,8%
-1,9%-2,0%-2,0%-2,0%
-4% -3% -2% -1% 0%
200620072008200920102011201220132014201520162017201820192020
1 160 €
1 659 €
775 €603 €
2 159 €
0
500
1 000
1 500
2 000
2 500
3 000
3 500
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Revision
Mobile bearing cementless Total knee
Partial Uni
Fixed bearing cemented Total knee
Partial Femoro Pat
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
34
TUTORIAL Orthopaedics Market
June 2016
Price trends (6/8)
Average sales price trendper year for shoulders
Example of price decrease for each product Average forecasted price decrease/year from 2013 to 2020: -1.5 %
-0,6%-0,8%
-1,0%-1,1%
-1,8%-2,3%
-0,9%-2,1%
-2,4%-1,4%
-1,1%-1,0%
-1,5%-1,5%-1,5%
-3% -2% -1% 0%
200620072008200920102011201220132014201520162017201820192020
1 439 €
2 000 €1 781 €
1 294 €
623 €
2 178 €
0
500
1 000
1 500
2 000
2 500
3 000
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Source: Interviews & Avicenne Research & Analysis 2016
Total standard cemented shoulder
Total reversed cementless shoulderTotal reversed hybrid shoulder
Partial
Resurfacing
RevisionEurope
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
35
TUTORIAL Orthopaedics Market
June 2016
The market limiters (7/8)Regulatory, Certification,…
Regu
lato
ry
REFERENTS DETAILS IMPACT ON THE MARKET
EuropeanDirective
93/42
ISO 13 485
CE markClinical testsSales autorization
Medical devicesvigilance systemCertification of « whole production line »
Additional costsLonger time to marketConcentration of the product rangeLimitation of new product launches
Longer time to marketShared risksAdditional InsurancecostsChange in contractmanufacturing practice
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
36
TUTORIAL Orthopaedics Market
June 2016
The market limiters (8/8)
Group purchasing developments in Germany drove the implant prices down… It now serves as a model in lot of other European countries
Source: Avicenne research & analysis 2016
Group purchasing was a success in
Germany…
For example the basic knee (fixed tibial plate - cemented) is priced at 1 350 €, for some tenders a Major proposed 900 € for this basic product.Another Major had in his customer portfolio the “Endoclinic and DAM Group” for 4 hospitals, with 10,000 knee and hip sales per year! Average price for the knee for this customer is much less than 1 000 €.
…it was much less successful in France and Italy
Some private hospital groups in France like “Vitalia or Générale de Santé” have tried to centralize their implant purchasing, but it is only the beginning. The discounted price was only a few % lower and those hospitals have to share these savings with the “French Caissed’Assurance Maladie”. The surgeon name reputation is considered as product marketing showcase of the private hospitals, which are making what is necessary to keep their surgeons. Hence they are not focusing on implants price reduction.In Italy, purchasing groups make less than 10% of the total orthopaedicmarket value per year and growing slowly.
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
37
TUTORIAL Orthopaedics Market
June 2016
The revision driver: more and more people have more than one implant in their lifeHip implant trends 2006-2020 (in volume)
Total, Partial & Revision hip Ratio (% of the global market)
Source: Interviews & Avicenne Research & Analysis 2016
66%60% 56%
18%15%
14%
12%16%
18%
4%1%
1%
8% 12%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Mini hip
Resurfacing
Revision
Partial
Total
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
38
TUTORIAL Orthopaedics Market
June 2016
Total hip trends 2006-2020 (in volume)
Cemented, Cementless, HybridCemented, Cementless & Hybrid ratio(% of Total hip)
Source: Interviews & Avicenne Research & Analysis 2016
25%19% 17%
54%60% 60%
21% 21% 24%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%20
06
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Hybrid
Cementless
Cemented
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
39
TUTORIAL Orthopaedics Market
June 2016
Cementless trends 2006 – 2020M/Pe, Ce/Pe, Ce/Ce, M/M
Source: Interviews & Avicenne Research & Analysis 2016
M/Pe, Ce/Pe, Ce/Ce & M/M ratio(% of Cementless & Hybrid Total hip)
43% 39% 37%
29% 34% 36%
21% 27% 27%
7% 1% 1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
M/M
Ce/Ce
Ce/Pe
M/Pe
Ce/Pe is continuing slightly to grow
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
40
TUTORIAL Orthopaedics Market
June 2016
Ceramic, Metal & PE trends for Heads and Cups 2006-2020% of Metal & CeramicHEAD
Source: Interviews & Avicenne Research & Analysis 2016
% of Metal, Ceramic & PE CUP
80% 77% 77%
15% 21% 22%
5% 1% 1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006
2008
2010
2012
2014
2016
2018
2020
Metal
Ceramic
PE
45%55%
57%
55%45% 43%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%20
0620
0720
0820
0920
1020
1120
1220
1320
1420
1520
1620
1720
1820
1920
20
Ceramic for heads is still growing in Europe
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
41
TUTORIAL Orthopaedics Market
June 2016
Knee implant trends 2006-2020Total, Partial, RevisionTotal, Partial & Revision Ratio(% of global knee market)
Source: Interviews & Avicenne Research & Analysis 2016
78% 76% 75%
11%9% 9%
10% 15% 17%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Revision
Partial
Total
Europe
Revision is the most growing
market
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
42
TUTORIAL Orthopaedics Market
June 2016
Total knee trends 2006-2020 (in volume)
Fixed bearing Vs. Mobile bearingFixed VS Mobile bearing Ratio (% of Total knees)
Source: Interviews & Avicenne Research & Analysis 2016
61% 60% 67%77%
39% 40% 33%23%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%20
06
