The Coronary Stents Market: Future status and future trends
Interventional cardiology has changed dramatically since the early 1990s as increasing numbers of physicians turn to stents (expandable scaffolding devices) to treat coronary disease. The market for coronary stents is growing quickly. In 1996 the value of the global market was $850 million but, by 1997, this value had risen to $1.2 billion, and accounted for about half of the angioplasty procedures carried out that year.
The first coronary stents were implanted in humans in 1986 but cardiologists were wary of the high risk of thrombosis. Growth in the market was triggered by two large randomised trials, STRESS and Benestent which, in 1993, found that stents significantly reduced restenosis compared to balloon angioplasty; and, more recently, by the findings that high-pressure deployment and antiplatelet therapy can reduce the risk of thrombosis without causing bleeding and vascular complications, which were often associated with heparin anticoagulant therapy.
Antiplatelet therapy has been shown to be extremely effective in preventing restenosis. The EPILOG-STENT trial, which was reported at the American College of Cardiology (ACC) meeting in Atlanta in 1998, showed that abciximab (also known by its trade name of ReoPro), not only reduced restenosis rates with stents, but also reduced the amount of restenosis associated with balloon angioplasty to such an extent that the balloon angioplasty results were comparable to the results achieved with stents.
The Palmaz-Schatz stent (manufactured by the Johnson & Johnson (J&J) owned Cordis) was launched in the US in 1994 and dominated the US market until the start of 1998. Manufacturers who wished to have a share in the US coronary stent market had to prove that their stent design was substantially different from the Cordis design and that their stents could improve on the results achieved with the Palmaz-Schatz stent. A number of coronary stent manufacturers have now entered the US and, as such, have entered the world's largest market for their products (see Table ES.1).
Table ES.1: The top seven markets for coronary stents (1998) Rank Market
These markets are the ones which currently have the highest value and which are predicted to remain the top markets into the next millennium. However, the countries of Central Eastern Europe are seen by the industry to be very promising markets for the future, along with certain African states. New trade agreements with South America also promise to bear fruit but these agreements are not expected to have any significant effect within the next 5 years and are therefore difficult to predict.
The coronary stent market has been rising rapidly over the past 5 years but many companies have realised that it will not be able to continue expanding in this manner, and even if new major geographical markets (such as the former Soviet States) open to them, the boom may be over within 3 years. Companies are therefore preparing themselves for this change and are strengthening their positions in a number of ways. These methods include extending their product range either by merger or acquisition, preferably with a company whose complementary products have received Food and Drug Administration (FDA) and CE-mark approval, and 'bundling' their products together for the purchaser. This is a path which has been followed by Arterial Vascular Engineering (AVE) with its acquisition of Bard's cardiology business. The most successful companies in the market are also placing large investments in R&D as the stent market is eager to try new technology, especially if it makes the stent procedure simpler and improves outcomes. Expansion into other fields is also an area that many companies are following. One such area of investment is that of a catheter-based technology to provide sutureless repairs of abdominal aortic aneurysms, which is becoming a very popular field.
It will be seen, therefore, that the coronary stent market is undergoing important changes, with opportunities to be exploited arising in a number of areas. The different regional markets vary significantly in their dynamics and manufacturers will need to vary their strategies accordingly to enter into them. The one factor that remains constant across the board in 1998 is the emphasis that purchasers are placing on the cost of coronary stents, and if suppliers are to succeed at breaking into new markets, or even to retain their hold on established ones, it is imperative that their manufacturing process and distribution network are made as cost-efficient as possible. The ones that realise this goal are likely to achieve great success in the coronary stent market.
This report reviews recent events within the global stents industry. It contains essential market data, and analyses market opportunities in France, Germany, Italy, Japan, Spain, the UK and the US � enabling you to access world sales figures and statistics for stent and angioplasty procedures for each country.
The Coronary Stents Market: Current Status and Future Trends examines both new and existing coronary stent products on the market and explores the new technologies currently driving the market, including new stent materials, laser technology, and the growing trend towards new anti-coagulation treatments such as the antiplatelet drug Abciximab. It analyses the latest developments within these areas, allowing you to estimate their impact on today's market and forecast future activity.
This report provides you with extensive information on the leading companies involved in the stents market. Profiles include contact details, company overview details of recent company activity, market shares, financial performance, including sales of stents, and a description of stent products.
