2018 - MARKETiN CEE · Hitachi-Aloka - combining Hitachi and Aloka brands, ... Diagnostic Medical...

2018

MARKETING SURVEYS & ANALYSES

MEDICAL TECHNOLOGIES

Medical Imaging and Radiation Therapy Technology in Slovakia

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Market Brief

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MARKET BRIEF: Medical Imaging and Radiation Therapy Technology in Slovakia January 2018

This is a just sample containing only a few examples from a full 30-page report compiled by MARKETiN CEE s.r.o. in January 2018.

For more information, please call + 421 2 20200030, or e-mail to [email protected].

© 2018. MARKETiN CEE s.r.o., Lichnerova 41, 903 01 Senec, Slovak Republic.

Tel./Fax: +421 2 20 20 00 30. E-mail: [email protected]. Website: www.marketincee.com.





Contents


List of Tables and Figures


1. Executive Summary

Based on our research, our qualified estimate of the size of the researched technology market (including AngioRTGs, CTs, MRIs, USGs and LINACs) reached about € 20.5 million in 2016.

Especially thanks to the central tenders planned by the Ministry of Health, Linear Accelerators and MRI unit sales are expected to grow in a significant way. After some 11 CTs expected to be sold in 2017 thanks to the central tenders, we expect some more to be still sold in 2018 thanks to the good negotiated prices and the available EU funding. Afterwards, the demand for CTs will be temporarily almost withdrawn, and it is expected to slow down towards 2019. Ultrasound scanner segment is also expected to slow down in 2017, yet only moderately, and it will still continue reaching interesting values. Angiography unit sales are expected to continue in a relatively steady, pace of growth.

The researched medical technology systems of all the major global producers of such apparatuses are available and in use in the Slovak market, including especially:

Siemens Healthcare - direct representation of Siemens; the brand controls 1/5 of local market;

GE Healthcare – every 10th researched unit available in local healthcare facilities is of GE brand;

Esaote - with similarly strong position especially thanks to a large number of USG scanners sold;

Philips Healthcare - enjoying ca. 8% overall researched market share, strong in all segments;

Hitachi-Aloka - combining Hitachi and Aloka brands, belongs to Top 5 in the researched market;

Canon (formerly Toshiba) Medical Systems – an important player with ca. 5% market share.

As for agents and distributors, important suppliers of angiography technology include S&T Slovakia or INTES Poprad.

The winners of the first round of CT central procurement made by the Ministry of Health - INTES Poprad, Audioscan, S & T Slovakia, Siemens Healthcare and Meditrade – are the leading CT suppliers in the country.

Siemens Healthcare and S&T Slovakia (Philips distributor) are also the two most important players in the MRI segment.

Leading suppliers of ultrasound scanners include Wega-MS (distributor of Esaote), Unique Medical (distributor of Hitachi-Aloka) and INTES Poprad (distributor of GE Healthcare). And there is even a Slovak producer of Ultrasound Scanners: BTL Slovakia, s.r.o. (www.btl.sk).

Amedis, the distributor of Varian devices, is the leading supplier of linear accelerators.

Although the window of opportunity for selling CT units in bigger quantities is going close sown soon, there are still big opportunities ahead for other devices, especially MRIs and linear accelerators. The Ministry of Health records the interest of 9 hospitals for 12 magnetic resonance units and 3 hospitals are interested in 9 angiographs. The hospitals now even have a possibility to draw EU funds for their modernisation and building acute capacities. So this is a good time to come and participate in the tenders of the Ministry of Health. Actually, the time is high, as these central auctions will be organized probably very soon.

.

http://www.btl.sk/


2. Research Focus and Terminology

Focus of This Study

This study focuses only on the following selected Medical Imaging and Radiation Therapy Technology:

Diagnostic Medical Imaging Technology:

X-Ray based diagnostic apparatus:

Angiography units

CT scanners

Electro-diagnostic apparatus:

MRI units

Ultrasonic scanners

Radiation Therapy Technology:

X-Ray based radiotherapy apparatus:

Linear accelerators

Therminology and Abbreviations

Following are definitions of the selected Medical Imaging and Radiation Therapy Technology covered in this study:

Angiography units / Digital subtraction angiography (DSA) units

Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers. This is traditionally done by injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques such as fluoroscopy.

Digital Subtraction Angiography technique combines a dynamic picture (obtained after contrast injection) with a static picture taken before contrast injection. Subtraction of these pictures creates an accurate image of the cardiovascular system.

Computed tomography (CT) scanners

Computed Tomography scanner is an x-ray machine which combines many x-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body.

