1、White PaperPost COVID-19 MedTech Industry View on Surgical Procedure Backlog PAUL BUEHLER,Director,Global Information Offerings,IQVIA MedTechSARA CHAPA MARRON,Manager,Client Services,IQVIA MedTech Table of contentsIntroduction 1Factors impacting healthcare system function throughout COVID-19 3Surgic

2、al procedure backlog due to COVID-19 4Inguinal hernia surgery 4Spinal fusion surgery 7Conclusion 9Data-driven global market measurement:Medtech Market Monitor 9References 10About the authors |1With the dust settling and much of the world resolved to co-existing with the COVID-19 virus,medical techno

3、logy companies need to know where they stand with product demand and patient needs.This is especially challenging for global MedTech companies,as there are many factors impacting how a countrys healthcare system functioned over the past few years.This paper highlights factors impacting access to car

4、e throughout the COVID-19 era and then applies real data standardized around the world to estimate and benchmark current backlogs for surgical procedures following the COVID-19 pandemic.Almost three years post pandemic,countries around the world are in different stages of recovery and adapting to th

5、e new normal in healthcare delivery.Countries were hit by the original virus and later variants at different times,during different seasons and at different levels of severity.Some countries had natural boundaries like oceans separating them from the world,making COVID-19 containment easier.Yet othe

6、rs suffered from being international travel hubs.Asian and African countries were able to draw upon their previous experiences with SARS and other viruses.The government policies around virus mitigation,and vaccine development also impacted how each country rebounded from the pandemic.Politics playe

7、d a more prevalent role in some countries than in others.It was originally thought that richer nations would fare better across the board with more money to institute testing,weather the cost of lockdowns and to secure personal protective equipment for essential workers.Yet almost three years later,

8、its clear that money was not as big a factor in dealing with COVID-19.In addition,healthcare infrastructure also varied significantly,so countries did not start the pandemic from the same place in delivering care,with some countries having excess capacity in areas like overall hospital or intensive

9、care unit(ICU)beds going into the pandemic while other systems had very few open beds.For example,as illustrated in Figure 1,above average hospital bed capacity likely played some part in countries such as S.Korea,Japan,Taiwan,Czech Republic and Germanys early success in weathering COVID-19 infectio

10、ns within their healthcare system.Conversely,as highlighted in Figure 2,bed availability was likely a factor working against India in coping with the Delta variant surge later on.IntroductionFigure 1:Countries above an average of 520 acute beds per 100K populationSource:MedTech Market Monitor(MMM),2

11、022South KoreaJapanRussiaRomaniaTaiwanCzech RepublicGermany600700800Acute beds per 100K of population9001,0001,1005002|Post COVID-19 MedTech Industry View on Surgical Procedure BacklogIsrael leveraged its sophisticated Electronic Health Record(EHR)infrastructure to secure early delivery of Pfizers m

12、RNA COVID-19 vaccine.This enabled the roll out of both initial shots and boosters several months ahead of the US and other countries who were at the very top of the list for vaccine delivery.Because Israels EHR system is centralized on a single platform,they were able to provide Pfizer with real tim

13、e data tracking everything from the total population vaccinated to the efficacy and side effects of the vaccine.This data played a critical role in determining and recommending when vaccine immunity had waned to the point where booster shots were needed,among other things.When considering COVID-19 m

14、itigation tactics,a countrys access to key medical equipment and protective gear may have also played a role in determining the best strategy.Figures 3 and 4 illustrate above and below average ICU bed availability.Figure 4:Countries below an average of 5 ICU beds per 100K populationSource:MedTech Ma

15、rket Monitor(MMM),2022Figure 2:Countries below an average of 150 acute beds per 100K populationSource:MedTech Market Monitor(MMM),2022IndiaUAEEgyptColombiaIndonesiaMexicoPhillippines014015090Acute beds per 100K of populationFigure 3:Countries above an average of 31 ICU beds per 100K popul

