Breast Cancer Imaging South America Analysis and Market Forecasts. GDME1036CFR / Published May 2013

Transcription

1 Breast Cancer Imaging South America Analysis and Market Forecasts GDME1036CFR / Published May 2013

2 Executive Summary Breast Cancer Imaging: Key Metrics in South American* markets 2011 Market Sales Brazil $42m Key Features of the Report Number of imaging techniques covered 17 Number of marketed products analyzed 51 Competitors profiled 17 Key Events ( ) Results of the Oslo Breast Cancer Screening Trial Results of the TOMMY trial Food and Drug Administration (FDA) approval of GE Healthcare and Siemens Healthcare tomosynthesis systems 2018 Market Sales Level of Impact Brazil $71m Source: GlobalData, 2013 South America = Brazil breast cancer imaging market GlobalData calculated the South American (Brazil) breast cancer imaging market to be worth $42m in 2011 and estimates that it will be worth $71m in 2018, increasing at a Compound Annual Growth Rate (CAGR) of 8% during this time period. The key drivers for the South American breast cancer imaging market are: Increase in the incidence of breast cancer Increased awareness of the benefits of screening Increased breast cancer incidence due to an aging population FDA reclassification of mammography equipment New technologies to drive growth in the market Adoption of digital mammography units in South America The key barriers for the South American breast cancer imaging market are: A shortage of dedicated breast radiologists High capital Investment for full-field digital mammography (FFDM) and tomosynthesis in the face of reduced hospital budgets Refurbished equipment sales Reimbursement issues Page 2 GDME1036CFR / Published MAY 2013

3 Executive Summary Significant Unmet Needs and Challenges for the South American Breast Cancer Imaging Market Even though the South American breast cancer imaging market is a mature one, it has significant needs that still have not been met. Some of these include exposure to ionizing radiation during mammographic examinations, patient discomfort due to compression of the breasts, unreliable mammograms in breasts that have been operated on and breasts with implants, a high number of false-positives and false-negatives, loss of mammography sensitivity in dense breasts, and limited training provided to technicians by equipment manufacturers. A few of these unmet needs are being addressed to a certain extent by using modalities such as ultrasound imaging and magnetic resonance imaging (MRI) in conjunction with mammography. However, there is a still a lot of room for improvement within the market, and new technologies currently in development that overcome these drawbacks show promise for the future. Future Landscape The South American breast cancer imaging market is primarily driven by the increasing incidence of breast cancer. It is also fueled by the need to overcome the drawbacks posed by film screen mammography, which is the most widely used technique for breast cancer detection and diagnosis in this region. GlobalData anticipates that newer technologies, such as digital mammography and tomosynthesis, will drive the future growth of this market. Tomosynthesis is predicted to be the new gold standard in the near future, with high adoption is western countries, including the US, due to its promising increase in cancer detection and reduction of false-positives, which are key concerns with mammography. In Brazil, FFDM systemswill continue to grow rapidly with a modest uptake in tomosynthesis, since digital mammography has yet to be widely adopted in these regions and the breast cancer incidence is rising steadily. What do Physicians Think? Radiologists feel that mammography is not an ideal tool for breast screening and there are significant unmet needs. Mammography is a useful tool, but it s a bad technique. Key Opinion Leader, January 2013 The biggest challenge [is] to have patient comfort [during] mammography, that s number one, I think Key Opinion Leader, January 2013 Radiologists feel strongly that tomosynthesis is very promising and will most likely replace digital mammography, the current paradigm. Mammography is a useful tool, but it s a bad technique. Key Opinion Leader, January 2013 I think there is space for everything...but the word is digital, the word is 3D.[The] breast is a 3D organ. Why should we look at [it] in 2D images? Key Opinion Leader, January 2013 If it s [tomosynthesis] going to find more cancers and fewer recalls, then it should be a win-win. Key Opinion Leader, December 2012 I ll tell you today that I am 95% sure that tomosynthesis is mammography s future and conventional mammography is gone. Key Opinion Leader, January 2013 Page 3 GDME1036CFR / Published MAY 2013

