ChangeWave Research: Taxus Stent & Avastin
ChangeWave Research Report:
New Medical Products: Cardiac Care & Cancer
Taxus Stent and Avastin – Success Based on Insurance Reimbursement
Overview
Past ChangeWave Alliance surveys show market acceptance for new medical products can often be hampered by insurance reimbursement rates and the lack of real world track records.
In a March 4-15, 2004 Alliance healthcare survey, we explored market acceptance and insurance reimbursement issues for two new medical products – Boston Scientific’s Taxus stent and Genentech’s cancer drug Avastin. A total of 96 healthcare members, knowledgeable about stents and/or cancer treatments, participated in the survey. Here’s what we found:
A. Cardiac Care: Taxus Stent vs. Cypher Stent
· Drug-Eluting Stents: Still Encountering Resistance. Although drug-eluting stents have now been on the market for some time, they have yet to gain full market acceptance. When asked why there is still some market resistance, 44% of respondents said that payor reluctance to reimburse is the major reason bare-metal stents are still being used. Another 32% said physicians are waiting for more real world data on the efficacy of drug-eluting stents.
· Taxus vs. Cypher – Taxus Favored. The recent approval of the Taxus stent is likely to threaten the primacy of Johnson & Johnson’s Cypher stent in the drug-eluding marketplace. A total of 1-in-5 respondents (20%) believe the two stents are equal in reducing restenosis rates. The Taxus Stent, however, is favored by 23% of respondents who view it as superior to the Cypher Stent in reducing restenosis rates, while only 2% believe it is inferior.
· Restenosis Rates Determine Stent Selection. Two-in-three respondents (67%) believe that “Data on Restenosis Rates” is the primary driver when choosing between the Cypher and Taxus Stent. Another 25% believe it’s “Guidelines from Payors,” while 21% say it’s the “Relationship with Vendor/Vendor Sales Force.”
· Marketing War Will Define Battle Between Taxus and Cypher Stents. Nearly a third (32%) of respondents believe the success of the Taxus Stent depends on the outcome of a head-to-head marketing war between Johnson & Johnson and Boston Scientific. Another 26% believe the Taxus stent will be gradually accepted over time as more real world data becomes available.
B. Cancer Treatments: Avastin and Off-Label Use
· Avastin: Is it Likely to be Prescribed Off-Label? Currently Avastin, combined with chemotherapy, has been approved with a narrow label for the treatment of Metastatic Colorectal Cancer. Respondents are fairly evenly split on whether it is likely to be prescribed off-label. Twenty-nine percent (29%) believe the drug will be prescribed off-label, while 23% think off-label use will only happen if it’s reimbursable. Another 11% believe it will be prescribed off-label, but patients or medical institutions will have to pay for the treatment.
· Reimbursement for Labeled Treatment Only. Respondents were bearish on the possibility of Avastin being reimbursed for off-label treatment. While 46% believe Avastin will be reimbursed by insurance companies for labeled use, only 5% believe insurance companies will reimburse for off-label use. Another 24% of respondents think insurance companies will wait at least 1 year before reimbursing for the new drug. Doctors (61%) were most likely to believe Avastin will be reimbursed for labeled use, but no doctors believed Avastin will be reimbursed for off-label treatment.
Bottom Line: In our March 2003 Stents survey, we reported that drug-eluting stents would “gain market share slower than many analyst forecasts.” The current survey results point to the issue of insurance company reluctance to reimburse for drug-eluding stents as a main roadblock to acceptance.
In addition, the newly approved Taxus Stent appears to have an edge over Johnson & Johnson’s Cypher Stent – but the overall success of the Taxus Stent will likely depend on the outcome of a head-to-head marketing war between Johnson & Johnson and Boston Scientific.
The survey results also suggest the cancer treatment drug Avastin is likely to be prescribed for off-label use. However, insurance company reimbursement will likely be limited to labeled treatment only.
The ChangeWave Alliance is a group of 4,500 highly qualified business, technology, and medical professionals in leading companies of select industries—credentialed professionals who spend their everyday lives working on the frontline of technological change. ChangeWave surveys its Alliance members on a range of business and investment research and intelligence topics, collects feedback from them electronically, and converts the information into proprietary quantitative and qualitative reports.
Helping You Profit From A Rapidly Changing World ™
www.ChangeWaveResearch.com
Table of Contents
Summary of Key Findings 4
The Findings 5
A. Cardiac Care: Taxus Stent vs. Cypher Stent 5
B. Cancer Treatments: Avastin and Off-Label Use 12
ChangeWave Research Methodology 18
About ChangeWave Research 19
I. Summary of Key Findings
Introduction
Past ChangeWave Alliance surveys show market acceptance for new medical products can often be hampered by insurance reimbursement rates and the lack of real world track records.
