The European Medical Technology Industry - in figures 2020
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Table of contents What is Medical Technology? 3 Regulations 7 Innovation 11 Employment 15 Companies 19
Expenditure on Medical Technology 21 MedTech Market in Europe 25 Trade in Europe 33 About MedTech Europe 39
Medical technologies are products, services or solutions used to save and improve people’s lives. In their many forms, they are with you all the time, from prevention, to diagnosis to cure. There are three main categories of medical technologies: • Medical devices (MDs) are products, services or solutions that prevent, diagnose, monitor, treat and care for human beings by physical means. • In vitro diagnostics (IVDs) are non-invasive tests used on biological samples (for example blood, urine or tissues) to determine the status of one’s health. • Digital health and care refers to tools and services that use information and communication technologies (ICTs) to improve prevention, diagnosis, treatment, monitoring and management of health and lifestyle. For the sake of this document, medical technology refers to medical devices and in vitro diagnostics. 4
There are more than 500,000 medical technologies available in hospitals, community-care settings and at home. Medical technology can be everyday objects such as sticking plasters, syringes, screening tests, or latex gloves. It could also be spectacles, wheelchairs, pregnancy tests or hearing aids. Medical technologies also include total body scanners, gene mutation tests, implantable devices such as heart valves and pacemakers, and replacement joints for knees and hips. You may not always notice medical technologies, but they are always there for you. 5
Medical technologies provide value in different ways. They allow people to live longer and better lives, thus empowering them to contribute to society for longer. At the same time, medical technologies improve the quality of care, and the efficiency and sustainability of healthcare systems. 6
In the European Union, medical technologies are tightly regulated by laws that govern the safety and performance of devices across their lifetime, pre- and post-market. Over the next few years, the European medical technology sector will transition from being regulated under the current medical devices directives to two new regulations. 8
Classification of In Vitro Diagnostic Medical Devices Today, the in vitro diagnostic (IVD) sector is regulated by Directive 98/79/EC. From 26 May 2022, the new Regulation 2017/746/EU will fully apply. Until this date, manufacturers can choose to comply with either the Directive or the Regulation. Classification of IVDs is important as it determines the level of involvement by a third party (the “notified body”) in assessing IVDs both pre- and post-market. This level of control is generally relative to the risk of an erroneous result from the assay. Under the IVD Directive, IVDs are classified into four classes following a positive list approach: Annex II Annex II Devices for Self-declared List A List B self-testing devices (e.g. ABO blood- (e.g. blood glucose (e.g. pregnancy (e.g. clinical typing) monitoring) tests) chemistry analyser) Under the IVD Regulation, all IVDs will be classified under a new risk-based classification system according to the risk the device poses to the health of the public and or an individual as a result of an incorrect test result. All IVDs will be classified under class A, B, C or D, with class D being the highest risk class. 9
Classification of Medical Devices The medical device (MD) sector is regulated by Directives 93/42/EC and 90/385/EEC. From 26 May 2021, the new Regulation 2017/745/EU will fully apply. Until this date, manufacturers can choose to comply with either the Directives or the Regulation. Classification of medical devices (estimated to be more than 500,000) drives many pre- and post-market requirements. Due to the large variety of products, the level of control made by a third-party (the “notified body”) before placing them on the market depends on the level of impact on the human body that their use might imply. The same notified body, together with the Competent National Authorities, is involved post-market to ensure the continued safety and performance of medical devices. Under the MD Directive, MDs are classified into 4 classes following a risk-based classification system: Class I Class IIa Class IIb Class III (e.g. simple (e.g. syringes for (e.g. anaesthesia (e.g. stents) bandages or wound pump infusion) machines) care products) Under the new MD Regulation, the risk-based classification system contained in the current Directives has been maintained, although some changes/additions have been introduced. The principle is the same: to link the class of the device to the potential risk posed to the health of the public and an individual as a result of fault in the functioning. All MDs are classified under class I, IIa, IIb or III, with class III being the highest risk class. 10
