THANK YOU SINCERELY Joshua Prager and Ali Rezai Ben Pless and
Salim Hayek Tom Tefft, Michael Demane Mona Patel, Brad Maruca
Slide 3
GOALS and RULES Lets bring industry and stake holders an event
to provide a platform to discuss the relevant issues for the
INVIGORATION of the field of Neuromodulation. (BE POSITIVE) Each
moderators should set the stage for the need, showcase some
emerging technologies, and the panel will THOUGHTFULLY discuss
opportunities, challenges.
Slide 4
GOALS Technology Spinal Cord Stimulation Regulatory and
Economics Study Designs Peripheral Nerve Stimulation Intrathecal
therapy Wrap-up
Slide 5
TRANSFORMATIVE technology - changes the practice of medicine?
NeuroNavigation Endovascular Surgery Minimally invasive Spinal
Neurosurgery Bone Morphogenic Protein Endscopic Neursorgery
Hemostatic Agents Deep Brain Stimulation/ NEUROMODULATION 20
Slide 6
NEUROMODULATION Market revenue source: Dodds, Matthew. Citi
Research, A Division of Citigroup Global Markets, Inc.
Neuromodulation Market Model, September 17, 2012 2011 Market
Revenue 2011 Market Units ($ millions)(estimate) Spinal Cord
Stimulation (SCS)$1,28660,643 Deep Brain Stimulation
(DBS)$39324,104 Sacral Neuromodulation (SNM)$38641,233 Vagal Nerve
Stimulation (VNS)$2118,612 Targeted Drug Delivery$34029,565
(Intrathecal Pain & Spasticity) Global Neuromodulation
Market$2,616164,158 15 1997
Slide 7
Approved VNS for Epilepsy, Depression DBS for PD, ET, OCD,
Dystonia SCS for limb and body pain IT for pain, spasticity PNS for
Urge incontinence 10
Slide 8
5
Slide 9
DBS for Depression, Epilepsy SCS for CHF RNS for Epilepsy PNS
for Headache, asthma, GI TECHNOLOGY PENETRATION Horizon +5
NEUROMODULATION REMAINS QUITE EXCITING ROBUST
Slide 10
OP Ed Remember that we are treating patients who have the worst
of the worst problem
Slide 11
Slide 12
The Creative Destruction of Medicine 7 billion people >3
million doctors >10,000 hospitals >6000 prescription drugs
>4000 procedures & operations Supplements, herbs,
alternative treatments
Slide 13
? In the Future SPINAL CARE IS FRAGMENTED Motrin/ Medications
Physical Therapy Accupuncture Chiropractor Epidural Steroid
Injection Spinal Surgeries Neurostimulation Who gets what where
when why? Define Patient Needs (DISEASE MANAGEMENT) Practice
Guidelines Define Success Define Technology GAPS Advance
Understanding of the disease
Slide 14
? In the Future SPINAL CARE IS FRAGMENTED Motrin/ Medications
Physical Therapy Accupuncture Neurostimulation Chiropractor
Epidural Steroid Injection Spinal Surgeries Who gets what where
when why? Define Patient Needs (DISEASE MANAGEMENT) Practice
Guidelines Define Success Define Technology GAPS Advance
Understanding of the disease
Slide 15
Choosing the Right Patient
Slide 16
In the Future Who gets what where when why? (Practice
Guidelines) Define Patient Needs (DISEASE MANAGEMENT) Define
Success Define Technology GAPS Advance Understanding of the disease
I dont want no WIRE in my back!
