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Current Issue Ventilators: A Vibrant Industry | Ventilators: A Vibrant Industry |
| Tuesday, 06 July 2010 | |
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Ventilators have evolved from small, pneumatically powered, and pneumatically controlled devices to marvels of microprocessor technology capable of closed-loop control.
Market Dynamics In 2009, the ventilator market is estimated at Rs. 350 crore with a total sale of 5350 units. Ventilators registered unit-wise growth of 24 percent and value-wise growth of 17 percent.
Max Meditech and Medisys dominated with a combined share of 77 percent in the Rs. 90 crore indigenous ventilators segment. In 2009, 1500 units of indigenous ventilators were sold. Air Liquide and Erkadi Systems are the other major brands in this segment. Erkadi had success with a Rs. 3.5 crore purchase by the U.P. government. Other significant players in this segment include Pricol and SUR. Refurbished ventilators sales are estimated to be at 1000 units, valued at Rs. 10 crore. These ventilators are preferred by small hospitals and nursing homes in tier II cities, tier III cities, and rural areas. Major players in this segment include Zigma Meditech, Ved Mediserve, SS Technomed, ICON (Andhra Pradesh), Unitech (Mumbai), and Maquet. This year saw major imports from the U.S. and some from the U.K., Germany, and Australia.
Other players in the ventilators market include Allied Medical Limited, Avasarala Technologies Ltd., Bangalore Medical Systems, Elder Instruments Pvt. Ltd., Instromedix (India) Pvt. Ltd., Ion Bio Med-iCare, Kopran Laboratories Pvt. Ltd., L&T Medical, Medica Enterprise, Medical Engineers, Meditech Electronics, Medion, Schiller Healthcare (India) Pvt. Ltd., Takaoka, and Versamed Inc., and Zigma. Market Trends India represents an attractive market for ventilators due to favorable demographics and the growing adoption of advanced technologies. The changing climatic conditions, increasing obesity, and pollution have attributed to increased incidence of respiratory diseases. On similar lines, during the swine flu outbreak in 2009, most of the cases required critical care, thus increasing the demand for ventilators, and other respiratory aids. Healthcare providers have augmented the demand for ventilators as the requirement comes from critical as well as non critical areas where there is a requisite for high and medium range equipment. Establishment of new hospitals, increasing government budget for healthcare, and improving private and public health insurance are some of the major driving factors behind the growth in ventilators market. The purchase criteria in the mechanical ventilators market is also changing. Buyers are placing greater emphasis on service, support, user-friendliness, and product design instead of prices and brand names. The non-invasive ventilation (NIV) mode is being preferred over the invasive ventilation because it caters to the need of patient safety and comfort. The clinical data and research studies suggest that the level of complication resulting from NIV is less than that occurring during invasive ventilation. The market for non-invasive ventilators has been boosted by the advantages that the treatment offers to the patients. Apart from eliminating the trauma associated with tracheostomy, it reduces the chances of ventilator associated pneumonia. The non-invasive mode allows shorter duration of ventilation thereby increasing the levels of patient comfort as well as reducing the treatment costs. NIV when used intermittently for short spans can improve compliance and quality-of-life of patients in advanced stages of pulmonary disorders that remain symptomatic despite standard pharmacological therapy. It has also been clinically demonstrated that non-invasive ventilation is helpful in slowing down the progression of respiratory failure in cystic fibrosis. The clinician's confidence in NIV has increased over the years as compared to invasive ventilation. This is because of reduction in the complexity of treatment, along with saving on treatment that it offers to be inline with the budget. Patient transport is easier as against when the patient is intubated. Thus, in emergency cases, requirement for non-invasive ventilation is on the rise. Indigenous vendors are benefiting immensely from these changing concerns since they are nimble-footed enough to focus on individual consumer needs. With an ability to penetrate neighboring markets, these manufacturers are posing a mounting threat to the larger multinational companies (MNCs). This may compel MNCs to scale down prices to an extent where there is conflict among geographies or a dilution of the brand equity. To match this new threat and as attention shifts toward smaller lighter models, MNCs must also offer enhanced product designs to effectively combat competition and for capturing and retaining market share. Intelligent maneuvering of product design and product management can allow manufacturers to counter this threat. Overall, there are numerous revenue maximization opportunities for both indigenous manufacturers and MNCs in the ventilators market given the escalating incidence of respiratory diseases and opening up of new geographical markets. The homecare and acute care sectors are expected to be high growth segments in the near future for both the traditional and developed markets. Technological Trends Many high-end ventilators are offering neurally adjusted ventilatory assist (NAVA) technology, which is a new approach to mechanical ventilation based on neural respiratory output. Conventional mechanical ventilators sense a patient effort by either a drop in airway pressure or a reversal in flow. The last and most slow reacting step in the chain of respiratory events is used to sense the patient effort. Hence, it creates a system that is sensitive to hyperinflation, intrinsic PEEP, and secondary triggering problems. With NAVA, the electrical activity of the diaphragm (Edi) is captured, fed to the ventilator, and used to assist the patient's breathing. As the ventilator and the diaphragm work with the same signal, mechanical coupling between the diaphragm and the ventilator is practically instantaneous. In NAVA the ventilator is cycled-on as soon as neural inspiration starts. Moreover, the level of assistance