16、ationSource:MedTech Market Monitor(MMM),2022TurkeyCzech RepublicTaiwanAustriaUnited StatesGermanySaudi Arabia35404550556030ICU beds per 100K of populationChinaChilieMalaysiaVietnamMexicoPhilippines34562ICU beds per 100K of |3Key factors impacting healthcare delivery during the pandemic Out of hospit

17、al care capacity Medical care was less likely to be postponed if it could be delivered in settings away from the hospital.Countries such as the US deliver more care in ambulatory surgery centers(ASCs)and outpatient surgery centers,which may have had a lower impact on postponed surgeries during the p

18、andemic.Technology adoption Countries adopt the latest technologies at different rates.Those at the forefront of the adoption curve are likely to deliver more care outside the hospital setting as some minimally invasive techniques are better candidates to perform outside the hospital.Critical MedTec

19、h equipment Some countries had no ability to manufacture items such as protective gear,ventilators and other important medical supplies.Others had exported much of their supply early on in the pandemic.Just knowing how many ventilators existed within a country and where they were located was beyond

20、the capacity of some health authorities,let alone how to best deploy it and how to build or order more quickly.Centralization The above example illustrates how Israels centralized EHR platform gave the country a jump-start on others in combatting COVID-19.Generally,the degree of centralization impac

21、ted a countrys ability to respond quickly to the pandemic.More centralized systems,such as Denmark were at least in theory are able to make quicker decisions around organization and procurement.Countries like Sweden operate in a more decentralized manner with 21 individual county councils,each havin

22、g some autonomy in organization and procurement,resulting in duplication of effort throughout the system.Surveillance Countries such as Iceland and several Asian countries were successful controlling the pandemic with sophisticated testing and other mitigation processes.Icelands extensive testing an

23、d contact tracing system not only allowed the country to avoid lockdowns,but they were also able to keep the country open for tourism,which is critical to the countrys economy.Vaccines Countries were forced to make bets on vaccines early on before knowing which would work.Many pharmaceutical compani

24、es began development on vaccines using different technologies,but not all were going to move successfully through clinical trials.The new and unproven mRNA vaccines turned out to be the most efficacious.4|Post COVID-19 MedTech Industry View on Surgical Procedure BacklogSurgical procedure backlog due

25、 to COVID-19After considering both healthcare and non-healthcare related factors impacting a healthcare systems ability to deliver care to patients throughout the COVID-19 pandemic,lets compare estimates for current backlogs of elective surgical procedures across around the world and across differen

26、t surgeries.This analysis is specific to a country and type of surgery and hence,the surgical procedure backlogs will vary.Generally speaking,ENT surgeries lagged behind other medical specialties but not in all countries.And while plastic surgery was expected to be the most impacted at the outset of

27、 the pandemic,these procedures actually grew in many places due to both factors mentioned above and patients being eager to schedule them given their newfound ability to recuperate while working from home.Using data from IQVIAs MedTech Market monitor(MMM)a global platform providing standardized heal

28、thcare data we can calculate with accuracy the backlog of surgeries postponed due to the COVID-19 pandemic.The most recent real dataset available globally is from 2021 allowing us to create actuals for 2015-2021 and forecast 2022.Since each country maintains its own medical coding classification sys

29、tem for surgeries,each local system is translated to a common standard system to give a true apples to apples comparison for any given surgery across countries.The uncertainty posed by COVID-19 waves and variants along with other factors like public behavior and the waning of vaccine immunity lower

30、the accuracy of any forecast for 2023 and beyond until we get further clarity at the country level.Among other things,the MMM database contains historical surgical procedure volumes for 1,000 surgeries across 45 countries.Well select just two of these surgeries which are performed via various techni

31、ques and settings across the healthcare system.Then well benchmark each surgery across a few countries.Inguinal hernia surgeryAn inguinal hernia occurs when soft tissue in the body protrudes through the abdomen.For example,the intestines may bulge through a week point in the abdominal muscles.Patien

32、ts could be asymptomatic or the condition could cause pain when the patient coughs,bends over or lifts heavy objects.Corrective surgery is performed either via an open incision or via a minimally invasive laparoscopic technique.Generally,this surgery is more elective than many others and could be pe

