The purchase of a large number of super premium systems by teaching institutes and a major inclination by others to stay away from refurbished and competitively priced, imported models reveals the discerning nature of the buyers.
Anesthesiologists work in an increasingly complex technological environment inside and outside of the operating room. Every day, they rely on sophisticated devices to provide safe care to patients. These devices include anesthesia machines, drug delivery systems, physiologic monitors, diagnostic imaging equipment, and electronic health records (EHRs). Anesthesia machine manufacturers are continuously introducing technological advances in their newest machine models. New technology focuses on patient safety as well as optimizing the efficiency of anesthetic delivery and minimizing anesthetic gas waste. Target-controlled low-flow anesthesia systems automate the fresh gas flow rate and vaporizer settings to achieve a specific end-tidal percentage that is set by the anesthesiologist. Each manufacturer continues to explore opportunities to integrate anesthesia machines with hospital information systems, including data sharing with anesthesia information management systems (AIMS) for automatic documentation. Improved connectivity and integration will offer new opportunities to enhance workflow efficiency and patient safety.
Indian Market Dynamics
The Indian anesthesia systems market in 2016 is estimated at Rs.167.5 crore, with sales of 5115 numbers. Super premium segment had excellent sales with the teaching institutes making major procurements. This trend is of course one of a kind, and may not be repeated in 2017. The mainstay continues to be the mid-tier and value segment, which together contributed 53 percent to the market in value terms in 2016. The premium and performance segment each have a market share in the 14 percent vicinity, whereas super value contributes 8.6 percent to the market. The buyer is increasingly exhibiting less inclination for refurbished systems and competitively priced imported models.
The teaching institutes made major procurements, with a preference for the super premium segment. Major buyers in 2016 included AIIMS; NEIGRIHMS (North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences), Shillong; BMSICL (Bihar Medical Services & Infrastructure Corporation) Patna; Indira Gandhi Institute of Medical Sciences, Patna; and AP Health Corporation, Hyderabad. Mindray had good success in this category.
With increasing competition on price, vendors are shifting to offering products from their Chinese partners, rather than European ones, and also focusing on Tier-II and Tier-III cities.
The global anesthesia devices market is estimated at Rs.52,125 crore in 2016, projected to reach Rs.90,500 crore by 2021, at a CAGR of 11.64 percent in the period, 2016 to 2021. Anesthesia and respiratory devices, owing to their capability to resolve various environmental and lifestyle induced respiratory disorders are expected to witness substantial growth. Increasing incidences of respiratory illnesses such as chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are high-impact rendering drivers for this market. Moreover, the increasing base of geriatric population and rising rates of environmental pollution are key drivers.
Based on product type, while anesthesia machines dominate the segment, the positive airway pressure devices are seeing maximum growth in the respiratory devices segment.
Region-wise, maximum growth is expected from the Asia-Pacific market, with rising disposable income, healthcare reforms, and economic development in the region.
Manufacturers are constantly investing and upgrading their product range. Over the past few years, the preference of people has shifted from hospital care to home healthcare services. This has encouraged leading players to introduce varieties of portable medical devices. The availability of a variety of home healthcare devices has propelled the market in the recent past.
The slow adoption rate of AIMS is expected to be a major challenge. However, destinations where the cost of manufacturing anesthesia and respiratory devices is low are expected to offer many growth opportunities to the global market.
Going forward, the global anesthesia and respiratory devices market is expected to benefit from the rise in pulmonary diseases. As per The American Society of Anesthesiologists (ASA), in the US, every year approximately 40 million anesthesia treatments are administered.
A cutting-edge anesthesia management system developed at the University of Washington (UW) Medical Center in Seattle, has generated an estimated return of
USD 1 million annually for the hospital while providing a major boost to patient care. The new Smart Anesthesia Manager (SAM) has resulted in a far more efficient use of expensive inhalation agents.
Developed over the past five years by Dr Bala Nair, PhD, associate professor of anesthesiology and pain medicine, UW, with assistance from other medical center colleagues, SAM has also boosted clinical care. The use of SAM has significantly improved blood pressure, glucose, and antibiotic management, resulting in greater compliance with institutional guidelines. Other benefits include barcode verification of drugs at the time of administration and a handoff tool, particularly helpful for the transfer of care from anesthesia to nursing at the end of a procedure.
