defining the landscape for neuromodulation 2020 or 20/20 dana mead 12/6/2012
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DEFINING THE LANDSCAPE FOR NEUROMODULATION
2020or
20/20
Dana Mead12/6/2012
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KPCB Confidential
Over 350,000 jobsMore than US $650 billion market cap
Company and Market Building Since 1972
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KPCB Confidential
Innovation Markets
Information Technology• Smartphones + tablets à PCs + laptops
• Third Wave of Innovation
Health Care & Life Sciences• Targeted therapeutics • “Digital” Health • Medical Devices
New Energy Technology• Science of small à enormous markets
• Speed and scale
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KPCB Confidential
Life Sciences PortfolioDIAGNOSTICS THERAPEUTICS TOOLS/SERVICESDEVICES
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KPCB Confidential
Presentation Pathway: 2012 2020
Therapies/IndicationsTechnologyCare ContinuumHealthcare EconomicsMarketsA Healthy Ecosystem ?
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KPCB Confidential
Neuromodulation Therapies 2012 2020
• Foundation of therapies across pain, spasticity, movement disorders, incontinence, epilepsy, sensory deficits
• Therapy efficacy is mixed despite trial step (SCS)
Expanding therapies to more complex neurodegenerative diseases
2020
• Expanded indications• Enhanced efficacy• Less invasive implant procedures• Improved efficacy, eliminate trial (SCS)2012
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KPCB Confidential
Traditional SCS: Trial Success Rates*
*Success defined as >50% VAS score improvementSource: Leerink Swann, Physician survey (n=50) and SMI prospective/retrospective data
Pelvic/Groin (37%)
Foot (59%)
Arms (49%)
Chest (31%)
Leg (75%)
Back (50%)
Hand (44%)
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KPCB Confidential
Neuromodulation Therapies: Current & Future
Parkinson’s Disease
Hearing Disorders
Vision Disorders
Urinary & Fecal Incontinence
Spasticity
Malignant Pain
Gastroparesis
Chronic Pain
Obsessive Compulsive Disorder
Dystonia
Essential Tremor
Depression
Pelvic Floor Disorders
Bowel Disorders
Heart Failure
Neurodegenerative Diseases Alzheimer’s Parkinson’s Huntington’s ALS
Migraine/Headache
Epilepsy
Sleep Apnea
COPD/Asthma
Dry Eye
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KPCB Confidential
Neuromodulation Technology2012 2020
• Complex programming• Intense patient involvement, subpar UI’s• Poor connectivity (EHR & provider)• High patient burden (size, stimulation, no MRI)
• Closed loop (sensing & therapy)• Therapy less intrusive for patient (stim perception,
passive recharging, no MRI restrictions)• Device data flow provides for remote Dx, EHR, etc.• MEMS/NANO/Next Gen Power Supplies/Wireless
Approaching next phase of technology innovation
2020
2012
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KPCB Confidential
Neuromodulation Care Continuum 2012 2020
• Disjointed care• Best practices undefined or concentrated with leaders• Role/sequence of therapy; devices, medication, & other
pain therapies remains unclear• Neuromodulation often a last-resort therapy
• Standard protocols for managing pain & other neuro conditions emerge
• Treatment paths well-defined and adopted• Quality outcomes defined, enforced & measured• Neuromodulational moving up the care
continuum
Moving from modest adoption to standard of care 2020
2012
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KPCB Confidential
Neuromodulation Healthcare Economics (US)2012 2020
• Primarily fee for service• Rewards treatment vs. outcome• Incentives don’t support ACO model• $20-25K ASP with mixed outcomes
• Expanded patient coverage WW• Value= quality outcomes/costs• Comparative effectiveness filter for de novo therapies • ASP pressure for legacy therapies• Accountable, at risk care
Industry must quantifiably demonstrate therapy value
2012
2020
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KPCB Confidential
Worldwide Neuromodulation Market2012 2020
2012
2020
New therapies, new indications and market penetration drive WW growth
• $2.87B WW• $1.41B SCS• 80% U.S./14% EU• 10% CAGR
• $6.2B WW• $3B SCS• 70-80% US; Asia?• 10% CAGR
Source: Analyst reports. Includes SCS, OBS, SNM, VNS, TDD
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Optogenetics: What does it do?
Optogenetics: Potential for Therapeutic and Cellular Specificity
• Target specific phenotypes• Induce suppression or activation• Affect specific neuroanatomies• Combined genetic and device therapy
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Brain-Machine Interfacing
• Progress in tissue-machine interfacing and coupling can provide advanced methodologies to develop neural-based therapies
• Nanoscafolding and other microfabrication techniques may contribute to providing the ability to control specific neural networks
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KPCB Confidential
A Healthy Neuromodulation Ecosystem - 2020
• Invest in the clinical trials to support efficacy/safety, indication expansion and cost-effectiveness
• Design “product” for emerging markets• Develop closed-loop devices (sensing & therapy)• Reduce programming requirements and need for follow-
up visits• Enhance connectivity (e.g., remote Dx, EHR interface)• Make the therapy non-invasive (e.g., reduce size,
volume, weight, subcutaneous, etc.)• Demonstrate clear value to the system
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