By James McIntosh and Kamran Zamanian, Ph.D., iData Research
The COVID-19 pandemic has been responsible for major declines in and changes to many medical markets, including urology. Many stable markets saw such strong declines that industry leaders chose to cut losses and exit the market, and many long-term trends have been magnified by the pressure created by the pandemic. Perhaps the most important is the emphasis on mitigating infection while treating a patient in surgical or other invasive procedures, as well as being able to perform a procedure in a timely and safe manner. Indeed, the number of patients being admitted to hospitals has skyrocketed in the majority of European countries as the influx of COVID-19 patients continues to ramp up.
Because of the lack of time and space, the importance of completing procedures in a timely manner is at the forefront of technological improvements. Limiting patient stay and recovery time has also been extremely important. In response to these new demands, there has been an enormous uptick in minimally invasive procedures, and major efforts have been made to create alternative, safe treatments for some of the most common problems. New technology is being developed in many important segments of the urology market, especially in the urological endoscope market. Riding the wave of pandemic-spurred funding in pulmonology was the bronchoscope, for which a single-use version was developed to mitigate COVID-19 infection, followed swiftly by the single-use ureteroscope.
First developed by Boston Scientific, the LithoVue has quickly gained popularity in the European market. Because of the high costs associated with acquiring such devices, ureteroscopy has been the perfect extension for single-use endoscopes. This market has quickly become competitive, with companies from around the world seeking to cash in on the movement toward single-use devices in the field of endoscopy. One of these companies is Pusen, a company based in China that has been making strong efforts to reduce the cost of acquiring a disposable ureteroscope. Pusen’s product, USCOPE, drastically undercuts the competition and has quickly led the company to hold a considerable share of the single-use ureteroscope market.
However, the trend toward single-use devices has not been rapid everywhere. In Europe, there is much more consideration for the cost to the consumer, and there are standardized costs for each procedure type. For example, there are two medical sectors, public and private, in the United Kingdom. In the public sector, patients are reimbursed based on the treatment they received and not how the treatment was performed. This subtle difference means that the cost of a ureteroscopy is standardized in the public sector. Therefore, there is a strong incentive to use a reusable scope so the cost of material is lower, which can earn the physician more for completing the procedure, as the cost of purchasing a disposable scope is simply too much to be economically viable. This trend, however, is reversed in the private sector, as the cost can be pushed to the consumer, so there is an incentive to use a disposable scope to increase the cost of material in the procedure. Beyond simple cost concerns, Europe is also very mindful of waste. For hospitals that are making efforts to be environmentally friendly, the waste created from disposables may be a factor in keeping reusable scopes in the toolbox, even more so when cost-effectiveness is still in question.
Technological advancements have been numerous in urology in recent years, with new products being developed to improve existing treatments. No field has seen development of quite as many alternative solutions as the benign prostate hyperplasia (BPH) treatment market. With new treatments Urolift, Rezum, and aquablation gaining popularity in Europe and approval from the governing medical agencies, there have never been as many options for treating BPH as there are today. As more men become affected by BPH, the number of patients seeking treatment will increase. The efficacy of drug treatments for BPH is questionable at best; therefore, many devices are being developed for the treatment of this affliction.
For some time, laser treatments have been increasing in popularity. This spawned innovation in the field, where greenlight lasers have long been the default laser in BPH treatment, although holmium, and now thulium, lasers are being developed for treating BPH. Lasers are important in sustaining growth within this market because they are truly a razor and blade-type of market, as many companies seek to capture a portion of the laser BPH market by giving away expensive equipment in hopes of securing long-term contracts for the sales of laser fibers. Laser fibers in Europe have a larger fraction of reusable fibers than single-use fibers, compared to other global markets. However, many of the lasers in use in Europe have been locked via software, so the lasers will only work with a compatible laser fiber in the future.
Transurethral resection of the prostate (TURP), which is the gold standard in BPH treatment, is continuing to evolve as developments in electrode technology cause a shift from monopolar to bipolar electrodes in the majority of European markets; this trend has been especially noticeable in the U.K. market. Bipolar electrodes offer several advantages but have a far higher price point than their monopolar counterparts; this will positively benefit the market.
One of the current shifting trends is in the treatments used to address urinary incontinence in women. For many years, the most common preventive treatment/surgery for urinary incontinence in women has been some kind of sling operation, the most common types of which are transvaginal tape (TVT), transobturator tape (TOT), and single-incision slings (SIS). Despite the growing popularity of sling procedures, long-term studies and public litigation have had drastically negative effects on the sling market. Studies show that there is a likelihood that implanted alloplastic material, like that of a sling, may have adverse reactions inside a patient as the patient’s tissue engulfs the material and creates areas with a high risk of infection at the boundary between patient and material. The response from the National Institute for Health and Care Excellence (NICE) in the U.K. was to ban the implantation of slings entirely; in 2019, the guidelines were altered to allow for the implantation of slings in select cases, but the damage was done in the U.K. market. Today, the dominant treatment method for urinary incontinence in women in the U.K. is one or several injections of urethral bulking agents.
Only time will tell if other countries follow the U.K.’s lead. The initial response in banning sling operations had an adverse effect on the whole urinary incontinence device market, and it has led to other treatments being prescribed in lieu of a sling.
Urinary catheters continue to be the dominant segment of the urology market in Europe. Representing over 65% of the total market value, urinary catheters continue to enjoy stable growth. Catheters are some of the most commoditized products in the space, and the number used each year is expected to continue increasing with the number of procedures. As more patients are admitted for various age-related ailments, more catheters will be needed to meet the demand. More interesting is the shift in materials being used. Many patients who have needed a urinary catheter have then needed to be treated for a catheter-associated urinary tract infection (CAUTI). Treating a patient for a CAUTI takes up costly resources, so there have been massive efforts to minimize the number of CAUTIs by using products with materials or coatings that reduce the risk of CAUTI. These coatings and materials are costly and have been responsible for raising the average sales price (ASP) of these products. Urinary catheter unit volumes are only expected to increase as the aging population continues to grow, and with rising ASPs, the market is expected to continue to benefit.
More details and the full syndicated report can be found here.
About The Authors:
James McIntosh is a research analyst at iData Research. He develops, writes, and models syndicated research projects regarding the medical device industry, publishing both the U.S. Urology and Gastrointestinal reports series.
Kamran Zamanian, Ph.D., is CEO and founding partner of iData Research. He has spent over 20 years working in the market research industry with a dedication to the study of medical devices used in the health of patients all over the globe.
About iData Research
For 16 years, iData Research has been a strong advocate for data-driven decision-making within the global medical device, dental, and pharmaceutical industries. By providing custom research and consulting solutions, iData empowers their clients to trust the source of data and make important strategic decisions with confidence.
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