The Geography of European Arrhythmology.

The Geography of European The Geography of European Arrhythmology.Arrhythmology.

PanosPanos E. E. VardasVardas MD, PhDMD, PhDHeraklionHeraklion, Greece, Greece

EUROPEAN ARRHYTHMOLOGY EUROPEAN ARRHYTHMOLOGY

MAIN ISSUESMAIN ISSUES

Training in Pacing and Training in Pacing and ElectrophysiologyElectrophysiologyFacilitiesFacilitiesUsageUsageEconomicsEconomics

EUROPEEUROPETRAINING IN PACING & ELECTROPHYSIOLOGYTRAINING IN PACING & ELECTROPHYSIOLOGY

Training in Pacing and Electrophysiology is:Training in Pacing and Electrophysiology is:

Compulsory in Compulsory in 99 countriescountriesNonNon--compulsory in compulsory in 2727 countriescountries

Average training durationAverage training duration is is 14 months14 monthsTraining durationTraining duration ranges from ranges from 3 to 24 months3 to 24 months

National SubNational Sub--specialty Examsspecialty Exams66 countries have registered examscountries have registered exams3131 countries have none yetcountries have none yet

EUROPEEUROPETRAINING IN PACING & ELECTROPHYSIOLOGYTRAINING IN PACING & ELECTROPHYSIOLOGY

OBSERVATIONSOBSERVATIONS

Exceptional variation exists concerning the Exceptional variation exists concerning the level of expertise between the experts who level of expertise between the experts who practice electrophysiology in Europe.practice electrophysiology in Europe.

The ministries of health and the regulatory The ministries of health and the regulatory bodies show a minimum of interest in proof bodies show a minimum of interest in proof of proper training.of proper training.

Simulation is still in its infancy. The Simulation is still in its infancy. The learning curve is based on mentoring or on learning curve is based on mentoring or on the opinion “dare and proceed”the opinion “dare and proceed”

European Pacing European Pacing CentresCentresper million populationper million population

0.69Russia

2.72Denmark

The lowest2.59Slovakia

3.17UK

4.50Spain

The median6.40Netherlands

6.50Greece

6.60Italy

8.35Switzerland

9.9France

11.9Germany

The highest12.10Belgium

European Pacing European Pacing CentresCentresQuestionsQuestions

Hyper or under usageHyper or under usage

Is there an unusually increased Is there an unusually increased number of pacing number of pacing centrescentres or are there or are there countries which have a lack of countries which have a lack of facilities?facilities?

Could the Industry contribute to the Could the Industry contribute to the development of new facilities? development of new facilities?

Europe Europe Facilities in pacing and electrophysiology Facilities in pacing and electrophysiology

ProposalsProposals

A common European approach A common European approach –– Guidelines Guidelines -- is is necessary for the creation and function of necessary for the creation and function of electrophysiology and pacing electrophysiology and pacing centrescentresIt is obvious that a hierarchy is necessary for the It is obvious that a hierarchy is necessary for the possibilities and the license of each centre. The possibilities and the license of each centre. The same applies for the investment in these.same applies for the investment in these.Centre distribution per country could be Centre distribution per country could be organisedorganisedby the national scientific bodies, since a certain logic by the national scientific bodies, since a certain logic needs to be followed.needs to be followed.

839Sweden

853Czech Republic

957France

974Italy

1045Germany

1086Belgium

Implanted PacemakersImplanted Pacemakers

European Countries with the highest rates

of implanted pacemakers

per million population, in 2005

434Lithuania

391Croatia

382Slovenia

379Slovakia

285Latvia

121Russia

Implanted PacemakersImplanted Pacemakers

European Countries with the lowest rates

of implanted pacemakers

per million population, in 2005

14.517.116.4Geriatric population (60 yrs and over)

9.21014.8Health expenditure% of GDP

862701.547Total Healthcare Spending (in billion US $)

73732287Total Population(in millions)

0.9 %0.9 %3.2 %2.4 %GDP Real Growth

9.32371710.446GDP (in billion US $)

EuropeCanadaUnited States

Market Management

Macroeconomic Analysis*Macroeconomic Analysis*

* based on 2004 statistics* based on 2004 statistics

EuropeEuropeGDP / Health expenditure %GDP / Health expenditure %

6.76.77.17.1IrelandIreland

9.49.410.510.5FranceFrance

7.07.08.38.3UKUK

7.47.48.18.1SpainSpain

5.65.66.56.5PolandPoland

9.29.28.18.1NetherlandsNetherlands

8.48.47.17.1ItalyItaly

10.910.910.310.3GermanyGermany

10.210.28.48.4GreeceGreece

11.611.69.79.7SwitzerlandSwitzerland

2004200419951995CountriesCountries

Pacemaker PricesPacemaker Prices

35001800UK

20501050Turkey

52003600Switzerland

30002000Sweden

37001800Spain

2300700Russia

29001800Norway

25001200Lebanon

1350700Israel

37002000Greece

3500*1800*Germany

34001650France

DDDVVICountry

These prices include neitherVAT, nor lead

cost.

