A healthy investment – the UK surgical appliances market

Advances in anatomical access and visualisation technology will drive significant growth in the surgery market in the next few years. This expansion is expected across a wide range of areas, from bariatric surgery to hernia repair and will focus on less invasive tools, improved patient outcomes and reduced average selling prices. Additionally, rapidly growing obesity indications, combined with more readily available healthcare, are expected to increase the worldwide volume of surgical procedures. While they are still developing, these immature markets will grow significantly compared with other segments, especially in the UK, where adoption of new appliances continues to rise, despite an adverse economic situation.

Many devices are being used for an expanded number of indications as system advances boost capabilities, which has resulted in ever shifting sales dynamics in the UK. For example, their comparative ease of use has seen previously limited surgical generators being increasingly chosen over argon plasma coagulators and ultrasonic generators. Their advantage of non-contact coagulation of bleeding tissues - which eliminates smoke, smell and impaired visibility - makes advanced surgical generators preferable to radiofrequency electrosurgical devices, electrocautery devices and ultrasonic generators. As a result, the surgical generator market is expected to grow by more than 6% during 2020.

British mesh pioneers

The UK hernia repair market is also expected to expand notably compared with that of nearby EU countries. Valued at £19 million ($33 million) in 2012 and expected to surpass £30 million ($50 million) by 2020, this field has experienced immense growth as a result of the increased adoption of laparoscopic treatments. The UK is unique in Europe in that its surgeons now use composite meshes for nearly all types of laparoscopic hernia procedures, whether incisional or inguinal. Hernia repair device growth, therefore, is dependent on laparoscopic procedure adoption. Growth in this sector is only expected to increase as reimbursement for composite meshes improves, despite the lack of adequate clinical trial data, its added costs and the steep learning curve that is required for a high rate of operative success. Additional clinical investigations must be conducted in order to validate further this technique's clinical and economic benefits in the treatment of hernias in the UK.

The biopsy devices market in the UK is expected to grow from £8 million ($14 million) in 2013 to over £12 million ($20 million) in 2020, driven by advanced biopsy procedures, especially those related to breast cancer. This market has benefitted from its suitability for diagnosing a variety of cancer indications. While the biopsy devices sector has matured quite significantly and offers opportunities for further growth, substantial barriers must still be overcome. Improvements to the reimbursement rates for image-guided breast biopsy procedures will affect both the average selling prices of these devices and the adoption levels of alternative tissue-extraction devices and procedures. The fastest-growing segment within the biopsy devices market will be vacuum-assisted devices, with a compound annual growth rate (CAGR) of 22% until 2020. The over-use (and subsequent contribution to over-diagnosis) of biopsy devices in the diagnosis of prostate, breast and thyroid cancers, however, has been criticised. A combination of progress in imaging technology with developed best practices has produced a diagnostic landscape in which most biopsies do not reveal cancerous tissue. In the instance of prostate cancer, around a quarter of biopsies performed reveal a positive cancer diagnosis. For breast cancer, that figure is only 13% and for thyroid cancer it is just 5%. The situation is very different for liver and lung cancer, though. The diagnostic regimen and biopsy tools used here return a higher percentage of positive diagnoses. For lung cancer, approximately 90% of biopsies performed reveal a positive cancer diagnosis. For liver cancer, this figure is approximately 51%. Despite these evolving market dynamics, biopsy devices are expected to be used more in future.

Challenging perceptions

Bariatric surgery devices have also undergone notable adoption in the UK in recent years. In 2013, approximately 25% of obese patients in the UK underwent weight-loss treatment and this figure is expected to increase at a CAGR of 2% through 2020. Of these just 0.35% had bariatric surgery, a percentage that has been slowly increasing due to improved clinical outcomes, but is still extremely small. Of the small percentage of obese patients undergoing surgery, roughly 57% are receiving a gastric bypass, one in five are undergoing sleeve gastrectomy and a tenth are having gastric banding. Of those not opting for bariatric surgery, similar volumes of patients are turning to endoscopic device implantation in the form of gastric stents, balloons and shuttle devices. These devices offer a relatively non-invasive, safe means of weight management and show significant promise for future development and use. Despite improvements in patient outcomes with bariatric surgery and device implantation, the vast majority of obese patients do not undergo surgical intervention, due to their lack of interest in the various procedures and a perceived lack of reimbursement. Patients sharing positive experiences, an increasing number of suitable candidates, improved patient outcomes, stronger reimbursement and a growing number of trained bariatric surgeons, however, should help to change this perception, leading to increased use and revenue generation.

With a rising number of diagnostic and surgical procedures requiring the use of endoscopes, the market for such instruments in the UK has also grown significantly. Better visualisation techniques and imaging tools have enabled improved clinical outcomes using endoscopes and the development of smaller, more advanced systems has increased their utility. The market for these procedures is expected to increase as their successful use highlights the benefits of next-generation systems and more people realise the value of bariatric surgery, endoscopic device implantation and other related interventions.

Non-vascular stents are also becoming increasingly popular in the UK, especially for oesophageal cancer. Their effectiveness has made them the preferred palliative treatment for this type of disease where tumours are inoperable and liable to cause severe dysphagia. Surgical removal of polyps for the treatment of gastric cancer has also driven the sales growth of non-vascular stents, in addition to their use in the treatment of pancreatic and colorectal cancer.

In terms of specific devices, the use of non-covered gastrointestinal stents is declining due to the growing preference for fully and partially covered gastrointestinal ones. British surgeons, alongside those in other developed countries, are expected to rely increasingly upon these types of mesh tubes.

The less invasive, the better

More women are choosing sterilisation as an effective means of birth control that does not involve the use of hormones or require any periodic or post-coital contraceptive effort.

The percentage of females undergoing mechanical sterilisation is expected to decrease, however, as the adoption of transcervical sterilisation increases in line with high patient satisfaction and low adverse event rates.

The market for gynaecological devices in the UK is expected to mirror those of other EU countries, which share its preference for minimally invasive procedures. The market for surgical devices in the UK has been slow to grow significantly, but is gaining speed as reimbursement improves, average selling prices drop and patient outcomes improve. It is expected to grow faster than the surgical devices market in Italy or Spain, which makes the UK an attractive place for manufacturers to promote and sell their wares.

With many next-generation medical tools either out now or expected to launch soon, sales dynamics will continue to evolve in the UK in the coming years.