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Mobile bearing
Fixed bearing
Mobile bearing rate is decreasing
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
43
TUTORIAL Orthopaedics Market
June 2016
Fixed bearing knee trends 2006-2020Cemented, Cementless, HybridCemented, cementless & hybrid ratio (% of fixed bearing Total knees)
Source: Interviews & Avicenne Research & Analysis 2016
66%56% 51%
15%23%
25%
19% 22% 25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Hybrid
Cementless
Cemented
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
44
TUTORIAL Orthopaedics Market
June 2016
Shoulder implant trends 2006-2020Total, Partial, Revision, ResurfacingTotal, Partial, Revision, Resurfacing shoulders Ratio(% of global shoulder market)
Source: Interviews & Avicenne Research & Analysis 2016
70% 69% 68%
20%13% 12%
10%13% 15%
5% 6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Resufacing
Revision
Partial
Total
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
45
TUTORIAL Orthopaedics Market
June 2016
Shoulder implant trends 2006-2020Standard Vs. ReversedTotal modular Shoulder implants Standard Vs Reversed(% of global shoulder market)
Source: Interviews & Avicenne Research & Analysis 2016
57%
35%28%
43%
65%72%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Reversed
Standard
Reversed shoulder is a growing market
Europe
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
46
TUTORIAL Orthopaedics Market
June 2016
The life cycle of the orthopaedic products: Growth forecasts by 2020
Source: Avicenne research & analysis 2016
1980 1990 2000
Mar
ket
Time
HIP CAGR 15-20: +2.5%
Mar
ket
Time
KNEECAGR 15-20: +4.5%
Mar
ket
Time
SPINECAGR 15-20: +3.3%
Entrance date into the mass market
Mar
ket
Time
EXTREMITIESCAGR 15-20: +9.9%
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
47
TUTORIAL Orthopaedics Market
June 2016
Worldwide orthopaedic market forecastsWorldwide orthopaedic market: CAGR 2015-2020 +4.4 %
11 BUS$
39 B US$
48 B US$
-
10 000
20 000
30 000
40 000
50 000
60 000
Knee Hip Extremities Trauma & CMF Spine Orthobiologics Others Ortho
2015-2020 CAGR: 4.4 %
Hip: 2.5 %
Knee : 4.5 %
M U
S$
CAGR 2015-2020
Extrem.:9.9 %
Trauma: 4.9 %
Source: Avicenne analysis 2016
Orthopaedics market Drivers in 2000-2010 were:
• Huge growth in hip & knee in developed countries• USA : No price erosion, Europe slow price erosion• Huge growth in spine procedures
Spine: 3.3 %
Orthobio : 5.1 %
2000-2015 CAGR: 8.9 %
Orthopaedics market Drivers: 2015-2020• High growth in volume in emerging countries • Orthobiologics growth in developed countries• Extremities become multi Billion market with double-digit
growth• Trauma with historical constant growth• Niche segments with high growth: vertebral disks,
vertebroplasty, trabecular products,...
Orthopaedics market limiters : 2015-2020• Price pressure at the end-market level • Continuous regulatory cost increase • Purchasing group power, in certain countries
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
48
TUTORIAL Orthopaedics Market
June 2016
SummaryThe orthopaedics market, including hip, knee, spine, trauma, extremities and Orthobiologics accounted for more than US$39B in 2015, with 4.3% growth.The United States remains the largest market due to historical trends & higher sale prices. In Europe, Germany is by far the biggest market for all segments. Followed by the UK, France & Italy.Even the 5 major companies, controlling more than 60% of the worldwide orthopaedics market, have continuously loose market share to the challengers. The challengers have gained 1 to 2% market share per year (US$400 to 800 additional revenue), achieving US$15B in revenue in 2015 (13 US$15B in 2014!) .The only way for the Majors to have two-digit growth is by acquiring rivals (Depuy & Synthes, Zimmer & Biomet, Medtronic & Covidien ).A huge gap remains between the size of the Majors and that of the Challengers. The revenues of the Majors are 10 to 50 times bigger of the Challengers. But the Challengers are growing more rapidly, on average by 15%, due to their wider range of products, their local, high level services. They are also attracting new sales forces.The main drivers of the orthopaedics market remain demographic & economic parameters. Product innovation, resulting in a better (or higher) Product Mix, is boosting the market.The reimbursement trend results in price pressure. This is the main limiter of the orthopaedic market. Price erosion of mature products in orthopaedics has been a constant over the past 20 years. We do not expect a major shift, but some countries will suffer a more significant price decrease than others.
Ali MADANIPhone: + 33 1 47 78 46 [email protected]
49
TUTORIAL Orthopaedics Market
June 2016
SummaryRegulatory issues are becoming heavier and resulting in a longer time to market for new product launches, additional costs and a more limited range of products.Competition is fierce. In each country, the local challengers have a robust market share: Aesculap & Link for example in Germany, Lima & Adler in Italy, Amplitude in France, etc.Revision Implants are growing for all types of implants, cementless & Hybrid products continue to gain market share. Reversed shoulder, mini hip, Trabecular for hips and cages are examples of growing segments.In spite of regulatory issues & reimbursement trends, the orthopaedics market must continue to introduce innovations & new products and instruments to improve the new, less invasive and much more reliable surgical techniques.In 2000, this market was US$11 B It grew to US$39B in 2015, and it will achieve around US$48 B in 2020.That represents an average of 4.4% growth in the coming years.
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