*Prices are average.

In certain countries final prices differ

significantly following negotiation.

Europe Revenue Forecasts 2002Europe Revenue Forecasts 2002--20082008

Revenue ForecastsRevenue ForecastsWorld Cardiac Rhythm Management MarketWorld Cardiac Rhythm Management Market

23.5 %23.5 %AsiaAsia19.3 %19.3 %USAUSA15.9 %15.9 %EuropeEurope

Cumulative Average Growth RateCumulative Average Growth Rate(2002 (2002 –– 2008)2008)

Market shareMarket share

Product ForecastProduct Forecast

Forecast analysis Europe Forecast analysis Europe Cardiac Rhythm management Market (World), 2004Cardiac Rhythm management Market (World), 2004

The European CRM Market generated an estimated The European CRM Market generated an estimated $1479.2 million in 2003.$1479.2 million in 2003.

The market is expected to grow at a CAGR of 15.9 % The market is expected to grow at a CAGR of 15.9 % through 2008.through 2008.

It is expected to reach $3100.1 million in 2008.It is expected to reach $3100.1 million in 2008.

Cardiac resynchronization therapy and MADIT II are Cardiac resynchronization therapy and MADIT II are driving ICD growth in Europe. driving ICD growth in Europe.

Pacemaker MarketPacemaker Market-- Europe 2002Europe 2002--20082008Cardiac Rhythm Management Market (World), 2004Cardiac Rhythm Management Market (World), 2004

3.5%3.5%CAGR 2003CAGR 2003-- 2008 2008

3.2%3.2%1,123.51,123.520082008

3.9%3.9%1,088.41,088.420072007

3.8%3.8%1,047.91,047.920062006

3.1%3.1%1,009.31,009.320052005

3.6%3.6%979.2979.220042004

8.0 %8.0 %945.4945.420032003

875.7875.720022002

GrowthGrowthRevenue Revenue (($ million)$ million)

YearYear

Pacemakers Pacemakers –– Revenue ($ million) Revenue ($ million) EuropeEurope

0

200

400

600

800

1000

1200

CRT -P 14,6 16,7 22,8 27,7 31,4 39,9 43,5

Pacemakers 861 928,7 956,4 981,7 1016 1048,5 1080

2002 2003 2004 2005 2006 2007 2008

ICD MarketICD Market-- Europe 2002Europe 2002--20082008Cardiac Rhythm Management (World), 2004Cardiac Rhythm Management (World), 2004

29.9%29.9%CAGR 2003CAGR 2003-- 20082008

20.0%20.0%1,976.61,976.620082008

22.2%22.2%1,647.21,647.220072007

26.7%26.7%1,347.51,347.520062006

42.7%42.7%1,063.31,063.320052005

39.6%39.6%745.0745.020042004

102.8%102.8%533.9533.920032003

263.2263.220022002

GrowthGrowthRevenue Revenue $ million$ million

YearYear

ICD ICD –– Revenue ($ million) EuropeRevenue ($ million) Europe

0

200

400

600

800

1000

1200

1400

1600

1800

2000

CRT-D 51,1 145,7 240,5 386,5 521,7 652,2 782,6

ICD 21,1 388,1 504,6 676,8 825,7 995 1194

2002 2003 2004 2005 2006 2007 2008

Pacemaker and ICD Market Trends and Pacemaker and ICD Market Trends and Forecast Analysis EuropeForecast Analysis Europe

The European pacemaker market generated an The European pacemaker market generated an estimate $945.4 million in 2003 and is expected to estimate $945.4 million in 2003 and is expected to reach $1123.5 million in 2008.reach $1123.5 million in 2008.

The market is expected to grow at a CAGR of 3.5 % The market is expected to grow at a CAGR of 3.5 % through 2008.through 2008.

The European ICD market is expected to reach $ The European ICD market is expected to reach $ 1976.6 million in 2008.1976.6 million in 2008.

The total ICD market in Europe is rapidly developing The total ICD market in Europe is rapidly developing and is expected to grow at aand is expected to grow at a

CAGR of 29.9 % through 2008.CAGR of 29.9 % through 2008.

ConclusionsConclusions

European arrhythmology is characterized by European arrhythmology is characterized by significant heterogeneity and is in need of significant heterogeneity and is in need of orchestration.orchestration.

It is required of EHRA to play a vital role not only in It is required of EHRA to play a vital role not only in creating scientific initiatives, but also to support creating scientific initiatives, but also to support national scientific bodies in the field.national scientific bodies in the field.

Industry will continue to enjoy satisfactory revenue Industry will continue to enjoy satisfactory revenue as the use of ICD/CRT devices increases accordingly.as the use of ICD/CRT devices increases accordingly.

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