Excludes: Single Photon Emission Computed Tomography (SPECT).


Magnetic resonance imaging (MRI) units

Magnetic Resonance Imaging is an imaging technique designed to visualise internal structures of the body using magnetic and electromagnetic fields which induce a resonance effect of hydrogen atoms. The electromagnetic emission created by these atoms is registered and processed by a dedicated computer to produce the images of the body structures.

Ultrasound scanners

Medical ultrasound (also known as diagnostic sonography or ultrasonography - USG) is a diagnostic imaging technique based on the application of ultrasound. High frequency sound waves travel from the ultrasound probe through human tissue. Some of the sound waves bounce back to the transducer. This reflected sound is used by a computer to form the ultrasound image. Ultrasonic scanning apparatus is used to see internal body structures such as tendons, muscles, joints, blood vessels and internal organs. Its aim is often to find a source of a disease or to exclude any pathology.

Radiotherapy equipment

Radiation therapy equipment are machines used for treatment with x-rays or radionuclide. They include: linear accelerators, Cobalt-60 units, Caesium-137 therapy units, low to orthovoltage x-ray units, high dose and low dose rate brachytherapy units and conventional brachytherapy units.

Linear accelerator (LINAC) Linear accelerator is a device most commonly used for external beam radiation treatments for patients with cancer. It customizes high energy x-rays or electrons to conform to a tumour’s shape and destroy cancer cells while sparing surrounding normal tissue.

Other Methodological Notes

At the end of time series in some the tables herein, we use the Compound Annual Growth Rate (CAGR) indicator. It represents the year over year growth rate over a multiple-year period. CAGR is an imaginary, mathematical number describing the rate at which a sector grew as though it had grown at a steady rate.

End of sample text from the chapter


3. Market Situation and Trends

3.1 Medical facilities

In 2016, there were over 13,160 healthcare facilities of various type in Slovakia, including outpatient, inptient and pharmaceutical care as well as hematology, transfusion and other facilities. Out of these facilities, there were 133 hospitals, including 73 general hospitals, 42 special hospitals and 18 sanotoria. An overview of the past development of the number of hospitals and general hospitals is presented below.

Number of Hospitals in Slovakia (2011-2015)

Healthcare Facilities in Slovakia 2011 2012 2013 2014 2015

Hospitals Total number 140 137 136 134 134

Per million population 25.93 25.33 25.12 24.73 24.71

General hospitals Total number 76 74 74 73 73

Per million population 14.08 13.68 13.67 13.47 13.46

Sources: National Health Information Centre, OECD (December 2017)

Slovakia is home to 3 oncology institutes:

Národný onkologický ústav Bratislava

Onkologický ústav sv.Alžbety, s.r.o., Bratislava

Východoslovenský onkologický ústav, a.s., Košice

The total number of healthcare facilities in Slovakia, which in 2016 operated at least one department specialized in nuclear medicine is 15.

Nuclear Medicine – Number of Healthcare Facilities and Staff

Region of Healthcare Facility

Number of Healthcare Facilities

Number of Staff in Occupations *

Doctor Nurse Radiology Technician

Healthcare Technician

Laboratory Diagnostician

Slovak Republic 15 52.79 35.49 36.73 13.00 7.73

Bratislava Region

Western Slovakia 7 25.93 17.40 15.00 12.00 4.03

Central Slovakia 4 10.21 10.00 7.68 – 2.00

Eastern Slovakia 4 16.65 8.09 14.05 1.00 1.70

Source: National Healthcare Information Centre. * Note: Registered staff number, whether or not employed, grossed up to full-time.

The total number of healthcare facilities in Slovakia, which in 2016 operated at least one department specialized in clinical oncology, paediatric haematology and oncology, tumour chemotherapy is 99.


Clinical Oncology – Number of Healthcare Facilities and Staff


Number of Healthcare Facilities

Number of Staff in Occupations *

Doctor Nurse Healthcare Assistant

Slovak Republic 99 267.91 586.10 45.93

Bratislava Region 11 65.79 155.35 20.33

Western Slovakia 30 62.88 151.98 8.00

Central Slovakia 26 69.19 117.37 6.00

Eastern Slovakia 32 70.05 161.40 11.60


The total number of healthcare facilities in Slovakia, which in 2016 operated at least one department specialized in radiation oncology is 15.

