Cardiac Diagnostics - Changing Practices

Review of key markets in Europe

Sohail Sheikh

Frost & Sullivan, 2003

The Future of Cardiac Testing

Agenda• Troponins in Europe - end user feedback• Decentralised testing in cardiac diagnostics• New and emerging markers• Questions

Motivation

• Troponin usage - how much, how often and how widespread ?

• Demand for POCt - what factors effect uptake ?• Emerging markers - How widespread will their use be ?

State of Cardiac Markers

Marker dynamics - Applications in cardiac care

Market Interest Market Focus Market Apathy

hsCRP

NPs

cTnmyo CKs

Troponins Usage - 2002

Sw

Fi

Fr % penetrati

on of cTn in

acute hosp.

Monthly usage per site

Dk It

Be Ne

UK

GeNo

Sp

High

Low

0 100

The Cost of Troponin

200

300

400

500

600

700

800

900

1000

2 2.5 3 3.5 4 4.5 5 5.5

Average test price (€)

Vo

lum

e u

sa

ge

(p

er

mo

nth

)

No

Fr

Ge

Ne

Dk

UK

Sw

Sp

It

Fi

Be

Factors to Consider

• COST IMPACT - POCt must have a real impact on cost savings through workflow patterns, ie. impacting on waiting times, hospitalisation and bed stay

• TIME SENSITIVE - POCt which target conditions where a rapid result and response outweighs the high sensitivity/performance of lab tests.

• PATIENT MANAGEMENT BENEFIT - A POCt allowing real benefits through therapeutic programmes, ie, the availability of routine medication following rapid diagnosis or by allowing constant monitoring of a patient drug regime, and or increase of QALY.

What Markers Make Good POC Tests?

COST IMPACTPATIENT MANAGEMENT

TIME SENSITIVE

STREPA

GLUCOSE

HP

TROP

Cardiac POCt - Challenges & Hurdles

• Benefits of troponins still being fully realised

• High up-front costs of POCt NOT offset by potential of cost savings

• Lack of will amongst non-lab staff

• Lack of end user choice

The Future of POC Testing

TAM

End user acceptanceof cardiac POCt

Be

GeFr

Scan

UK

Sp

Ne

It

End Users and New Markers• Lack of implementation practices - hindering usage• Low usage of BNPs not surprising• hs-CRP - widely researched, but less clinical applications so

far• Only one visible company (Mercodia) offering mLDL

0 20 40 60 80 100

hsCRP

BNP

Hoc

mLDL

% of respondants

Usage Awareness

Natriuretic Peptides - The New ‘Troponins’ !

• End users unable to differentiate between BNP and proBNP• Growth of proBNP will outpace BNP• 40% of NP market $ will be proBNP by 2005

• Adoption of NPs dictated by platform in use at lab• Over 50% of end users unable to quickly adopt BNP test

0

10

20

30

40

2001 2002 2003 2004 2005 2006

TA

M (

$m)

BNP proBNP

Others49%

E201022%

Dimen.13%

Centaur6%

Axsym10%

And Finally……..

• Have companies forecasted the impact NP use will have on troponin sales?

• If a troponin - NP double test panel is recommended, will there be end users jumping from one supplier to another?

• What will happen to your supply chain if group purchasing continues?

Thank You - Any Questions?

For further information:

call: +44 (0)20 7343 8383 email: enquiries@frost.com

www.biotech.frost.com