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The US market
for pain management, which comprises a broad range of pharmaceuticals
and devices, is estimated at $18 billion in 2000. Growing at an average
annual growth rate (AAGR) of 12%, it is expected to reach $32 billion
by 2005. These are among the findings of a new study from Business Communications
Co, Pain Management.
The pharmaceutical sector controls the bulk
of the total market and will account for over 95% of this market through
2005. During that period, the pharmaceutical sector is expected to grow
at an AAGR of 12%.
In contrast, pain management devices account
for only 3% of the market. These devices, which include transcutaneous
electrical nerve stimulation (TENS), spinal cord stimulators, neuromuscular
stimulators, analgesia infusion devices, and electrothermal and electromagnetic
therapies, will generate about $458.2 million in 2000. The device segment
is expected to lose market share despite technological advancements and
a gradually declining cost structure. Nonetheless, device sales should
reach $719.2 million by 2005, thanks to a 9% AAGR.
Pain management, in general, has been hindered
by inadequacies in both healthcare delivery and in the range of available
therapeutic modalities. Pain is generally divided into two main types,
acute and chronic. Acute pain can be modulated and removed by treating
its cause. Chronic pain is more complex; often, the source of the pain
is known but cannot be eliminated. Chronic pain may be one of the most
costly health problems in the United States. Not surprisingly, manufacturers
have stepped up the pace of development of new pain drugs and devices,
driven by research breakthroughs and increased recognition of expanding
market opportunities. Because of the evolving nature of this area of medicine,
manufacturers must remain vigilant of the changing environment and strive
to keep abreast of new and currently used modalities in all facets of
pain management.
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The jury
is still out on the experimental interventional procedure known as carotid
stenting. This is the chief finding of a report from Datamonitor, US
& EU Carotid Stenting and Distal Protection.
Carotid stenting involves a significantly higher
incidence of neurological complications than the vastly more common endarterectomy
procedure. Consequently, the procedure is considered useful only for patients
with severe stenosis. Parity with surgical complication rates could conceivably
generate greater acceptance of carotid stenting, and better clinical outcomes
will help physicians decide whether it is worthwhile to study and teach
the procedure.
The age of those needing care has also influenced
adoption of the technology. Of the total number of patients treated by
US vascular surgeons, 70% are elderly and therefore eligible for Medicare
benefits. Government reimbursement will therefore be crucial to the rise
of carotid stenting as an alternative to endarterectomy.
Currently, there are no dedicated carotid
stents being sold in the US, and only one is available in the EU. This
is expected to change soon, with CE marking expected in 2001 and FDA approval
anticipated in 2003. Commercial release of these products will probably
lead to a short-term price rise, followed by a stabilization or gradual
decline two or three years thereafter. In both moderate- and high-impact
scenarios, revenue will primarily come from off-label carotid use.
Bard’s Memotherm is currently the only stent
CE Marked specifically for the carotid artery, although Boston Scientific’s
Wallstent dominates both the EU market and US investigational market.
A number of other companies have products either in development or in
clinical evaluations, including Guidant, Medtronic, and Cordis.
Distal protection is thought by many to be
the force that will drive the carotid stenting market. Eventually, equivalency
in complication rates could provide justification for an interventional
approach to carotid stenosis in patients other than those exceptionally
ill-suited to surgery. Percusurge’s GuardWire occlusion balloon is the
only distal protection device approved in Europe; it is expected to win
FDA approval by early next year.
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