Radiation Oncology – Number of Healthcare Facilities and Staff


Number of Healthcare Facilities Doctor Nurse

Radiology Technician

Slovak Republic 15 77.79 167.03 98.40

Bratislava Region

Western Slovakia

5 40.16 68.48 51.40

Central Slovakia 7 18.12 46.55 26.00

Eastern Slovakia 3 19.51 52.00 21.00


3.2 Patients and Examinations

The number and development of CT and MRI exams in Slovakia, according to OECD data, are demonstrated in the following table.

Number of Diagnostic Exams in Health Care Facilities in Slovakia (2011-2016)

2011 2012 2013 2014 2015

CT exams Total number 534 783 581 657 664 550 730 390 847 209

Per 1 000 population 99.1 107.6 122.8 134.8 156.2

MRI exams Total number 187 420 220 966 250 501 279 562 307 935

Per 1 000 population 34.7 40.9 46.3 51.6 56.8

Sources: OECD (2011 - 2017); National Health Information Centre (2016). Processed by MARKETiN CEE.

http://stats.oecd.org/OECDStat_Metadata/ShowMetadata.ashx?Dataset=HEALTH_PROC&Coords=%5bVAR%5d.%5bDGTSMREX%5d&ShowOnWeb=true&Lang=en


As obvious from the next Figure, Slovakia (yellow bar) has a fairly average number of MRI and CT exams when compare with the rest of 28 OECD countries.

FIGURE 1 Frequency of Diagnostic Exams in Slovakia and OECD Countries (2015)

Source: OECD Health Statistics 2017

However, according to European Commission’s 2017 Cancer Screening in the European Union report, Slovakia is not faring well in terms of cancer screening. The report shows that all the countries in the EU except Bulgaria, Croatia and Slovak Republic have national breast cancer screening policy mandated by a law or an official recommendation. And there is no population-based breast cancer screening programme in Bulgaria, Greece and Slovak Republic. Similar situation is with colorectal cancer screening. On the other hand, Slovakia is making progress in cervical cancer screening. Slovak Republic has initiated planning for population-based cervical cancer screening, even though only non-population based service is available in 2016.

According to the National Health Information Centre, clinical oncology departments registered 742 171 patient visits (2.7% of them consisted of children and adolescents of up to 19 years of age), up by 4.0% compared to the previous year. Tertiary preventive examinations reached 97,175 (+ 7.2% less as in 2015) and the number of oncology patients was 519,257 (11.7% more than in 2015). The most common treatment used was chemotherapy (89,597 patients), with a year-on-year increase of 2.7% and palliative-symptomatic treatment (27,920 patients). Hormonal treatment was administered to 13,435 patients (it was by 37% more than in 2015) and biological treatment to 8,959 patients.

Departments of radiation oncology recorded 195,627 patient visits, of which 0.1% were children and adolescents. Compared to the previous year, the number of visitors grew by 6.7%. The irradiation plans formed almost 50% for all examinations, while their share increased year-on-year by 4.8 percent. Simulator examinations formed 30.6% and CT scanning for radiation planning formed 19.6%. As regards the nature of treatment, mainly the external radiotherapy was applied, while 36,520 patients (25,273 non-tumour and 11,247 antitumor therapy) undertook that treatment. Brachytherapy was performed on 726 patients. From the anti-tumour therapies, external radiotherapy was most often performed with linear accelerators (90%) and from the non-tumour therapeutic visits, it was X-ray therapy (90% of visits).


Based on the diagnosis found in 2016, the most men undertook the radiation treatment of prostate cancer (951 patients), malignant bronchial and lung tumours (632 patients), and malignant rectal cancer (452 patients). These were followed by malignant laryngeal cancer (196) and skin malignancy (196). In the case of women, it was mainly breast cancer (2,570), malignant cervical cancer (392) and malignant tumour of the uterus (388). The bronchial bronchial and lung cancer was treated with irradiation in the case of 263 women and the rectal cancer in the case of 244 women.

Regardless of gender, the most common cancer sites are colorectal, breast, lung or prostate in Slovakia, as the following figure depicts.

FIGURE 2 Estimated Number of Incident Cases of Top 10 Cancer Sites in 2012

Source: Globocan 2012, World Health Organisation

According to the National Health Information Centre, there were 281,373 antitumor treatments and 712 non-tumour treatments conducted with linear accelerators in radiation oncology departments of healthcare facilities in Slovakia. And there were 292,066 pregnancy ultrasound exams conducted in Slovakia in 2016.



4. Market Size and Development

4.1 Market Size

The table below shows numbers of available medical equipment by the healthcare facilities in Slovakia. However, it is worth noting the methodological change in collecting data in 2014, which cause some jumps in numbers, e.g. the CTs. There are often mistakes in reporting.