4 Executive Summary If I have to put money in something, I will put it in tomosynthesis and MRI [in the] short term [and in the] long term, maybe.. molecular imaging techniques. Key Opinion Leader, January 2013 Radiologists feel that the impact of tomosynthesis compared with digital mammography is much greater in comparison to the change from analog to digital mammography. The change from analog to digital mammography [in the US], went so fast, so quickly. amazing, now almost 90% [adoption]...if you look at the FDA site 90% [adoption], I mean it is incredible. So, what my way of thought is, I say, look if from analog to digital, it was not such a big deal, by that I mean it was the same technology, only digital The difference was not so big [so only small improvement], like it is from mammography to tomosynthesis. You are talking about [image] slices; you are talking about 3D [imaging] [so large improvement].i think, the gain between digital [2D FFDM] and tomo[synthesis] is much, much, much higher than it was from analog to digital. Key Opinion Leader, January 2013 Radiologists feel that there is not enough commitment from the manufacturers towards technician training. A banker can buy a machine much faster than anyone out there, right? But I mean the banker cannot get a good image. Key Opinion Leader, January 2013 Training is needed because if the technician has not given good positioning, whatever good factors may be there, good equipment may be there, you won t be able to see things. Key Opinion Leader, December 2012 Radiologists feel that in the future, they foresee more emphasis being placed on lowering radiation dose. [On future market trends] there is going to be more emphasis on low [radiation] dose, understanding breast density, and being efficient doing more with less. Key Opinion Leader, December 2012 If there is a good product which does good imaging and it has low [radiation] dose and it s reliable, then it may be of value. Key Opinion Leader, December 2012 Page 4 GDME1036CFR / Published MAY 2013

5 1 Table of Contents 1 Table of Contents List of Tables List of Figures Introduction Catalyst Disease Overview Anatomy & Physiology of the Breast Pathophysiology of Breast Cancer Detection of Breast Cancer Types of Breast Cancer Clinical Presentation Clinical Outcomes Assessment Procedure Screening Guidelines Epidemiology of Breast Cancer Economic Impact of Breast Cancer Imaging Imaging Techniques Mammography Overview Types of Mammography Non-Mammographic Techniques Breast Ultrasound Imaging Breast Magnetic Resonance Imaging Comparison of Mammography, Ultrasound, and MRI Alternative Breast Imaging Techniques Nuclear Imaging Techniques Computed Tomography Page 5 GDME1036CFR / Published MAY 2013

6 4.4.3 Optical Breast Imaging Electric Impedance-Based Techniques Thermography Elastography Ductogram Competitive Assessment Overview Film Screen Mammography Performa (GE Healthcare) Alpha RT/Alpha ST (GE Healthcare) MAMMOMAT 1000 (Siemens Healthcare) MAMMOMAT 3000 Nova (Siemens Healthcare) M-IV/M-IV Platinum (Hologic) MammoDiagnost (Philips Healthcare) Planmed Nuance Classic (Planmed) Planmed Sophie Classic (Planmed) Analog Giotto Image (Internazionale Medico Scientifica) HAWK-2M (Hologic) MGU-1000A (Toshiba Medical Systems) CR Mammography Fuji Computed Radiography Mammography Suite (FCRMS) (Fujifilm Medical Systems) KODAK DirectView (Carestream Health) Xpress CR System (Konica Minolta) REGIUS PureView (Konica Minolta) Agfa CR Mammography Systems (DX-M, CR 30-Xm, and CR 85-X) (Agfa Healthcare) Full-Field Digital Mammography Selenia Dimensions (Hologic) Page 6 GDME1036CFR / Published MAY 2013

7 5.4.2 Selenia (Hologic) Selenia S (Hologic) Selenia Performance (Hologic) Senographe DS (GE Healthcare) Senographe Essential (GE Healthcare) Senographe Care (GE Healthcare) SenoBright CESM (GE Healthcare) MAMMOMAT Inspiration (Siemens Healthcare) Aspire HD (US)/Amulet (Outside the US) (Fujifilm) MammoDiagnost DR (Philips Healthcare) MicroDose (Philips Healthcare) Giotto Image 3D/3DL (Internazionale Medico Scientifica) Planmed Nuance/Nuance Excel (Planmed) Fairy DR (Allengers Medical Systems) Serenity D Mammography Selenia Dimensions 3D System (Hologic) GE Breast Tomosynthesis (GE Healthcare) True 3D Breast Tomosynthesis (Siemens Healthcare) Giotto Tomo (Internazionale Medico Scientifica) FUJIFILM 3Dimensional Mammography (Fujifilm) Breast Ultrasound Imaging somo.v Automated Breast Ultrasound (ABUS) (GE Healthcare) SonoCine AWBUS (SonoCine) ACUSON S2000 ABVS (Siemens Healthcare) Terason t3200 Ultrasound System Breast Series (Terason Ultrasound) Breast MRI Aurora 1.5T Dedicated Breast MRI System (Aurora Imaging Technology) Page 7 GDME1036CFR / Published MAY 2013