Innovation
Medical technology is characterised by a constant flow of innovations, which are the results of a high level of research and development within the industry, and of close co- operation with the users. The average global R&D investment rate (R&D spending as a percentage of sales) is estimated to be around 8% in the medical technology sector1. Products typically have a lifecycle of only 18-24 months before an improved product becomes available. In 2019, nearly 14,000 patent applications were filed with the European Patent Office (EPO) in the field of medical technology representing a 0.9% growth in patent applications compared to the previous year.2 The medical technology field accounts for 7.7% of the total number of applications, second highest among all the sectors in Europe. In comparison, around 7,700 applications were filed in the pharmaceutical field and around 6,800 in the field of biotechnology. (Figure 2) 39% of all patent applications were filed from EPO countries (including EU27, UK, Norway and Switzerland) and 61% from other countries, out of which with the majority of applications filed from the US (40%). Figure 1. Medical technology patent applications filed with EPO in 2019 39% EPO countries (including EU27, NO, CH, UK) 61% Other countries 12
Figure 2 – Top 10 technical fields in patent applications Number of patent applications filed with EPO, 2019 (ref. 2) Digital communication 14,175 Medical technology 13,833 Computer technology 12,774 Electrical machinery, apparatus, energy 11,255 Transport 9,635 Measurement 9,045 Pharmaceuticals 7,697 Biotechnology 6,801 Other special machines 6,436 Organic fine chemistry 6,167 THOUSAND SEPARATORS 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000
While over the last decade the number of EPO filings in the field of medical technology has doubled, pharma and biotech patent applications were relatively stagnant. Furthermore, the ratio of granted patents to patent applications in the medtech sector has been continuously growing in the past years reaching 76% in 2019. In comparison, this ratio is around 50% in the pharmaceutical and biotechnology field. (Figure 3) Figure 3 – Evolution of European patents by technical field (ref 2.) 16,000 80% 14,000 70% 12,000 60% 10,000 50% Granted Patents Applications 8,000 40% 6,000 30% 4,000 20% 2,000 10% 0 0% 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 MedTech Applications Pharma Applications BioTech Applications MedTech Granted Pharma Granted BioTech Granted
Employment
730,000 The European medical technology industry employs directly more than 730,000 people3. Germany had the highest absolute number of people employed in the medical technology sector, while the number of medical technology employees per capita is highest in Ireland and Switzerland. In comparison, the European pharmaceutical industry employs around 765,000 people4. The jobs created by the medical technology industry account for around 0.3% of total employment in Europe.5 These jobs are also highly productive, as the value added per employee is estimated to reach €160,000 per employee. These indicators show that the medical technology industry has an important economic and societal impact in Europe. 16
Figure 4 – Top 10 European countries with highest medtech employment Direct employment in the medical technology industry in 2018, or latest year available (ref. 3) Denmark 16,500 Sweden Belgium 27,000 17,800 Germany United Kingdom 97,600 227,700 Ireland Switzerland 40,000 58,500 France 89,130 Spain 25,500 Italy 76,400
Figure 5 – Number of people directly employed in the medical technology industry per 10,000 inhabitants 2018 or latest year available (ref. 3) nd la Ire nd la er itz Sw k y ar en an m ed m en er Sw D G s nd um rla ry e ia i ga he nc lg tr ly K Be un et a us Ita U Fr N A H ia al ia d an e ug ak n ec n la m ai ov rt re n Ro Sp Po Sl Fi G 83 69 29 28 27 16 15 13 13 12 10 9 7 5 5 4 3 3
Companies
32,000 medical technology companies in Europe 95% SMEs There are more than 32,000 medical technology companies in Europe. The highest number of them are based in Germany, followed by Italy, the UK, France and Switzerland. Small and medium-sized companies (SMEs) make up around 95% of the medical technology industry, the majority of which employ less than 50 people (small and micro-sized companies)3. 20