In a March 4-15, 2004 Alliance healthcare survey, we explored market acceptance and insurance reimbursement issues for two new medical products – Boston Scientific’s Taxus stent and Genentech’s cancer drug Avastin. A total of 96 healthcare members, knowledgeable about stents and/or cancer treatments, participated in the survey. Here’s what we found:
A. Cardiac Care: Taxus Stent vs. Cypher Stent
B. Cancer Treatments: Avastin and Off-Label Use
II. The Findings
A. Cardiac Care: Taxus Stent vs. Cypher Stent
(1) Question Asked: Johnson & Johnson's Cypher drug-eluting stents have been on the market for a while, yet some patients are still receiving bare-metal stents. Why do you think this is still occurring?
Total Respondents / Doctors / HealthcareWorkers / Other
Respondents
Physicians are waiting for more real world data on the efficacy of drug-eluting stents / 32% / 32% / 37% / 31%
Cost/payor reluctance or refusal to reimburse for drug-eluting stents / 44% / 59% / 37% / 31%
Don't Know/No Answer / 24% / 10% / 26% / 39%
Other / 13% / 7% / 5% / 22%
Drug-Eluting Stents: Still Encountering Resistance. Although drug-eluting stents have now been on the market for some time, they have yet to gain full market acceptance. When asked why there is still some market resistance, 44% of respondents said that payor reluctance to reimburse is the major reason bare-metal stents are still being used. Another 32% said physicians are waiting for more real world data on the efficacy of drug-eluting stents.
(2) Question Asked: Assuming Boston Scientific gets FDA approval, it will soon introduce the Taxus drug-eluting stent into the marketplace. Do you believe the new Taxus stent is superior to, inferior to, or the same as Johnson & Johnson's Cypher stent in reducing rates of Restenosis?
Workers / Other
Respondents
Taxus Stent is Superior to Cypher Stent in Reducing Restenosis / 23% / 29% / 21% / 17%
Taxus Stent is Inferior to Cypher Stent in Reducing Restenosis / 2% / 0% / 0% / 6%
Taxus Stent is Same as Cypher Stent in Reducing Restenosis / 20% / 22% / 16% / 19%
Don't Know/No Answer / 55% / 49% / 63% / 58%
Other / 7% / 7% / 11% / 6%
Taxus vs. Cypher – Taxus Favored. The recent approval of the Taxus stent is likely to threaten the primacy of Johnson & Johnson’s Cypher stent in the drug-eluding marketplace. A total of 1-in-5 respondents (20%) believe the two stents are equal in reducing restenosis rates. The Taxus Stent, however, is favored by 23% of respondents who view it as superior to the Cypher Stent in reducing restenosis rates, while only 2% believe it is inferior.
(3) Question Asked: Which of the following do you think will be the primary drivers in choosing between the Cypher Stent and the Taxus Stent? (Choose No More Than Two)
Workers / Other
Respondents
Data on Restenosis Rates / 67% / 80% / 58% / 56%
References from Other Professionals / 17% / 10% / 21% / 22%
Relationship with Vendor/Vendor Sales Force / 21% / 22% / 37% / 11%
Guidelines from Payors / 25% / 37% / 21% / 14%
Patient Input / 3% / 0% / 11% / 3%
Other / 7% / 7% / 0% / 11%
Restenosis Rates Determine Stent Selection. Two-in-three respondents (67%) believe that “Data on Restenosis Rates” is the primary driver when choosing between the Cypher and Taxus Stent. Another 25% believe it’s “Guidelines from Payors,” while 21% say it’s the “Relationship with Vendor/Vendor Sales Force.”
(4) Question Asked: Which of the following statements best describes how you believe the new Taxus Stent will fare once it is introduced into the marketplace?
Workers / Other
Respondents
The Taxus stent will dominate the market within six months, due to claims by Boston Scientific that its trials show superior rates in eliminating restenosis / 12% / 12% / 16% / 11%
There will be a head to head marketing war between Johnson & Johnson and Boston Scientific - with success driven by each vendor's ability to market their product / 32% / 44% / 26% / 22%
Acceptance of the Taxus stent will occur slowly. Practitioners and payors will wait until there is real world (and not just trial) data before accepting the Taxus stent / 26% / 27% / 37% / 19%
Don't Know/No Answer / 29% / 17% / 21% / 47%
Other / 3% / 2% / 5% / 3%
Marketing War Will Define Battle Between Taxus and Cypher Stents. Nearly a third (32%) of respondents believe the success of the Taxus Stent depends on the outcome of a head-to-head marketing war between Johnson & Johnson and Boston Scientific. Another 26% believe the Taxus stent will be gradually accepted over time as more real world data becomes available.