provided during inspiration is determined by the patient's own respiratory center demand. With NAVA the patient's own respiratory demands determine the level of assistance. It gives the opportunity to avoid over or under assistance of the patient. Adaptive support ventilation (ASV) is a newly developed dual control mode, using measured dynamic compliance and time constant, with an automated adjustment of tidal volume and respiratory rate combined to meet the preset minute ventilation. ASV can be used as a safe weaning mode for specific postoperative and chronically ventilated patient groups, save manpower and management, and reduce lung injury induced by mechanical ventilation. To try to deliver a constant tidal volume to a patient with stiff lungs results in further lung complications. High frequency oscillatory ventilation (HFOV) reduces this risk by delivering small tidal volumes. HFOV keeps the lungs/alveoli open at a constant, less variable, airway pressure. This prevents the lung inflate-deflate cycle, which has been shown to damage alveoli and further complicate lung disease. The delivery of tidal volumes of dead space or less at very high frequencies enables the maintenance of a minute volume. Lungs are kept open to a constant airway pressure via a mean pressure adjust system. Further, HFOV allows for the decoupling of oxygenation from ventilation. It allows the clinician to separately adjust either oxygenation or ventilation. The advanced ventilator platform can be customized to meet the needs of neonatal, pediatrics, adults, or all patient categories. It also supports both invasive and non-invasive ventilation. Despite development of many automatic techniques for control of the main outputs of mechanical ventilators, the majority of the commercially available ventilators are still mainly open-loop controlled devices. Challenges in the ventilators market include satisfying the requirement of the hospital and being alive in this competitive scenario. Providing quality products within a limited price range is a major challenge. However, to regain a more profound market penetration, the manufacturers need to supply products that are flexible, have the option of add-on modules, and sell these products in the limited price range which is affordable to the end-users. Industry Speak Turbine-Based Ventilators See Rise in Demand On company activities Air Liquide Medical Systems has 25 years of presence in India and excels in post-sales service. It is a dedicated company for ventilators. With a nationwide network of service engineers, we maintain close to 5000 ventilators all over India. We have successfully transferred the CE certified Horus product line from France to India. It is the only ventilator manufactured in India to have CE certification. The new model T75 is becoming popular because of its turbine and color touch screen. On market trends 2009 has been a good year for ventilators. Had there been no recession, the result would have been much better. We expect good sales in 2010. On market share Our share in ventilators market is approximately 15 percent. On key growth drivers Some of the factors driving this segment are:
On emerging trends and new technologies The ventilators' market is expanding. Turbine-based ventilators are being introduced. Color touch screen graphics will be made available in all the ventilators. Diagnostic functions will guide the user about the amount of PEEP and tidal volume to be introduced. Ventilating a stiff lung is a major challenge. Diagnostic information about the relaxation of airways during nebulization will be introduced. On challenges and opportunities The challenge for Indian manufacturers is to establish quality systems and get their products certified from international agencies. Quality systems will help Indian manufacturers sell their products not only in India but also in Asia-Pacific region, and without the standards in place, that cannot be done. Low price will not be the only criterion to get orders as Indian hospitals demand quality products. Industry Speak Government Investment in Healthcare Drives up Ventilator Sales On company's activities Schiller Healthcare provides its customers a comprehensive range of ventilators that cover neonatal and pediatrics, adult ICU ventilators, and a range of transport and emergency usage ventilators. With recent installations at AIIMS, New Delhi; PGI, Chandigarh; and a spate of government and private users, we see the ventilator division becoming a significant contributor in our sales revenue this year. On market trends We launched the ICU ventilator in 2009 and have notched up excellent sales in our first year. We already have a presence in the niche neonatal ventilators' market and the ICU ventilator completes our product offering to our critical care customers. We expect that 2010 will see us continue to increase our market share in the ICU ventilator market. On trends The adult ICU ventilators market remains the most significant in size. This includes the mid and high-end segments. Small niche segments like neonatal ventilators are yet to see significant numbers but the transport ventilator segment has seen a major surge in sales with various emergency services starting ambulance services. Transport ventilators are now finding government support because of upcoming Commonwealth Games. On key driving Government investment in healthcare has finally increased and will become the largest contributing factor to drive ventilator sales. Corporate hospitals foray in a large way in the metros, and now, secondary towns remain a significant contributor. We are confident that the market will continue to grow at around 16 percent in 2010 too. On new technologies ICU and respiratory care clinicians are demanding the inclusion of newer advanced ventilation modes such as lung mechanics and PRVC modes, graphics, and loops at lower prices. Ease of use by clinicians and technicians is a primary factor in the purchase decision. Lower cost of ownership and not just purchase price, is the hospital administration's objective. On challenges and opportunities Local manufacturers continue to face limited acceptance of their products in mainstream hospitals due to lack of CE or FDA compliance. The lack of depth in their clinical R&D is the major hurdle that limits their sales in private clinics and hospitals.