33、rformed either as an outpatient or outside the hospital more than many other surgeries.So this is a good candidate to measure in terms of potential for backlog.UNITED KINGDOM(UK)UK generally performs about 80,000 inguinal hernia surgeries on average per year.Figure 5 highlights a steep drop in 2020

34、and a surgical backlog of 75,590 surgeries,which is almost an entire years worth of inguinal surgeries nationwide.The country saw an enormous drop of 52%in 2020,which is high across any surgery or country.Fortunately,volume headed back in the right direction in 2021,but was still 24%below its 2019 b

35、aseline.Figure 5:Inguinal hernia surgery United KingdomSource:MedTech Market Monitor(MMM),2022Forecasted surgeriesActual surgeries90,00080,00070,00060,00050,00040,00030,0002000222015-75,590B|5As a top travel hub worldwide,the UK was among the hardest hit by all COVID-19 waves,f

36、rom the initial outbreak to delta to omicron variants.The health system was already struggling to keep up with elective surgeries prior to COVID-19.Brexit worsened existing pre-COVID-19 healthcare worker shortages.This along with retirement levels that were typical in many countries led to significa

37、nt healthcare worker burnout in the UK.In fact,healthcare strikes occurred in the UK in 2022 and nurses went on strike for the very first time.JAPAN The interesting aspect of hernia surgery backlog for Japan in Figure 6 is a double dip,with the volume of surgeries actually falling not only in 2020,b

38、ut also in 2021.Even with a relatively flat trend line for this specific surgical procedure,the total backlog is just under seven months.As discussed earlier,the pandemic affected countries at different times and in different ways.COVIDs impact within the healthcare setting was less severe in Japan

39、during the initial outbreak than subsequent waves.In addition,hernia surgery is likely more elective than many or most other elective surgeries,so it is possible that it could be one of the first surgeries postponed during a COVID-19 surge.FRANCE The backlog in France is a little more than 4 months

40、of hernia surgeries,despite a slightly above average rebound for France over other western countries.However,with full year 2021 surgery volume remaining 8%below 2019 volumes,full recovery of the backlog is likely to take some time.Figure 6:Inguinal hernia surgery JapanSource:MedTech Market Monitor(

41、MMM),2022Figure 7:Inguinal hernia surgery FranceSource:MedTech Market Monitor(MMM),2022It is clear across countries and surgeries in the analysis of the latest data that surgery volumes have not yet returned to the normal pre-COVID-19 levels.Forecasted surgeriesActual surgeries160,000150,000140,0001

42、30,000120,000110,000100,0002000222015-79,823BacklogForecasted surgeriesActual surgeries160,000150,000140,000130,000120,000110,0002000222015-50,222Backlog6|Post COVID-19 MedTech Industry View on Surgical Procedure BacklogUNITED STATES Figure 8 is an interes

43、ting case for several reasons,including that it was the smallest backlog in our analysis of less than 1 day.In addition,2021 not only rebounded over 2020,but it also moved above the orange trend line below to capture some 2020 backlog immediately in 2021.This is consistent with the US having well ab

44、ove average out of hospital capacity to perform elective surgeries.Aside from the US example above,it is clear across countries and surgeries in the analysis of the latest data that surgery volumes have not yet returned to the normal pre-COVID-19 levels.For example,even the US with its above average

45、 out of hospital capacity had overall surgery volumes(inpatient and outpatient)below 2019 levels for the full year 2021.While we do not yet have full year volumes for 2022,if we look at 1H raw(unprojected)volumes in the US for 2022,those totals(inpatient and outpatient)were 9%less than 2021 and only

46、 marginally higher than 2020.This is consistent with early 2022 omicron case counts approaching 1M per day in the US.This trend may have reversed in 2H 2022 in the US,but with many surgeries trending higher YoY due to demographic and other factors,backlogs in most countries could go higher before th