Companies profiled include: Angiodynamics ; Arterial Vascular Engineering; Boston Scientific; Cordis; Guidant; Medtronic; Vascular Therapies.
Published: August 1998
Ref: CBS787E
Pages: 100
Price: £370/$780/¥89,000
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CONTENTS
LIST OF TABLES
LIST OF FIGURES
EXECUTIVE SUMMARY
ABBREVIATIONS
LIST OF STUDIES
CHAPTER 1 INTRODUCTION
1.1 Aims of the report
1.2 Scope of the report
1.2.1 Products included
1.2.2 Markets included
1.2.3 Companies included
1.2.4 Years covered
1.3 Methodology
1.3.1 Forecasting
1.3.2 GDP and GNP data
1.3.3 Currency exchange
1.4 Coronary artery disease
1.4.1 Coronary artery bypass grafting
1.4.2 Coronary angioplasty
1.4.3 Stents
1.4.4 Rotational atherectomy
1.4.5 Cutting balloons
1.4.6 Lasers
CHAPTER 2 CLINICAL DEVELOPMENTS
2.1 Stent design
2.1.1 Slotted tube stents
2.1.2 Coil stents
2.1.3 Ring stents
2.1.4 Bifurcated stents
2.1.5 Stent size
2.1.5.1 Lumen diameter
2.2 Stent coatings
2.3 Radioactivity
2.4 Antiplatelets and anticoagulants
2.5 Complementary therapies
2.5.1 Laser angioplasty
2.5.2 Rotablator angioplasty
2.5.3 Coronary intravascular ultrasound
2.6 Clinical applications
2.6.1 Myocardial infarction
2.6.2 Heart transplants
2.6.3 Stroke
CHAPTER 3 CURRENT AND FUTURE PRODUCTS
3.1 Overview
3.2 Stent designs
3.2.1 Material of construction
3.2.1.1 Polishing
3.2.2 Slotted tube stents
3.2.3 Coil stents
3.2.4 Ring stents
CHAPTER 4 THE GROWING MARKET FOR CORONARY STENTS
4.1 The global market
4.1.1 Emerging markets
4.2 The US stent market
4.2.1 Population
4.2.2 Cardiovascular disease
4.2.3 Stent procedures
4.2.4 Other influencing factors
4.3 The Japanese stent market
4.3.1 Population
4.3.2 Cardiovascular disease
4.3.3 Stent procedures
4.3.4 Other influencing factors
4.3.5 Healthcare reforms
4.4 The French stent market
4.4.1 Population
4.4.2 Cardiovascular disease
4.4.3 Stent procedures
4.4.4 Other influencing factors
4.5 The German stent market
4.5.1 The German healthcare market
4.5.2 Population
4.5.3 Cardiovascular disease
4.5.4 Stent procedures
4.5.5 Other influencing factors
4.6 The UK stent market
4.6.1 Population
4.6.2 Cardiovascular disease
4.6.3 Stent procedures
4.6.4 Other influencing factors
4.7 The Italian stent market
4.7.1 The Italian healthcare market
4.7.2 Population
4.7.3 Cardiovascular disease
4.7.4 Stent procedures
4.7.5 Other influencing factors
4.8 The Spanish stent market
4.8.1 Population
4.8.2 Cardiovascular disease
4.8.3 Stent procedures
4.8.4 Other influencing factors
CHAPTER 5 COMPANY PROFILES
5.1 Angiodynamics
5.1.1 Company addresses
5.1.2 Products
5.1.3 Company finances
5.1.4 Research and development
5.1.5 Strategies for success
5.1.6 Market share
5.2 Arterial Vascular Engineering Inc
5.2.1 Company addresses
5.2.2 Products
5.2.3 Company finances
5.2.4 Research and development
5.2.5 Strategies for success
5.2.6 Market share
5.3 Boston Scientific Inc
5.3.1 Company addresses
5.3.2 Products
5.3.3 Company finances
5.3.4 Research and development
5.3.5 Strategies for success
5.3.6 Market share
5.4 Cordis Corporation
5.4.1 Company addresses
5.4.2 Products
5.4.3 Company finances
5.4.4 Research and development
5.4.5 Strategies for success
5.4.6 Market share
5.5 Guidant Corporation
5.5.1 Company addresses
5.5.2 Products
5.5.3 Company finances
5.5.4 Research and development
5.5.5 Strategies for success
5.5.6 Market share
5.6 Medtronic Inc
5.6.1 Company addresses
5.6.2 Products
5.6.3 Company finances
5.6.4 Research and development
5.6.5 Strategies for success
5.6.6 Market share
5.7 Vascular Therapies
5.7.1 Company addresses