Availability of Medical Equipment in Health Care Facilities in Slovakia (2011-2016)

Researched Medical Technology 2011 2012 2013 2014 2015 2016

Angiography units Total number 46 48 49 46 47 44

- in Hospital sector 45 48 49 46 46 n/a

- in Ambulatory sector 1 0 0 0 1 n/a

CT scanners Total number 81 84 83 94 97 92



MRI units Total number 38 34 36 45 48 48



Ultrasound scanners Total number n/a 1006 1052 1105 1166 1 266

- in Hospital sector n/a n/a n/a n/a n/a n/a

- in Ambulatory sector n/a n/a n/a n/a n/a n/a

Radiotherapy equipment Total number 61 66 66 64 67 62

(incl. Linear accelerators) - in Hospital sector 60 64 64 62 64 n/a


Linear Accelerators Total number n/a 16 18 18 20 19

- in Hospital sector n/a n/a n/a n/a n/a n/a

- in Ambulatory sector n/a n/a n/a n/a n/a n/a

Other Not-Researched Medical Technology 2011 2012 2013 2014 2015 2016

Gamma cameras Total number 33 34 31 27 27 27



Lithotriptors Total number 33 32 33 36 37 39



PET scanners Total number 5 5 6 7 8 8



Sources: National Health Information Centre, Eurostat, OECD. Processed by MARKETiN CEE. Note: The increase in the availability of medical equipment in ambulatory setting in year 2014 is caused by purchase of new equipment and the expansion of the number of reports from statistical units which have been sent to National Health Information Centre.

The researched technology market (including AngioRTGs, CTs, MRIs, USGs and LINACs) reached about € 20.5 million in 2016.


FIGURE 3 Researched Medical Technology Sales (2012 – 2016)

Sales Value (in € million) 2012 2013 2014 2015 2016 CAGR 12-16

Angiography units 2.2 2.4 2.0 3.1 1.4 -10.7%

CT units 5.6 5.4 3.0 5.6 3.7 -9.8%

MRI units 4.1 3.8 5.6 10.4 5.3 6.6%

Ultrasound scanners 4.7 4.8 7.2 8.3 9.7 19.9%

Linear Accelerators 4.0 1.3 1.6 4.6 0.5 -40.5%

Source: MARKETiN CEE estimates.

While ultrasound scanners have seen a healthy compound annual grow rate of almost 20% and MRI units of more than 6% between 2012 and 2016, other segments were declining. Especially linear accelerators have recorded a drop in demand last year, after the spike in 2015. However the demand is expected to pick up significantly again as these devises, together with MRI units, are becoming obsolete and the Ministry of Health plans to procure them centrally in 2018.

The decline in most segments in 2016 was just temporary as many health care centres postponed their purchases waiting for the Ministry of Health to centrally procure for them the devices for better prices through the central online auction. And especially CT units are expected to see a record growth in 2017, since by September 8 CTs had been already sold to healthcare centres across Slovakia.


4.2 Foreign Trade Development

As regards foreign trade, CT unit imports were relatively stable, with the exception of years 2014 and 2016, partly caused by the scandals with overpriced devices sold to public hospitals and subsequent decision of the government to start procuring medical devices centrally again. Some old or dysfunctional CTs and accessories were sold by healthcare centres and exported out of the country.

Imports of other X-ray-based units, including i.a. linear accelerators, have been steadily increasing. MRI unit imports had a record year in 2015, and the next year they returned approximately to the level of 2014. Ultrasound scanners imports have been constantly growing in very interesting rates.

FIGURE 4 Medical Technology - Foreign Trade Development (2012 – 2016)

2012 2013 2014 2015 2016

CT units Import 5 569 530 5 444 041 3 016 370 5 644 956 3 689 357

Export 474 000 2 475 500 1 423 226 1 758 350 3 161 455

Balance 5 095 530 2 968 541 1 593 144 3 886 606 527 902

Other X-ray-based units* Import 3 658 576 3 636 187 4 604 984 5 968 484 7 615 827

Export 1 900 857 029 2 462 000 2 305 719 411 028

Balance 3 656 676 2 779 158 2 142 984 3 662 765 7 204 799

MRI units Import 4 124 320 3 837 358 5 647 744 10 424 269 5 318 995


Export 114 064 0 222 595 930 714 781 410

Balance 4 010 256 3 837 358 5 425 149 9 493 555 4 537 585

Ultrasound scanners Import 5 500 628 5 736 675 7 498 444 8 443 801 10 219 493

Export 7 083 524 6 132 340 3 307 229 3 143 483 5 993 550

Balance -1 582 896 -395 665 4 191 215 5 300 318 4 225 943

Source: Eurostat. * Note: Includes apparatus based on the use of X-rays, whether or not for medical, surgical, dental or veterinary uses, including radiography or radiotherapy apparatus.