47、ey recede as volumes will need to exceed the trend lines for the backlog to clear.It is highly likely that some elective surgeries may never be performed if the patients decided to opt out of surgery or died of COVID-19 or other causes.The overall fatality rate from COVID-19 within a population,when

48、 considering all(symptomatic and asymptomatic)infections is very small and in fact negligible compared to the backlog figures.In addition,many elective surgeries are performed on patients of all ages(and some particularly on younger patients),or on patients not considered at high risk of death from

49、COVID-19.In other words,candidates for elective surgery are not necessarily at any higher risk of death from COVID-19(or other causes)than the general population,so actual backlogs should be close to the numbers above.Figure 8:Inguinal hernia surgery U.S.Source:MedTech Market Monitor(MMM),2022Foreca

50、sted surgeriesActual surgeries950,000900,000850,000800,000750,000700,0002000222015-2,303B|7Figure 9:Spinal fusion surgery AustraliaSource:MedTech Market Monitor(MMM),2022Spinal fusion surgerySpinal fusion surgery aims to fuse two or more bones in the spine to prevent movement a

51、nd pain.Bone material is placed between the spinal bones and is held together by metal fixtures until the full structure fuses together and heals as a single bone.This is a good surgery for our analysis because unlike hernia surgery,spinal fusion is a predominantly inpatient procedure.AUSTRALIA Aust

52、ralia had a uptick in procedural volumes leading up to the pandemic.Figure 9 shows a slight drop and quick recovery for spinal fusion surgeries,with a 4.5%decline in 2020.The 2021 numbers rebounded 3.8%to within only 180 surgeries from the pre-COVID-19 volume.But spinal fusion volumes in Australia h

53、ave shown slow and steady growth due to both the aging population and relative incidence of osteoarthritis and other conditions that are requisite precursors for the surgery.So the 2021 volume is still 2.4%below the trend line and the forecast for 2022 is still below the relative trend line.The smal

54、ler backlog here is likely due to the country having prior experience with the previous SARS-CoV outbreak over a decade earlier,leading authorities to take quick action to close borders early on,which is easier to do when you are an island.GERMANY Spinal fusion in Germany is another double dip in bo

55、th 2020(5.8%)and 2021(18.2%)for a total fall of 23%off pre-COVID-19 volumes.With fusion surgery volumes growing steadily similar to Australia,it could take some time to clear the backlog.Note that there are less invasive alternatives to spinal fusion,such as laminectomy or discectomy,among others fo

56、r patients who meet certain clinical criteria.But backlogs for these are proportionately similar,as Germanys reimbursement system discourages the performance of such surgeries on an outpatient or out-of-hospital basis,and inpatient surgeries within a hospital were more likely to be postponed through

57、out COVID-19.With fusion surgery volume growing steadily similar to Australia,it could take some time to clear the backlog.Forecasted surgeriesActual surgeries22,00021,00020,00019,00018,0002000222015Figure 10:Spinal fusion surgery GermanySource:MedTech Market Monitor(MMM),2022-

58、49,914BacklogForecasted surgeriesActual surgeries100,00095,00090,00085,00080,00075,00070,00020002220158|Post COVID-19 MedTech Industry View on Surgical Procedure BacklogJAPANUnlike the backlog for hernia surgery in Japan and other procedures across most countries,the volume of

59、spinal fusion surgeries in Japan turned in a rare growth in 2020 surgery volume via a 1%increase vs.2019.This is likely due to Japan and other countries responding quickly at the outset of the COVID-19 pandemic and seeing less of an immediate impact compared to many western countries.The public not

60、only did not resist COVID-19 mitigation initiatives,but the wearing of face masks was common in Japan even before COVID-19.At one point in 2020,Japan was considering going through with the Olympic games originally scheduled for July 2020 in Tokyo,but eventually postponed the games to 2021.Due to hav

61、ing one of the largest over age 65 populations(as a percentage of the total population),this is another surgery that is showing steady YoY growth,which is contributing to much of the backlog.Figure 11:Spinal fusion surgery JapanSource:MedTech Market Monitor(MMM),2022-25,107BacklogForecasted surgerie