8 5.8 Other Breast Imaging Techniques PEM Flex Solo II (Naviscan) Computerized Tomography Laser Mammography (CTLM) Model 1020 (Imaging Diagnostic Systems) Dilon 6800/Dilon 6800 Acella (Dilon Diagnostics) LumaGEM (Gamma Medica) Discovery NM 750b (GE Healthcare) Unmet Needs Lower Radiation Dose Increase Patient Comfort Reduce False-Positives and False-Negatives Loss of Sensitivity of Mammography in Dense Breasts Unreliable Mammograms in Surgically-Operated Breasts and Breasts with Implants Commitment to Training Pipeline Products Breast Cancer Imaging Pipeline Products Overview MAMMOMAT Inspiration PRIME Edition Overview SWOT Analysis MicroDose SI Overview SWOT Analysis Selenia Dimensions 2D Contrast-Enhanced Digital Mammography (CEDM) Overview SWOT Analysis SenoCase Overview SWOT Analysis Page 8 GDME1036CFR / Published MAY 2013

9 7.6 Electrical Mammogram Overview SWOT Analysis Industry Overview Purchasing Cycle Product Life Cycle Cost Effectiveness in Screening Settings Cost-Effectiveness in Diagnostic Settings Market Access Purchasing Decisions Regulatory Process Quality Assurance Adoption of New Technologies Influence of Clinical Trials Results Reimbursement Economic Resources Competitive Advantage Current Reimbursement Trends Trends in Detector Technology for Digital Mammography Evolving Scatter-Removal Mechanisms Overdiagnosis Malpractice Litigations Mergers and Acquisitions/Key Partnerships GE Healthcare Acquires U-Systems Koninklijke Philips Electronics Acquires MicroDose Mammography from Sectra Hologic Acquires Beijing Healthcome Technology Hologic Acquires Sentinelle Medical Koninklijke Philips Electronics Acquires Shanghai Apex Electronics Technology 186 Page 9 GDME1036CFR / Published MAY 2013

10 Fujifilm Medical Systems acquired FUJIFILM-RU Other Key Events Current and Future Players Overview Trends in Corporate Strategy Company Profiles GE Healthcare Hologic Siemens Koninklijke Philips Electronics Fujifilm Medical Systems Internazionale Medico Scientifica (IMS) Planmed Konica Minolta Medical Imaging Agfa Healthcare Carestream Health SonoCine Aurora Imaging Technology Imaging Diagnostic Systems Naviscan Dilon Diagnostics Gamma Medica Allengers Medical Systems Market Drivers & Opportunities Market Drivers Increase in the Incidence of Breast Cancer Increased Awareness of the Benefits of Screening Increased Breast Cancer Incidence Due to an Aging Population Page 10 GDME1036CFR / Published MAY 2013

11 FDA Reclassification of Mammography Equipment New Technologies to Drive Market Growth Adoption of Digital Mammography Units in South America Opportunities Emerging Economies Promise Future Growth Invest in Emerging Technologies Product Improvement Market Barriers Shortage of Dedicated Mammography Professionals Reduced Hospital Budgets Refurbished Equipment Sales Reimbursement Substitutes Country Outlooks & Forecasts Brazil Brazil Market Analysis Appendix Bibliography Abbreviations Report Methodology Overview Coverage Secondary Research Forecast Methodology Physicians and Specialists Included in this Study Primary Research Physician Survey About the Authors Page 11 GDME1036CFR / Published MAY 2013

12 Analysts Global Head of Healthcare Definitions About MediPoint About GlobalData Contact Us Disclaimer Page 12 GDME1036CFR / Published MAY 2013

