Q & A: SIMON WRIGHT
Report Predicts Rise in Use of Synthetic Bone-Graft Substitutes
European bone-graft procedures are currently dominated by autografts (the bone is taken from one part of an individual's body and transferred to another part) and allografts (the bone originates from a different individual). Synthetic bone-graft substitutes presently account for only 10% of such procedures, but their market share may rise dramatically, according to a report published by Datamonitor (London). The firm's European medical analyst Simon Wright explains why substitute materials are poised for growth.
Q: According to Datamonitor's most optimistic projection, synthetic bone-graft substitutes could attain an average annual growth rate of 42% and capture US$73.8 million of the European market by 2003. But even on the low end, the numbers are quite impressive.
A: Absolutely. In 1998, synthetic substitutes accounted for US$16.55 million in Europe. Our research indicates that such products could cannibalize away 35% of market share from allografts and autografts in a high-impact scenario. In a low-impact situation, substitutes may account for 15% of the bone-grafting market, while a medium-impact scenario raises that figure to 25%. In terms of values, that is a low of US$31.6 million and a medium-impact figure of US$52.7 million. You already mentioned the high end.
Q: What is driving the use of synthetic materials?
A: There are a variety of factors. Autograft has long been considered the gold standard, if you will, but both autograft and allograft have a number of inherent disadvantages. Autograft requires two surgical operations, which can cause a serious amount of discomfort and is not advisable for elderly or at-risk patients. In turn, allograft procedures are faced with a shortage of bone bank material in Europe. The extent of the shortage varies by country, but it is a common trend. And there is also concern about disease transmission.
Q: Are there issues that may hinder the use of synthetics by surgeons?
A: Although manufacturers have been quite successful in developing materials with osteoconductive properties, they are having some difficulty achieving osteoinductive, or bone growth, properties. Companies that are able to combine those properties in a substitute material will have a product that will seriously compete with autografts.
Q: What about cost factors?
A: One of the obstacles to product acceptance that was mentioned by many manufacturers I spoke with is a perception among many surgeons that an allograft is a zero-cost product. Because some hospitals have their own bone banks and surgeons are able to procure allografts from there, they almost perceive them to be cost-free materials. When you take a step back and look at the costs of storage, the actual procedure of obtaining material, and making sure it's free of disease, there are costs involved. It will be up to manufacturers to prove this to surgeons.
Q: What other challenges will manufacturers have to overcome to turn your high-impact scenario into reality?
A: The most important factor, which I mentioned earlier, is the development of osteoinductive materials. Until that happens, autografting will remain the gold standard for these types of procedures. There are a number of companies, both large medical and pharmaceutical firms and smaller enterpreneurial ventures, that are working toward this. When they achieve results with these materials that are at least equivalent to autografts, then synthetic substitutes will have an obvious advantage over the other two procedures.