Slide 17
Equipment Familiarity Device Complications Minimal Invasiveness
Ease of use - programming How do we make people good and WANT to
FEEL BIONIC? Navigation MRI Guidance INTRA OP MER? SPINAL
Flouroscopy/ XRT? Wires running around the body Ease of Programming
Device Comfort Healing
Slide 18
In the Future Who gets what where when why? (Practice
Guidelines) Define Patient Needs (DISEASE MANAGEMENT) Define
Success Define Technology GAPS Advance Understanding of the
disease
Slide 19
Practice of Medicine is Evolving Neurosurgery (General)
Vascular Tumor Functional Epilepsy Spine Pediatric Neurology,
hematology Medical and Radiation onc Movement Disorder Neurology
Epilepsy neurology, Neuropsych Pain, PM&R Pediatrics Maybe an
Opportunity in the field of Internventional Headache and Epilepsy
Management
Slide 20
Defining Role of Device Development CONVERGENCE CARDIAC
Manufacturing IPG Lead design and material (2-16/20) Sensing
(rhythm, closed loop, posture, LFP) Home/ Remote monitoring
Diagnostics Health care IT systems Objectification of patient
symptoms
Slide 21
In the Future Who gets what where when why? (Practice
Guidelines) Define Patient Needs (DISEASE MANAGEMENT) Define
Success Define Technology GAPS Advance Understanding of the disease
HEADACHE LIFE TRANSFORMING How do we get the Patients involved to
let their voices get heard? Medicine is a science of uncertainty
and an art of probability.
Slide 22
Studies - DESIGN Effectiveness - The extent to which a
treatment achieves its intended purpose Efficacy - The extent to
which a specific intervention, procedure, regimen, or service
produces a beneficial result under ideal conditions
Slide 23
In the Future Who gets what where when why? (Practice
Guidelines) Define Patient Needs (DISEASE MANAGEMENT) Define
Success Define Technology GAPS Advance Understanding of the
disease
In the Future Who gets what where when why? (Practice
Guidelines) Define Patient Needs (DISEASE MANAGEMENT) Define
Success Define Technology GAPS Advance Understanding of the
disease
Slide 26
TRIALS Occipital Stimulation for Headaches Deep Brain
Stimulation for Depression Cortical Stimulation for Stroke DBS and
RNS for Epilepsy VNS for Obesity What have we learned about the
disease and science? - Brian Kopell
Slide 27
Disruptive Forces EASY TO USE, EASY TO CONSUME
Slide 28
Pharmaceutical Challenges R&D1995 - $15billion 2010 -
$85billion Approved drugs 1996 56 2010 21 100,000 sales reps for
700,000 physicians 250,000 defibrillators implanted on the
rise
Slide 29
Pharmaceutical Challenges Dendreon vaccine for Prostrate revs
up immune system, costs $93,000, four month survival advantage
Rheumatoid Arthritis - $14 billion, remicade, Enbrel, humira half
effective 10% actually active and beneficial How many drugs are
wasted?
Slide 30
Costs of medications Avinza 90mg Qday $338/month ($4056)
Percocet 5/325 Qid $465/month ($5580) Oxycontin 40mg Bid $421/month
($5052) Neurontin 600mg Tid $375/month ($4500) A typical regimen
for chronic pain might include a sustained release drug, Oxycontin,
a breakthrough drug, Percocet and a Neuromodulator, Neurontin which
cost over $1000/month Budd K. Spinal Cord Stimulation: Cost-
Benefit Study.Neuromodulation 2002;5:75-78 Cost neutrality is
reached within 5 years following SCS implant
Slide 31
OUR ADVANTAGES Compliance Gains in the Costs of unused
medications Low risk, low rewards (medications) Higher risk, higher
rewards (intervention) Take it for the rest of my life (medicine)
When does it work, how well does it work (medicine) Opiod Abuse SCS
Study Defining role for intervention for spine surgeries
Slide 32
OPPORTUNITY NANS Foundation SOCIETY TO TAKE UPON A
TRANSFORMATIVE APPROACH REGISTRIES GUIDELINES POSITION STATEMENT
DEFINE THE TECHNOLOGICAL GAPS
Slide 33
OPPORTUNITY Care more particularly for the individual patient
than the special features of the disease. - Sir William Osler 1899
COLLABORATION PATIENTS PHYSICIANS SOCIETY INDUSTRY REGULATORY
Slide 34
Conclusion White Papers & Neuromodoulation Consider a
Neuromodulation community forum Survey the membership to define the
gaps Email ideas, collaboration, new thoughts
[email protected]