Expenditure on Medical Technology
225 Expenditure on medical technology per capita in Europe In Europe, an average of approximately 10% of gross domestic product (GDP) is spent on healthcare. Of this figure, around 7.4% is attributed to medical 10% technologies, i.e. less than 1% of GDP. The spending on medical of GDP spent technology is estimated to vary significantly across European on healthcare countries, ranging from around 5% to 12% of the total healthcare expenditure. Expenditure on medical technology per capita in Europe is at around €225 (weighted average).* * Medtech Europe calculation based on sources 4-8. 22
Figure 6 – Breakdown of total healthcare expenditure in Europe 2018 (ref. 4–8) 16% Pharmaceuticals & other medical non-durables 7.4% Medical Technology 0.7% In vitro diagnostics 6.7% Medical devices (incl. imaging) 76.6% Inpatient & outpatient care, other
24
MedTech Market in Europe
120 billion market The European medical technology market is estimated at roughly €120 billion in 2018. 7,8 The biggest medical device markets in Europe are Germany, France, the United Kingdom, Italy and Spain. The same group of countries 27% form the top 5 IVD markets in Europe. (Figures 7 and 8) of the world market Based upon manufacturer prices the European medical device 2 market is estimated to make up 27% of the world market. nd It is the second largest medical device market after the US (around 43%).8 largest market after US 26
Figure 7 – European medical device market by country 2018 (ref. 8) 27.1% Germany 14.6% France 11% UK 10.1% Italy 6.3% Spain 4.2% Netherlands 3.7% Switzerland 2.7% Belgium 2.6% Poland 2.5% Austria 15% Others
Figure 8 – European IVD market by country 2018 (ref. 7) 19.4% Germany 14.5% Italy 14.5% France 9.0% Spain 8.8% UK 4.2% Switzerland 3.6% Poland 3.5% Belgium 2.6% Netherlands 2.4% Austria 17.5% Other
Figure 9 – Europe in the global medical device market 2018 (ref. 8) 6% China 7% Japan 17% Rest of the world 27% Europe 43% US
Figure 10 – World medical technology market by area and sales growth 2017-2024 (ref. 1) 18% 16% In–Vitro Diagnostics (IVD) 14% WW Market Share % in 2024 12% Diagnostic Imaging 10% Source: Evaluate, September 2018 Cardiology 8% Ophtalmics General & Plastic Surgery Drug Delivery 6% Orthopedics 4% Endoscopy 2% Dental Diabetic Care 0% +3.0% +4.0% +5.0% +6.0% +7.0% +8.0% +9.0% % Sales Growth: CAGR 2017-24 Medical technology offers solutions for many disease areas. On a worldwide perspective, in vitro diagnostics (IVD) are the largest sector, followed by cardiology and diagnostic imaging.1 30
Figure 11 – European medical device market growth rates 2009-2018 (ref. 8) 15% 10% USA Europe Japan China 5% 43% 27% 7% 6% 0% 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Canada Brazil Russia Others 2% 1% 1% 13% -5% The European medical device market has been growing on average by 4.2% per annum over the past 10 years. Demand fell in 2009 due to the economic crisis, resulting in a growth rate of only 1%. The market recovered in 2010, since then the annual growth rate has varied between 2.6 and 9.3% in the European medical device market.7
Figure 12 – European IVD market growth rates 2009-2018 (ref. 7) 5% 4% 3% 2% 1% 0% 2013 2014 2015 2016 2017 2018 -1% -2% -3% -4% The European IVD market growth has been slowing down until 2013, while annual growth rates in the pre-crisis period were at around 2-4%. In 2013 the European market started to recover and the annual growth rate in 2018 was around 1%.
Trade in Europe
billion Estimation of Europes ’ trade surplus in 2018 Europe has a positive medical devices trade balance of €11.7 billion (2018). Compared to the previous years, the main European medical device trade partners remain the same: the US, China, Japan and Mexico.9 Medical devices trade balance of individual countries varies a lot across Europe as shown in Figures 15 and 16. Based on export and import values including European intra-community trade, the international trade balance indicator is highest in Ireland and Germany followed by Switzerland and the Netherlands. 34
Figure 13 – Top export destinations of the European medical devices market 2018 (ref. 9) Russia Canada 3.8% 1.9% Japan USA 6.5% South Korea 41.5% Turkey 1.9% China 2.3% Saudi Arabia 1.9% 10.2% India 2.1% Australia 3.1%
Figure 14 – Top import suppliers to the European medical devices market 2018 (ref. 9) USA Japan 6.0% 50.4% South Korea Mexico Israel China 1.5% 6.6% 1.5% 12.7% Costa Rica Malaysia 2.1% 3.7% Singapore 3.7% Australia 1.6%