62、sActual surgeries155,000145,000135,000125,000115,|9ConclusionOne thing that is evident around the world after COVID-19 is that is that the supply and demand of most things are well off their equilibrium.There is pent up demand for everything from commodities,to capital equipment and services.It span

63、s categories like electronics,home goods and transportation.It includes workers from every industry,including healthcare.In fact,there is pent up demand for MedTech products in most countries around the world mostly due to the COVID-19 surgery backlog from postponed surgical procedures.While we did

64、not have full year 2022 data for this analysis,COVID-19 case counts were at their highest during the Omicron surge in early 2022 and as discussed earlier,overall surgery volumes were still below pre-COVID-19 volumes through mid-2022.Therefore,its likely that backlogs could not begin declining until

65、at least the second half of 2022,into 2023 and beyond.Supply and demand in MedTech will adjust and fall in line,but in the meantime,there is immediate opportunity for MedTech companies to capture the excess demand for their products.And the companies who best capture this excess demand will do so by

66、 having a good understanding of the demand curves in various countries.Data-driven global market measurement:Medtech Market MonitorUsing real data,collated and harmonized in IQVIAs Medtech Market Monitor(MMM),you can compare a wide range of healthcare systems.MedTech Market Monitor consists of real

67、surgical procedure volumes for 1,000 surgeries across 45 countries,which are standardized to a single classification system to allow for a true global comparisons.This first-of-its-kind database enables:Understanding of volume,growth and YoY trends of surgical procedures An input to R&D decisions vi

68、a insight into disease and treatment patterns The calculation of market share and building of MedTech market models Setting country level targets and market size Channel analysis The adoption of the latest medical technologies,including those used in minimally invasive surgeries.There is immediate o

69、pportunity for MedTech companies to capture the excess demand for their products.And the companies who best capture this excess demand will do so by having a good understanding of the demand curves in various countries.10|Post COVID-19 MedTech Industry View on Surgical Procedure BacklogReferences 1.

70、IQVIA MedTech Market Monitor,2022.2.Organization for Economic Cooperation and Development.The National Health Service(NHS)Adapted from The Information Services Division(ISD),a division of National Services Scotland,part of NHS Scotland.The Department of Health Northern Ireland.3.Minister of health L

71、abour and Welfare:2nd NDB Open Data.4.Agence technique de linformation sur hospitalisation(ATIH),National Statistics France,Organization for Economic Cooperation and Development.5.Australian Institute of Health and Welfare(AIHW).Australian Bureau of statistics,Organization for Economic Cooperation a

72、nd Development.6.Federal Statistical Office DESTATIS,Federal Bank,Organization for Economic Cooperation and Development.7.Johns Hopkins University&Medicine Coronavirus Resource Center.(https:/coronavirus.jhu.edu/map.html)|11About the authorsPAUL BUEHLERDirector,Global Information Offerings,IQVIA Med

73、TechPaul has over 20 years of experience working with life sciences companies throughout all stages of the Commercial and Strategy Development process.Throughout his career,Paul has built and managed many local and global commercial information offerings and has led various consulting,operations and

74、 services teams.In his current role,he is responsible for IQVIAs global commercial information offerings specifically related to the Medical Technology segment.This includes product development and management,as well as data acquisition and commercialization.Paul holds a Bachelor of Science in Marke

75、ting and Finance and an MBA from Temple University.SARA CHAPA MARRONManager,Client Services,IQVIA MedTechSara is an expert on the surgical coding systems used around the world and has expertise in data acquisition,analytics,and integration.She is currently the Client Service Manager within the IQVIA

76、 Global MedTech team and her main responsibility in working with MedTech clients to help them create data driven approaches for answering business questions that are critical to their business.Sara holds a Bachelors Degree in Business Management and Marketing,and a Masters in Digital transformation of the healthcare and pharmaceutical industry.CONTACT USMMM-I 2023.All rights reserved.IQVIA is a registered trademark of IQVIA Inc.in the United States,the European Union,and various other countries.2023.03.MT