13 1.1 List of Tables Table 1: Breast Cancer Types, Including Diagnostic Procedures Table 2: ACR Breast Imaging Reporting and Database System (BI-RADS) Table 3: Breast Cancer Incidence Rates in Brazil, Table 4: Comparison of Mammography, Ultrasound, and MRI for Breast Imaging Table 5: Performa Product Profile Table 6: Performa SWOT Analysis Table 7: Alpha RT/Alpha ST Product Profile Table 8: Alpha RT/Alpha ST SWOT Analysis Table 9: MAMMOMAT 1000 Product Profile Table 10: MAMMOMAT 1000 SWOT Analysis Table 11: MAMMOMAT 3000 Nova Product Profile Table 12: MAMMOMAT 3000 Nova SWOT Analysis Table 13: M-IV/M-IV Platinum Product Profile Table 14: M-IV/M-IV Platinum SWOT Analysis Table 15: MammoDiagnost Product Profile Table 16: MammoDiagnost SWOT Analysis Table 17: Planmed Nuance Classic Product Profile Table 18: Planmed Nuance Classic SWOT Analysis Table 19: Planmed Sophie Classic Product Profile Table 20: Planmed Sophie Classic SWOT Analysis Table 21: Analog Giotto Image Product Profile Table 22: Analog Giotto Image SWOT Analysis Table 23: HAWK-2M Product Profile Table 24: HAWK-2M SWOT Analysis Table 25: MGU-1000A Product Profile Table 26: MGU-1000A SWOT Analysis Table 27: Fuji Computed Radiography Mammography Suite (FCRMS) Product Profile Page 13 GDME1036CFR / Published MAY 2013

14 Table 28: Fuji Computed Radiography Mammography Suite (FCRMS) SWOT Analysis Table 29: KODAK DirectView CR System Product Profile Table 30: KODAK DirectView CR System SWOT Analysis Table 31: Xpress CR System Product Profile Table 32: Xpress CR System SWOT Analysis Table 33: REGIUS PureView Product Profile Table 34: REGIUS PureView SWOT Analysis Table 35: Table 36: Agfa CR Mammography Systems (DX-M, CR 30-Xm, and CR 85-X) Product Profile Agfa CR Mammography Systems (DX-M, CR 30-Xm, and CR 85-X) SWOT Analysis Table 37: FFDM SWOT Analysis Table 38: Selenia Dimensions Product Profile Table 39: Selenia Dimensions SWOT Analysis Table 40: Selenia Product Profile Table 41: Selenia SWOT Analysis Table 42: Selenia S Product Profile Table 43: Selenia S SWOT Analysis Table 44: Selenia Performance Product Profile Table 45: Selenia Performance SWOT Analysis Table 46: Senographe DS Product Profile Table 47: Senographe DS SWOT Analysis Table 48: Senographe Essential/Senographe Essential E Product Profile Table 49: Senographe Essential SWOT Analysis Table 50: Senographe Care Product Profile Table 51: Senographe Care SWOT Analysis Table 52: SenoBright CESM Product Profile Table 53: SenoBright CESM SWOT Analysis Table 54: MAMMOMAT Inspiration Product Profile Page 14 GDME1036CFR / Published MAY 2013

15 Table 55: MAMMOMAT Inspiration SWOT Analysis Table 56: Aspire HD/Amulet Product Profile Table 57: Aspire HD/Amulet SWOT Analysis Table 58: MammoDiagnost DR Product Profile Table 59: MammoDiagnost DR SWOT Analysis Table 60: MicroDose Product Profile Table 61: MicroDose SWOT Analysis Table 62: Giotto Image 3D/3DL Product Profile Table 63: Giotto Image 3D/3DL SWOT Analysis Table 64: Planmed Nuance/Nuance Excel Product Profile Table 65: Planmed Nuance/Nuance Excel SWOT Analysis Table 66: Fairy DR Product Profile Table 67: Fairy DR SWOT Analysis Table 68: Serenity Product Profile Table 69: Serenity SWOT Analysis Table 70: Selenia Dimensions 3D System Product Profile Table 71: Selenia Dimensions SWOT Analysis Table 72: GE Breast Tomosynthesis Product Profile Table 73: GE Breast Tomosynthesis SWOT Analysis Table 74: True 3D Breast Tomosynthesis Product Profile Table 75: True 3D Breast Tomosynthesis SWOT Analysis Table 76: Giotto Tomo Product Profile Table 77: Giotto Tomo SWOT Analysis Table 78: FUJIFILM 3Dimensional Mammography Product Profile Table 79: FUJIFILM 3Dimensional Mammography SWOT Analysis Table 80: somo.v ABUS Product Profile Table 81: somo.v ABUS SWOT Analysis Table 82: SonoCine AWBUS Product Profile Page 15 GDME1036CFR / Published MAY 2013