Figure 15 – Export and import of medical devices by country Including intra-community trade, million euros, 2018 (ref. 9) GERMANY 26,604 17,217 20,677 NETHERLANDS 15,384 IRELAND 11,599 2,083 BELGIUM 10,401 9,146 SWITZERLAND 9,915 4,154 FRANCE 7,352 9,607 5,861 UK 7,600 ITALY 3,816 5,737 POLAND 2,596 2,186 AUSTRIA 2,031 2,055 DENMARK 1,880 1,303 FINLAND 1,822 931 SPAIN 1,560 4,242 SWEDEN 1,414 1,673 CZECH REPUBLIC 1,161 1,100 0 5,000 10,000 15,000 20,000 25,000 30,000 Export Import
Figure 16 – Medical devices trade balance by country Including intra-community trade, million euros, 2018 (ref. 9) IRELAND 9,516 GERMANY 9,386 SWITZERLAND 5,761 NETHERLANDS 5,293 BELGIUM 1,255 FINLAND 891 HUNGARY 577 DENMARK 576 POLAND 410 CZECH REPUBLIC 61 LITHUANIA 45 MALTA 22 ESTONIA 8 -19 SLOVENIA -23 AUSTRIA -34 BULGARIA -51 LATVIA -60 CYPRUS -93 LUXEMBOURG -168 SLOVAKIA -235 CROATIA -259 SWEDEN -359 ROMANIA -586 GREECE -674 PORTUGAL -684 NORWAY -1,740 UK -1,921 ITALY -2,255 FRANCE -2,681 SPAIN -4,000 -2,000 0 2,000 4,000 6,000 8,000 10,000
About MedTech Europe
MedTech Europe is the European trade association representing the medical technology industries, from diagnosis to cure. We represent diagnostics and medical devices manufacturers operating in Europe. MedTech Europe’s mission is to make innovative medical technology available to more people while helping healthcare systems move towards a sustainable path. MedTech Europe encourages policies that help the medical technology industry meet Europe’s growing healthcare needs and expectations. It also promotes medical technology’s value for Europe focusing on innovation and stakeholder relations, using economic research and data, communications, industry events and training sessions. MedTech Europe’s Facts & Figures publication is an annually updated report with robust industry data compiled from multiple sources. The publication is used as the quintessential source of data by international stakeholders seeking an up-to-date view of industry innovation and employment, SME activity, expenditure on medical technology, trade and market size in Europe. 40
Scope of this report • In this report Europe refers to EU27, Norway, Switzerland and the United Kingdom, unless specified otherwise. • The Innovation chapter defines medical technology following the methodology of the World Intellectual Property Orga- nization (based on the WIPO IPC-Technology concordance as revised in August 2014). Patents are attributed by the country of residence of the applicant. EPO countries refer to the 38 member states of the European Patent Organisation. • The Employment and Companies chapters are based on data from the 2019 survey carried out among MedTech Europe’s National Associations. Figures refer to 2018 or the latest year available. An enterprise is considered to be a SME if it employs fewer than 250 persons and has an annual turnover not exceeding €50 million (small and micro-sized companies employ fewer than 50 persons and have a turnover of less than €10 million). • The Expenditures on Medical Technology chapter is based on MedTech Europe calculations using healthcare statistics from the following sources: EFPIA, Eurostat, Fitch Solutions, WHO. • The MedTech Market in Europe chapter is based on manufacturers’ sales (revenue) not including margins, such as value added in the wholesaling and retailing, transportation costs, some taxes included in the final price, etc. • The Trade in Europe chapter data refers to the medical technology products in the following categories, excluding in vitro diagnostics: orthopaedics & prosthetics, patient aids, dental products, diagnostics imaging, consumables, other medical devices (incl. wheelchairs, ophthalmic instruments, hospital furniture, medical & surgical sterilisers, ultra-violet or infra-red ray apparatus, blood pressure monitors, endoscopy apparatus, dialysis apparatus, transfusion apparatus, anaesthetic apparatus & instruments). References 1 Evaluate MedTech, 2018, World Preview 2018, Outlook to 2024. 2 European Patent Office (EPO), 2020, Patent Index 2019. 3 MedTech Europe, 2019, National Associations Survey. 4 EFPIA, 2019, The Pharmaceutical Industry in figures. 5 Eurostat, 2020, Employment and Population Statistics. 6 WHO, 2019, Global Health Expenditure Database. 7 MedTech Europe, 2019, European IVD Market Statistics Report 2019. 8 Fitch Solutions, 2019, Worldwide Medical Devices Market Factbook. 9 International Trade Centre, 2020, International Trade Statistics – MedTech Europe calculations. 41
www.medtecheurope.org
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