5.7.2 Products
5.7.3 Company finances
5.7.4 Strategies for success
5.7.5 Market share
CHAPTER 6 COMPANIES DIRECTORY
APPENDIX
EXCHANGE RATES
REFERENCES
LIST OF TABLES
Table ES.1 The top seven markets for coronary stents (1998)
Table 1.1 Coronary stent segmentation
Table 2.1 Major slotted tube stent designs
Table 2.2 Major coil stent designs
Table 2.3 Major ring stent designs
Table 3.1 Properties of the most common stent materials
Table 3.2 Slotted tube stents � present and future designs, 1998
Table 3.3 Coil stents � present and future designs, 1998
Table 3.4 Ring stents � present and future designs, 1998
Table 4.1 Coronary stent procedures per country (1992�1994)
Table 4.2 Coronary stent and PTCA procedures by country (1994)
Table 4.3 Number of catheter laboratories per country (1994)
Table 4.4 US population and predicted demographic development (1993�2020)
Table 4.5 Stent usage in the US
Table 4.6 The US GDP (1992�1997)
Table 4.7 Japan's population and predicted demographic development (1993�2020)
Table 4.8 Stent usage in Japan
Table 4.9 Japan's GDP (1992�1997)
Table 4.10 France's population and predicted demographic development (1993�2020)
Table 4.11 Deaths from CVD in France (1993)
Table 4.12 Stent usage in France
Table 4.13 France's GDP (1992�1997)
Table 4.14 Germany's population and predicted demographic development (1993�2020)
Table 4.15 Deaths from CVD in Germany (1994)
Table 4.16 Stent usage in Germany
Table 4.17 Germany's GDP (1992�1997)
Table 4.18 UK's population and predicted demographic development (1993�2020)
Table 4.19 Deaths from CVD in the UK (1993)
Table 4.20 Stent usage in the UK
Table 4.21 The UK's GDP (1992�1997)
Table 4.22 The UK Government's expenditure (in millions) on the NHS (1991�1999)
Table 4.23 Italy's population and predicted demographic development (1993�2020)
Table 4.24 Deaths from CVD in Italy (1992)
Table 4.25 Stent usage in Italy
Table 4.26 Italy's GDP (1992�1997)
Table 4.27 Spain's population and predicted demographic development (1993�2020)
Table 4.28 Deaths from CVD in Spain (1992)
Table 4.29 Stent usage in Spain
Table 4.30 Spain's GDP (1992�1997)
Table 5.1 E-Z-EM's and AngioDynamic's net sales and operating profit (1995�1997)
Table 5.2 E-Z-EM's net sales by region (1995�1997)
Table 5.3 E-Z-EM's expenditure on R&D (1995�1997)
Table 5.4 A selection of the coronary stents produced by AVE
Table 5.5 Bard's divisional sales (1993�1997)
Table 5.6 AVE's net sales and income (1995�1998)
Table 5.7 AVE's net sales by region (1995�1998)
Table 5.8 AVE's expenditure on R&D (1995�1997)
Table 5.9 AVE's estimated market share (1998)
Table 5.10 Boston Scientific's net sales and income (1994�1997)
Table 5.11 Boston Scientific's net sales by region (1995�1997)
Table 5.12 Boston Scientific's expenditure on R&D (1994�1997)
Table 5.13 J&J's net sales and net earnings (1995�1997)
Table 5.14 J&J's net sales by region (1995�1997)
Table 5.15 J&J's expenditure on R&D (1994�1997)
Table 5.16 J&J's estimated market share (1998)
Table 5.17 Guidant's net sales and income (1993�1997)
Table 5.18 Guidant's divisional sales (1994�1997)
Table 5.19 Guidant's net sales to unaffiliated customers by region (1994�1997)
Table 5.20 Guidant's expenditure on R&D (1994�1997)
Table 5.21 Guidant's estimated market share (1998)
Table 5.22 Medtronic's net sales and income (1993�1997)
Table 5.23 Medtronic's net sales ($ million) by region (1995�1997)
Table 5.24 Medtronic's expenditure on R&D (1994�1997)
Table 5.25 Medtronic's estimated market share (1998)
Table 5.26 USS's net sales and income (1994�1997)