16 Table 83: SonoCine AWBUS SWOT Analysis Table 84: ACUSON S2000 ABVS Product Profile Table 85: Acuson S2000 ABVS SWOT Analysis Table 86: Terason t3200 Ultrasound System Breast Series Product Profile Table 87: Terason t3200 Ultrasound System Breast Series SWOT Analysis Table 88: Aurora 1.5T Dedicated Breast MRI System Product Profile Table 89: Aurora 1.5T Dedicated Breast SWOT Analysis Table 90: PEM Flex Solo II Product Profile Table 91: PEM Flex Solo II SWOT Analysis Table 92: Table 93: Computerized Tomography Laser Mammography (CTLM) Model 1020 Product Profile Computerized Tomography Laser Mammography (CTLM) Model 1020 SWOT Analysis Table 94: Dilon 6800/Dilon 6800 Acella Product Profile Table 95: Dilon 6800/Dilon 6800 Acella SWOT Analysis Table 96: LumaGEM Product Profile Table 97: LumaGEM SWOT Analysis Table 98: Discovery NM 750b Product Profile Table 99: Discovery NM 750b SWOT Analysis Table 100: Breast Cancer Imaging Pipeline Products Table 101: MAMMOMAT Inspiration PRIME Edition SWOT Analysis Table 102: Philips MicroDose SI SWOT Analysis Table 103: Selenia Dimensions 2D Contrast Imaging SWOT Analysis Table 104: SenoCase SWOT Analysis Table 105: Electrical Mammogram SWOT Analysis Table 106: Other Key Events in the Breast Cancer Imaging Market Table 107: GE Healthcare SWOT Analysis, Table 108: Hologic SWOT Analysis, Table 109: Siemens SWOT Analysis, Page 16 GDME1036CFR / Published MAY 2013

17 Table 110: Koninklijke Philips Electronics SWOT Analysis, Table 111: Fujifilm Medical Systems, SWOT Analysis, Table 112: Internazionale Medico Scientifica SWOT Analysis, Table 113: Planmed, SWOT Analysis, Table 114: Konica Minolta Medical Imaging, SWOT Analysis, Table 115: Agfa Healthcare, SWOT Analysis, Table 116: Carestream Health, SWOT Analysis, Table 117: SonoCine, SWOT Analysis, Table 118: Aurora Imaging Technology, SWOT Analysis, Table 119: Imaging Diagnostic Systems, SWOT Analysis, Table 120: Naviscan, SWOT Analysis, Table 121: Dilon Diagnostics, SWOT Analysis, Table 122: Gamma Medica, SWOT Analysis, Table 123: Allengers Medical Systems, SWOT Analysis, Table 124: Sales Forecasts for Breast Cancer Imaging in Brazil, Table 125: Physicians Surveyed, By Country Page 17 GDME1036CFR / Published MAY 2013

18 1.2 List of Figures Figure 1: Anatomy of the Breast Figure 2: Breast Cancer Screening, Diagnostic Evaluation, and Follow-Up Figure 3: Percentage Use of Ultrasound Imaging and MRI for Breast Cancer Screening and Follow-Up, Figure 4: Breast Cancer Risk Factors Figure 5: Projected Breast Cancer Incidence in Brazil, Figure 6: Comparison Between Digital (FFDM) and Analog (FSM) Mammography Figure 7: Use of Alternative Breast Imaging Modalities, Figure 8: Performa Figure 9: Alpha RT Figure 10: Alpha ST Figure 11: MAMMOMAT Figure 12: MAMMOMAT 3000 Nova Figure 13: M-IV/M-IV Platinum Figure 14: MammoDiagnost Figure 15: Planmed Nuance Classic Figure 16: Planmed Sophie Classic Figure 17: Analog Giotto Image Figure 18: HAWK-2M Figure 19: MGU-1000A Figure 20: Aspire CRm Figure 21: KODAK DirectView CR System Figure 22: Xpress CR System Figure 23: REGIUS PureView Type M Figure 24: DX-M Digitizer Figure 25: Selenia Dimensions Figure 26: Selenia Figure 27: Selenia S Page 18 GDME1036CFR / Published MAY 2013