(5) Question Asked: Finally, are there any other important factors that will influence stent product acceptance (e.g., ease of insertion)?
Important Factors. A significant number of respondents named ease of insertion as an important factor that will influence stent acceptance. Other factors mentioned were cost and restenosis rates.
Sample of Alliance Member Responses:
a. Doctor Respondents
· BOB8982 writes, “There is currently a perception that the Taxus stents are easier to place, based on past difficulties placing other J&J stents. Hence there will be a marketing war between Cordis (JNJ) and Boston Sci.”
· ZSA8198 writes, “Taxus stent already widely used and the dominant stent in Europe.”
· LEO7024 writes, “Reduction of bodily trauma and increase in patient survivability.”
· MTA6607 writes, “J & J has annoyed lots of Cardiologists; Bos. SC. Stent is much easier to use!”
· MIK3319 writes, “Incidence of thrombus formation, I had a patient die last night because her Cypher stent thrombosed 5 days after it was inserted, this may be a more significant problem than was thought previously and was a problem with some stents when they first came out years ago.”
· JGE3402 writes, “In Europe only reimbursement problems will count.”
· SR10005 writes, “I believe acceptance will be based on clinical factors such as restenosis rates and ease of use however, we can never forget the importance of insurance reimbursement in this equation.”
· GHM8270 writes, “Flexibility of the stent, expandability and such influence its acceptance. But if one is CLEARLY superior to the other, it will get the largest market share – and the inferior stent will probably have some refinements made to it.”
· SHA3342 writes, “Easy to use is an important factor.”
· KER5863 writes, “Delivery system adaptability, third party payor reimbursement for cost of device.”
· JAM8235 writes, “Cost, ease of use, reimbursement.”
· SOM4483 writes, “BSX's stent delivery tools have incumbent position and this perhaps is BSX's biggest advantage.”
· STE3218 writes, “Actual data and cost.”
b. Healthcare Worker Respondents
· 1CL7343 writes, “Taxus is easier to insert.”
· RJR3451 writes, “Real world data and that which we may not know yet will determine the outcome and product acceptance. Some MD's are old school as many are always futuristic in thought and technology. TIME WILL TELL.”
· DDU7628 writes, “Physicians' knowledge about The Taxus stent and its side effect.”
· BPB4890 writes, “Marketing and advertising.”
· DEL7220 writes, “How well the hospital keeps each stent in stock and which doctors are allowed to use them.”
· MAJ8741 writes, “How much longer will the device makers be able to cram these costs on the hospitals? The hospitals cannot pass these costs along. Shades of being a GM supplier!”
· ERI7758 writes, “Factors effecting stents are always the same. Long term success, cost, and real restenosis rates. Currently we have a very limited picture of real restenosis rates. Cost/benefit ratio is yet to be established. Payors are very hesitant to commit to a very expensive item given the current data.”
· CRA1451 writes, “Ease of insertion is always major, as is cost vs. reimbursement (medical has only two drivers, money and technology).”
c. Other Respondents
· MAD2680 writes, “Yes, the lead system product may lend to acceptance more readily by Cardiologists even if closure data is the same.”
· GRE5724 writes, “Yes, ease of insertion/ease of delivery is key.”
· BIO9114 writes, “Variety of sizes available, cost, thrombosis rate is accepted as same rate for non-coated stents.”
· WIL1338 writes, “Reimbursement, visibility in the market for both patients and doctors.”
· PWG2815 writes, “...while the excuse for not using the new coated stents will be there is not enough data the real reason is cost containment. That will continue until the data is too strong to ignore.”
· JEN2085 writes, “Ease of insertion.”
· CEN9132 writes, “Ease of Insertion and catheter withdrawal; stent's esthetic appearance.”
· JFD0468 writes, “Cost will drive acceptance as will the perception of the ease of insertion (i.e., Taxus stent is perceived to be better); however, data from REALITY trial shows comparable insertion.”
· WAT6220 writes, “As more patients learn that there are non-invasive approaches to dealing with the underlying problem nutritionally, more and more patients will (like I) refuse stents except in emergency situations. Fortunately, I did not have any significant blockage, but the nutritional approaches have corrected what little there was. Those approaches, in my experience, have also dealt effectively with rhythm problems (arterial flutter and ventricular tachycardia) which have disappeared within a short period of time.”