Table 5.27 USS's net sales by region (1996�1997)
LIST OF FIGURES
Figure 2.1 Stent placement in a bifurcated lesion
Figure 3.1 Estimated share of the US coronary stent market, 1998
Figure 3.2 Estimated share of the European coronary stent market, 1998
Figure 3.3 Prevalence of coronary stent designs, 1998
Figure 3.4 Frequency of use of materials employed in stent manufacture
Figure 4.1 Coronary stent procedures per country (1992�1994)
Figure 4.2 The top seven markets for coronary stents as percentages of the global market (1998)
Figure 4.3 Estimated value of the global coronary stent market (1995�2000)
Figure 4.4 US population and predicted demographic development (1993�2020)
Figure 4.5 The US GDP (1992�1997)
Figure 4.6 Healthcare expenditure in Japan (1990�1994)
Figure 4.7 Public and private healthcare expenditure in Japan (1992�2003)
Figure 4.8 Japan's population and predicted demographic development (1993�2020)
Figure 4.9 Japan's GDP (1992�1997)
Figure 4.10 Japan's healthcare expenditure, as a percentage of GDP (1991�1995)
Figure 4.11 Healthcare expenditure in France (1992�2003)
Figure 4.12 France's population and predicted demographic development (1993�2020)
Figure 4.13 France's GDP (1992�1997)
Figure 4.14 France's healthcare expenditure, as a percentage of GDP (1991�1995)
Figure 4.15 Healthcare expenditure in Germany (1990�1994)
Figure 4.16 Healthcare expenditure in Germany (1992�2003)
Figure 4.17 Germany's population and predicted demographic development (1993�2020)
Figure 4.18 The number of smokers in Germany (1992 and 1995)
Figure 4.19 Germany's GDP (1992�1997)
Figure 4.20 Germany's healthcare expenditure, as a percentage of GDP (1991�1995)
Figure 4.21 Healthcare expenditure in the UK (1992�2003)
Figure 4.22 UK's population and predicted demographic development (1993�2020)
Figure 4.23 The UK's GDP (1992�1997)
Figure 4.24 The UK's healthcare expenditure, as a percentage of GDP (1991�1995)
Figure 4.25 The UK Government's expenditure (in millions) on the NHS (1991�1999)
Figure 4.26 Healthcare expenditure in Italy (1990�1994)
Figure 4.27 Healthcare expenditure in Italy (1992�2003)
Figure 4.28 Italy's population and predicted demographic development (1993�2020)
Figure 4.29 Smoking status of the Italian population (1995)
Figure 4.30 Italy's GDP (1992�1997)
Figure 4.31 Italy's healthcare expenditure, as a percentage of GDP (1991�1995)
Figure 4.32 Healthcare expenditure in Spain (1990�1994)
Figure 4.33 Healthcare expenditure in Spain (1992�2003)
Figure 4.34 Spain's population and predicted demographic development (1993�2020)
Figure 4.35 Spain's GDP (1992�1997)
Figure 4.36 Spain's healthcare expenditure, as a percentage of GDP (1991�1995)
Figure 5.1 E-Z-EM's and AngioDynamics' net sales and operating profit (1995�1997)
Figure 5.2 E-Z-EM's net sales by region (1995�1997)
Figure 5.3 AVE's net sales and income (1995�1997)
Figure 5.4 AVE's net sales by region (1995�1998)
Figure 5.5 Boston Scientific's net sales and income (1994�1997)
Figure 5.6 Boston Scientific's net sales by region (1995�1997)
Figure 5.7 J&J's sales and net earnings (1995�1997)
Figure 5.8 J&J's net sales by region (1995�1997)
Figure 5.9 Guidant's net sales and income (1993�1997)
Figure 5.10 Guidant's divisional sales (1994�1997)
Figure 5.11 Guidant's net sales to unaffiliated customers by region (1994�1997)
Figure 5.12 Medtronic's net sales and income (1993�1997)
Figure 5.13 Medtronic's net sales by region (1995�1997)
Figure 5.14 USS's net sales and income (1994�1997)
Figure 5.15 USS's net sales by region (1996�1997)
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