19 Figure 28: Selenia Performance Figure 29: Senographe DS Figure 30: Senographe Essential Figure 31: Senographe Care Figure 32: SenoBright CESM* Figure 33: MAMMOMAT Inspiration Figure 34: Aspire HD Figure 35: MammoDiagnost DR Figure 36: MicroDose Figure 37: Giotto Image 3D/3DL Figure 38: Planmed Nuance/Nuance Excel Figure 39: Fairy DR Figure 40: Serenity Figure 41: Selenia Dimensions 2D System Figure 42: Senographe Essential Figure 43: True 3D Breast Tomosynthesis* Figure 44: Giotto Tomo Figure 45: Fujifilm 3D Mammography Viewer Figure 46: somo.v ABUS Figure 47: SonoCine AWBUS Figure 48: ACUSON S2000 ABVS Figure 49: Terason t3200 Ultrasound System Breast Series Figure 50: Aurora 1.5T Dedicated Breast MRI System Figure 51: PEM Flex Solo II Figure 52: CTLM Model Figure 53: Dilon 6800 Acella Figure 54: Dilon Figure 55: LumaGEM Page 19 GDME1036CFR / Published MAY 2013

20 Figure 56: Discovery NM 750b Figure 57: Percentage of False-Positive, False-Negative and Accurate Breast Cancer Diagnoses from Figure 58: SenoCase Figure 59: Product Life Cycle Figure 60: Detector Evolution Figure 61: Comparison Between a Typical Direct Conversion Detector and a Direct Optical Switching Detector Figure 62: Photon-Counting Detector Technology Figure 63: Linear and High Transmission Cellular Grids Figure 64: Increase in FFDM Systems in the US, Figure 65: Trends in the Use of Mammographic Techniques, Figure 66: Sales Forecasts for Breast Cancer Imaging in Brazil, Page 20 GDME1036CFR / Published MAY 2013

21 Introduction 2 Introduction Breast cancer is the most common form of cancer in women in both the developed and developing world, but is a rare disease in men. The global incidence of breast cancer is increasing due to an increased lifespan and increasing adoption of a westernized lifestyle, which is associated with an increased risk of the disease. Early diagnosis of breast cancer is the foundation for increasing survival rates, and diagnostic imaging is the most widely used technique to achieve early detection, making it a cornerstone of breast cancer control. Diagnostic imaging is used for the early detection of breast cancer in asymptomatic patients in population-based screening programs in most developed countries, or for opportunistic screening in developing nations. Regardless of these differences, imaging has proved to be an indispensable tool in fighting breast cancer and has been proven to reduce mortality. This report provides an analysis of the mammography market in relation to dedicated breast cancer screening and diagnosis in South America (Brazil) and identifies the unmet needs in the market. This report also discusses physician attitudes towards current breast cancer screening and diagnostic techniques, and the future of breast cancer imaging modalities in the face of rapid technological advancements. 2.1 Catalyst The South American breast cancer imaging market is a mature industry with complex dynamics. Therefore, it is essential to examine the market opportunities and barriers that are specific to this region. This report provides an in-depth review of the evolving technologies and the regulatory landscape in the South American breast cancer imaging market. Another key issue, that is discussed, is that purchasing decisions concerning breast cancer screening and diagnostic imaging equipment are complex. Firstly, breast cancer screening and diagnosis involves the challenge of making major purchasing decisions concerning new capital equipment in a technologically fast-evolving market. Secondly, diagnostic imaging modalities are often multipurpose in nature, and so equipment purchasing decisions are not solely driven by the needs of breast cancer screening and diagnosis. For example, a diagnostic mammogram is accompanied by ultrasound imaging in over 50% of cases, but the ultrasound equipment also has various other applications for imaging other parts of the human body. Since the prevalence of breast cancer is higher in women than in men, this report is restricted to the use of imaging techniques for breast cancer screening and diagnosis in women. Page 21 GDME1036CFR / Published MAY 2013

22 Appendix 12.9 About MediPoint MediPoint is the flagship product for GlobalData s Medical team. Each MediPoint report is built from the ground up by our team of healthcare analysts in the US and UK. Each report includes input from experienced physicians and leading Key Opinion Leaders (KOLs). Running throughout each report in the series, What Physicians Think quotes provide a unique insight into how healthcare professionals are reacting to events within the industry, and what their responses could mean for industry strategists About GlobalData GlobalData is a leading global provider of business intelligence in the Healthcare industry. GlobalData provides its clients with up-to-date information and analysis on the latest developments in drug research, disease analysis, and clinical R&D. Our integrated business intelligence solutions include a range of interactive online databases, analytical tools, reports, and forecasts. Our analysis is supported by a 24/7 client support and analyst team. GlobalData has offices in New York, Boston, London, India, and Singapore. Page 260 GDME1036CFR / Published MAY 2013

23 Appendix Disclaimer All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of the publisher, GlobalData. Page 261 GDME1036CFR / Published MAY 2013