S. Raveendran‚ Industry Speak Policy Needed to Monitor Imports K. Y. Ashok Murthy Managing Partner, Erkadi Systems On market trends We do hope a sensible regulatory policy is introduced in 2010. The present form of policy is meant to provide a free path to obsolete, outdated, and even refurbished imported equipment, while making Indian manufacturers adhere to the latest and strictest standards. The Indian manufacturers have come up despite government policy and not because of it. Hopefully, they will be able to clear this discriminatory hurdle too. On emerging trends and new technologies Easy user interfaces, lower running costs and better preservation of spontaneous breathing have been the thrust areas in technology. The ventilator market is also moving toward convergence of data with other devices in the ICU and outside. On challenges and opportunities We have focused on the high-end of the market. The challenge has been to find a viable volume of sales in a market that is essentially looking for a mid-range or refurbished devices. The continued import of ventilators with old/obsolete safety standards is an anomaly that Indian manufacturers have had to traditionally deal with. We have been fortunate in starting over a decade back in our efforts, and have been able to move through several iterations of improvement- all in the high-end segment of the market. We are now positioned to exploit opportunities provided by other markets and look beyond the Indian market. On key achievements We have been able to build a base of 500 plus machines in the high-end segment, which is very demanding. We have always focused on producing devices that address the most important clinical needs, and will continue to serve this segment, even though the market in India is looking for cheap machines. In about 24 months we will be introducing, a more restricted version of our existing ventilator for the less sophisticated user, without sacrificing our clinical efficacy. Industry Speak Home Care Ventilaters Emerging as a Large Segment  On market trends
2009 has been an average year in terms of sales of ventilators. On types of ventilators There are three types of ventilators- ICU, transport, and home care ventilators. ICU ventilators have a share of 50 percent value-wise and 30 percent volume, transport ventilators have a share of 30 percent value-wise and 40 percent volume-wise, and home care ventilators have a share of 20 percent value-wise and 30 percent volume-wise. On installation base Total installed ventilator base is 30,000 and we have a share of 5 percent. On key driving factors Spread of communicable diseases like swine flu, bird flu and CWG are the factors that have fuelled the market growth. On emerging trends and new technologies Ventilator market is growing quite fast. Automation, seamless solutions, compact designs, etc. are the new innovations seen in the newer designs in the ventilator market. Hamilton has introduced Cockpit technology ventilation called ASV, which brings automation in weaning the patients, reducing the human errors and reducing the weaning time. On challenges and opportunities Flood of several brands at competitive prices and low customs duty are the challenges faced by local manufacturers. On key achievements Instromedix (India) is over 25 years old in the healthcare segment and is highly focused on providing solutions in the field of critical care. We have been marketing ICU/transport ventilators for over two decades and have trained engineers and stocks of spares to provide efficient after sales support to the customers. We have record to win awards for large projects in defense, DGHS, state government hospitals etc. Hamilton / Instromedix has launched latest model called C-2 which is ICU ventilator with all high-end features. It is a compact and portable unit. We have extensive plans to grow our share in the upcoming market in the field of ICU and transport ventilators. Industry Speak Range of Products to Suit Customer's Requirement
2009 was a good year for ventilators sales due to swine flu scare. A lot of units were sold last year. The government tenders also came out in huge numbers. Overall, the ventilators sale was at the maximum. 2010 also seems to be a promising year with the sale of ventilators keeping the same trend and more and more buyers looking for investing in critical care. On total installation base We have sold more than 700 ventilators in the past five years. On company's offerings Medion represents Tecme S.A., Argentina which manufactures ventilators since 1966 and sells two models of intensive care ventilators under the Neumovent brand namely Neumovent Graph and Neumovent Graphnet. For transport and portable ventilator range, we distribute products of Siare, Italy with models Sirio S2T, Falco 202 and Sirio Baby 200. We at Medion Healthcare have a complete range of ventilators with various models to suit intensive care, portable and transport facilities for adult and neonatal applications. We have a total of 10 different models for various segments. The categories are as below:
