Indonesian Market for Cardiac Rhythm Management

• Publication date: April 2012
• Report size: 111 pages

This research service presents an analysis of the cardiac rhythm management market in Indonesia. The study is segmented based on the following four main procedures performed: pacemaker, implantable cardioverter-defibrillators, cardiac resynchronization therapy, and cardiac ablation. It provides an in-depth analysis by procedural volume, unit and revenue forecast by segment, drivers and restraints, technology trends, and strategies. Key opinion le...

This research service presents an analysis of the cardiac rhythm management market in Indonesia. The study is segmented based on the following four main procedures performed: pacemaker, implantable cardioverter-defibrillators, cardiac resynchronization therapy, and cardiac ablation. It provides an in-depth analysis by procedural volume, unit and revenue forecast by segment, drivers and restraints, technology trends, and strategies. Key opinion leaders in Indonesian hospitals and market participants were interviewed to obtain their perceptions on the cardiac rhythm management devices used in the country.

Executive Summary

•According to Indonesia’s Ministry of Health, Indonesia faces the burden of healthcare with both communicable and non-communicable diseases.
•Of the non-communicable diseases, cardiovascular disease is prevalent among x.x percent of the total population of xxx.x million. It is also the fourth leading cause of mortality.
•The Government of Indonesia is carrying out programs on healthy lifestyle to create awareness on balanced diet, physical activity, avoidance of tobacco, and stress management.
•An estimated x.x million Indonesians suffer from disorders in the rhythm of the heart.
•In Indonesia, the cardiac rhythm management (CRM) market is expected to experience high growth on a small base, as potential cardiac patients are available for implants. However, affordability and awareness about CRM devices are poor.
•The overall price of implants is likely to increase by a marginal x.x percent every year. Although the prices of CRM devices did not change significantly in terms of the Indonesian Rupiah (IDR), in the last few years, there was a significant impact due to the currency exchange factor.
•Nearly xx.x percent of the total population does not have health insurance, as government coverage is only for government employees and the very poor. Of the xx.x percent working in the private sector, only xx.x percent have health insurance.
•The insurance industry is expected to continue to grow in 2010 and the near future. However, there is still a low level of awareness regarding self-insured health programs.
•In 2011, women dominated the population undergoing CRM procedures. Most of the people who underwent these procedures were aged xx and above.
•There are only xx interventional cardiology centers and 5 electrophysiology centers in Indonesia to perform CRM procedures. Similarly, the availability of specialists, too, is restricted to xx interventional cardiologists and 5 electrophysiologists.
•Due to the lack of infrastructure and competent physicians, people with less financial constraints prefer to go to neighboring countries such as Singapore, Malaysia, or Thailand for CRM.
•In Indonesia, the CRM market is dominated by existing key participants such as St. Jude Medical, Inc., Biotronik, and Medtronic, Inc., as they compete for hospital tenders.
•However, their products are sold through locally appointed distributors, as distributors are essential for sales in public hospitals. Direct sales is possible only in private hospitals.
•Pacemakers, implantable cardioverter-defibrillator, cardiac resynchronization therapy, and cardiac ablation are reimbursed to some extent under government insurance schemes.
•A considerable price difference exists between CRM procedures conducted in public and private hospitals.
•While a public hospital package covers the cost of the pacemaker, other out-of-pocket expenses have to be borne by the patient. In private hospitals, patients with complete insurance packages undergo CRM procedures.

Market Overview—Definitions
•Cardiac Rhythm Management: A device is surgically placed inside the body to restore function by replacing or reinforcing a damaged structure.
•Indonesian Cardiac Rhythm Management Market: The cardiac rhythm management market is sustained by cardiac patients who seek treatment for arrhythmia-related problems.
•Units: The number of cardiac implants utilized by the market.
•Revenue: This is the income generated from the sale of cardiac implants in the market. The unit price used for calculation is the end-user price in hospitals.
•Arrhythmia: Abnormality of the electrical signal conduction within the heart; severity can range from minor to life threatening, and the frequency of occurrence, from an isolated event to chronic.
•Atrial Fibrillation: This is the most common cardiac rhythm problem and is associated with irregular heart beats.
•Bradycardia: An abnormally slow heart rhythm, less than xx beats per minute.
•Cardiac Ablation: This is a minimally invasive procedure that may reduce the number of episodes or treat atrial fibrillation. Common energies used in cardiac ablation are radiofrequency, cryogenics, microwave, laser, thermal, ultrasound, and electrode.
•Cardiac Resynchronization Therapy (CRT): This therapy involves the modification of traditional pacemaker devices that include a third lead for left ventricular pacing, in addition to the right atrium and right ventricle. By coordinating the bottom ventricles, the heart it is able to pump blood efficiently. CRT devices are rapidly becoming the device of choice for heart-failure patients. These devices are available in two forms—one, as a three-lead CRT-P (CRT-Pacemaker) device, which is an advanced pacemaker, or, two, a CRT-D (CRT-Defibrillator) device that combines pacemaker and ICD elements.
•Congestive Heart Failure: This is a condition where the heart muscle is weakened and unable to sufficiently pump blood throughout the body, leading to abnormal fluid accumulation in the limbs, lungs, and liver.
•Heart Block: This occurs when electrical impulses generated in the upper chambers of the heart are not properly transmitted to the lower chambers.
•Implantable Cardioverter—Defibrillator (ICD): This is a device used in patients at the risk of sudden cardiac death. It is a small battery-powered device to detect cardiac arrhythmia and correct it by delivering a jolt of shock.
•Pacemaker Implant: This is a procedure in which a small device is placed under the skin of the chest or abdomen to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate.
•Tachycardia: An abnormally fast heart rhythm.

Cardiovascular Devices Industry in Indonesia

TABLE OF CONTENTS

Executive Summary 4
Market Overview 10
Total Cardiac Rhythm Management Market -
External Challenges: Drivers and Restraints 25
Forecasts and Trends 32
Market Share and Competitive Analysis 43
Mega Trends and Technology Trends 53
Pacemaker Segment Breakdown 57
Implantable Cardioverter—Defibrillator (ICD) Segment Breakdown 64
Cardiac Resynchronization Therapy (CRT) Segment Breakdown 71
Cardiac Ablation Segment Breakdown 78
Conclusions and Key Strategies for Success 85
The Last Word (Conclusions and Implications) 89
Appendix 94