CT units were mostly imported from Germany, Hungary and the Czech Republic in 2016. Other X-ray-based units, including LINACs, were sourced mainly from Germany, the Czech Republic and Switzerland.

MRI Units come predominately from Netherlands, Germany and Italy. There is some relatively small production of ultrasound scanners in Slovakia, but most of the devices sold in the country were imported from other EU. countries, such as the Netherlands, Germany or Italy.


4.3 Forecast to 2019

Based on the expected positive economic outlook for the country, declared determination of the Minister of Health to help public healthcare facilities with modernisation efforts while keeping at bay their costs as well as with fighting corruption within his tenure, and also based on the actual steps and future plans of the Ministry of Health to gradually centrally procure medical devices for healthcare facilities, we have devised the following forecast for the sales of researched medical devices.

FIGURE 5 Researched Medical Technology Sales Forecast (2017 – 2019)

Sales Value (in € million) 2017 2018 2019 CAGR 17-19

Angiography units 2.8 4.2 3.2 6.9 %

CT units 10.2 14.8 3.4 -42.3 %

MRI units 3.2 10.8 7.2 50.0 %

Ultrasound scanners 10.2 7.4 4.0 -37.4 %

Linear Accelerators 1.6 13.2 6.6 103.1 %

Source: MARKETiN CEE estimates.

Especially thanks to the central tenders planned by the Ministry of Health, Linear Accelerators and MRI unit sales are expected to grow in a significant way. After some 11 CTs expected to be sold in 2017 thanks to the central tenders, we expect some more to be still sold in 2018 thanks to the good negotiated prices and the available EU funding. Afterwards, the demand for CTs will be temporarily almost withdrawn, and it is expected to slow down towards 2019. Ultrasound scanner segment is also expected to slow down in 2017, yet only moderately, and it will still continue reaching interesting values. Angiography unit sales are expected to continue in a relatively steady, pace of growth.


5. Competitive Situation

5.1 Major Brands and Their Market Share

Overall Market Shares

The researched medical technology systems (Angio RTG, CT, MRI, RTG and LINAC) of all the major global producers of such apparatuses are available and in use in the Slovak market, including:

Siemens Healthcare - controlling about one fifth of the local market;

GE Healthcare – every 10th researched unit available in local healthcare facilities is of GE brand;

Esaote - with similarly strong position especially thanks to a large number of USG scanners sold;

Philips Healthcare - enjoying ca. 8% overall researched market share, strong in all segments;

Hitachi-Aloka - combining Hitachi and Aloka brands, belongs to Top 5 in the researched market;

Canon (formerly Toshiba) Medical Systems – an important player with ca. 5% market share.

The Figure below is only illustrative, and aimed to roughly illustrate the position of the major brands (further demonstrated on the next Figures) on the Slovak market consisting only of the researched product category segments, such as Angiography, Computer Tomography, Magnetic Resonance, Ultrasound and Linear Accelerator/Radiotherapy.

FIGURE 6 Researched Medical Devices – Brand Shares in Installed Base in Slovakia (2016)

Source: Processed by MARKETiN CEE. Note: Market shares of producer’s brands on the researched local medical device market are estimated on the basis of position (% share) of the brands on the total numbers of units installed in healthcare facilities in Slovakia by the end 2016 in each of the five researched product market segments - Angio RTG, CT, MRI, RTG and LINAC.

Siemens; 19%

GE; 10%

Esaote; 9%

Philips; 8%

Hitachi-Aloka; 7%Canon/Toshiba; 5%

other; 31%

unspecified; 11% Siemens

GE

Esaote

Philips

Hitachi-Aloka

Canon/Toshiba

other

unspecified

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End of sample text from the full 30-page report.

Mr. Pavol Kopec (PhD.) CEO & Senior Consultant MARKETiN CEE s.r.o. Lichnerova 41 903 01 Senec Slovak Republic Telephone: +421 2 20 20 00 30 E-mail: [email protected]

DISCLAIMER: Whilst every possible care has been taken in the preparation of this document, we do not hold ourselves responsible for any expressions of opinion or error or omission, or any action resulting therefrom. All statements in this press release are based on information available to us as of the date hereof, and we assume no obligation to update these statements. No part of this publication may be reproduced without written permission.



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2018 - MARKETiN CEE · Hitachi-Aloka - combining Hitachi and Aloka brands, ... Diagnostic Medical...

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