Medion Healthcare is focusing mainly on respiratory care and we have a wide range of products to suit customers' requirements and budgets. We are now launching new models with more features to cater the high-end users, at the same time we are also working toward introducing lower-end models, that can be marketed to start-ups or smaller hospitals. Industry Speak New and Refurbished Ventilators to Co-exist
The sale of refurbished ventilators have had a remarkable growth in 2009 due to government funding schemes for small hospitals. On total installation base Total installation base is more than 3000. We have sold 600 units. On emerging trends and new technologies For new technologies to become cost-effective, it will take a couple of years because the refurbished market in India totally depends on the drain from US market and how it is manufacturing new ventilators. Since customers are very branded in the refurbished segment, Siemens is the most popular model. In the emerging scenario, you could see more of Respironics and Viasys models coming in. On challenges and opportunities It is eventually the low-cost customer who looks for this option and both new and refurbished will co-exist side by side. There will be opportunities to provide mixed bag of new and refurbished for the higher-end customers also. On company's activities
Industry Speak Transport/Emergency Ventilators Poised for Growth
The observed growth rate was 10-15 percent in 2009. It is likely to increase in 2010 by another 10 percent. On growth factors
On type of ventilators
On emerging trends There will be an emerging trend for the transport/emergency ventilators in India. On challenges and opportunities Acceptance of indigenous ventilators as good performers. On new models launched We are currently offering anesthesia and transport ventilators. Our company is launching a new model in transport ventilator sector, namely I-VENT, with various modes and LCD display. In anesthesia segment, high-end ventilator, namely AV 10 is in the pipeline and will be launched in Q4, this year. |
Ventilated patients are among the most vulnerable patients in the hospital facing an increased risk of infection, ventilator-induced injuries, and higher mortality rate after failed extubation. Years of research in ventilator designs and close co-operation with leading clinical researchers has shown the importance of improving the flow delivery and regulation to suit the unique needs of individual patients. The newer ventilation platforms can enhance interaction between the patient and the ventilator by offering unprecedented levels of speed in sensing and control as well as a range of ventilation modes and treatment features, which will help clinicians address the specific needs for a wide array of patient characteristics. Ventilators have evolved from small, pneumatically-powered, and pneumatically- controlled devices to marvels of microprocessor technology capable of closed-loop control. Mechanical ventilation with an endotracheal tube or via tracheostomy has become a major component of intensive care. However, unavoidable drawbacks related to the invasive character of this treatment have been observed. This has led to wide acceptance of non-invasive ventilation (NIV) as a long-term treatment for patients with hypercapnic respiratory failure. Interest in the use of this method appears to be growing for other types of respiratory failure as well.
Imported brands, at sales of Rs. 250 crore (2850 units) dominated the market with a 71.4 percent share. This includes high-end and mid-end ventilators, which find their way to large and medium-sized hospitals and nursing homes. Maquet Medical and GE Healthcare have a combined market share of 39 percent in this segment. Draeger Medical, Covidien, Trivitron Healthcare, Philips Healthcare, Viasys Healthcare, and Air Liquide each are in the vicinity of 10 percent market share. While Trivitron offers ventilators from Hamilton, Viasys Healthcare distributes its products through Trans Healthcare in southern India, Rohanika in northern India, and Life Care in western India.
The home care ventilators are emerging as a niche segment and almost 30 percent of these products are finding their place in hospitals. With sales of 4500 units, valued at Rs. 35 crore, this segment expects a major growth. Competitively priced in the range of Rs. 55,000 to Rs. 1 lakh, Resmed dominates this segment with 55 percent market share. Other brands available in this segment include GE, Philips, Nidek, Covidien, Cardinal, and Fisher & Paykel.
"The ventilators market in 2009 was good. In 2010, the ventilator business is likely to grow at least by 35-40 percent as many new projects are coming up. This has also been aided by the fact that ventilators were made mandatory by government-sponsored health schemes and insurance policies. Availability of refurbished ventilators at one-fourth the cost of a new ventilator is one of the major driving forces. In fact, the refurbished market is more than double the size of the new ones. Some manufacturers even offer refurbished ventilators to the customers officially."
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