In addition to the UW Medical Center, SAM also has been installed at Harborview Medical Center, also in Seattle, and at Ochsner Medical Center in New Orleans.
“Timing of notification is as critical as the decision rule itself. The strategy is to get the provider’s attention in a very optimal fashion without bombarding them with a lot of messages,” Dr Nair said, “You have to balance that.”
Dr Nair began developing SAM in 2009 as a way of building on existing technology that had proved to be limited in its utility. His idea was to build a support module for the AIMS, a documentation system that turned out to have limited ability to improve quality of care and revenue.
The new SAM system conveys a real-time stream of prompts and information, a major upgrade over AIMS. That capability, in turn, has boosted revenue while enabling tighter monitoring on the clinical care side and improved quality of care.
SAM’s savings. SAM’s biggest bottom line impact has been in the use of gas. The system has resulted in far more efficient use of expensive inhalant agents, leading to reduction in use of sevoflurane, desflurane, and isoflurane (28, 33, and 12%, respectively). That change alone has saved the UW Medical Center an estimated USD 120,000 a year.
More efficient billing has been another important benefit. SAM captures charges for procedures that were previously missed through lack of supporting documentation, including some invasive line special procedures and physician attestations. There also has been a significant improvement in billing accuracy and documentation compliance as well. Meanwhile, patient care and safety also has improved. SAM has more than halved extended gaps in blood pressure monitoring at the UW Medical Center, from 15.7 instances per 1000 cases to 6.7 instances. Before SAM, the maximum gap in blood pressure monitoring was 64 minutes, but after the new system was installed, it dropped to 28 minutes.
Additionally, SAM has also proved helpful to clinicians dealing with unusually complex or rare cases. Dr Nair has also developed a handoff tool through SAM that can be used when transferring patient care from one provider to another. SAM will page the ICU or post-anesthesia care unit nurse coordinator when a patient is in transport and print a transfer summary report to supplement a handoff checklist.
Technology has been integrated into almost every facet of anesthesia practice, from patient monitors and anesthesia machines to documentation and drug delivery. In the course of a typical day, anesthesia practitioners care for patients using an array of technologies whose sophistication and utility are continually increasing.
Physiologic monitors. Accelerometers, magnetometers, and gyroscopes in consumer devices such as smartphones and activity trackers allow for monitoring various aspects of individuals’ daily lives, from exercise to sleep. Medical device manufacturers are exploring the role of wearable devices integrated in physiologic monitors. Research groups are integrating wearable devices and motion sensors in patients’ homes to detect cognitive impairment in vulnerable populations, such as older adults. There is potential for growth in this sector, particularly to maximize patient safety on both an inpatient and ambulatory basis. However, the benefits of monitoring physiologic data remotely on an outpatient basis require scrutiny, particularly if such monitoring requires significant time and resources for implementation.
Capnographic analysis. Continuous respiratory monitoring is one of the most essential components of anesthesiologists’ vigilance. Minimally invasive monitoring of ventilation is appealing, particularly for settings outside of the operating room. Noninvasive monitors range from oxygen delivery systems with integrated capnography masks to transcutaneous measuring devices. Anesthesiologists often administer 100 percent inspired oxygen to minimize the risk for hypoxemia during periods of apnea, such as during laryngoscopy.
Surgical blood loss monitoring. Monitoring surgical blood loss is fraught with imperfections. Suction canisters may contain blood and other body or irrigation fluids. Visual estimation based on number of sponges and saturation of sponges also is inaccurate. Weighing sponges is time-consuming and may be inaccurate, particularly if there are other body fluids intermixed with blood.
Simulation. Medical simulation continues to play an integral role in education in the operating room. In 2016, consumer devices for consumption of virtual reality content are entering the market. Generating content is also becoming increasingly easy with consumer cameras. Medical simulation and education may benefit from this increased accessibility. Virtual reality headsets range from the cardboard box frames that house a smartphone to sophisticated devices. The virtual-reality industry is just beginning to find applications in the consumer and healthcare markets.
Consumer and medical device electronics continue to develop at a rapid pace. Will patients take home wearable monitors after discharge from the post-anesthesia care unit? Will anesthesiologists rely on physiologic data recordings during the preoperative period for perioperative counseling and risk stratification? Will immersive virtual reality revolutionize medical simulation and training? The answers to these questions will be an exciting endeavor indeed!