This report originally appeared in the March 2012 print edition of DOTmed Business News.

Anesthesia is now safer than ever. Over the past 25 years, anesthesia-related mortality rates have dramatically decreased from one death per 5,000 anesthetics administered, to one death per 200,000-300,000 anesthetics administered, according to the American Society of Anesthesiologists. In layman's terms: a person is 40 times more likely to be struck by lightning than they are to die from anesthesia.

Despite these improvements, as many as one in four patients postpone surgery due to lack of understanding and apprehension about anesthesia, according to the ASA’s Vital Health Report from 2010. And on its website, the National Institute of General Medical Sciences says that for elderly patients and those with certain chronic, systemic diseases like diabetes, general anesthetics are still among the most dangerous drugs used by doctors.

To counteract this, in October, the Anesthesia Quality Institute pioneered the Anesthesia Incident Reporting System, the first nationwide system that collects data including anesthesia-related issues from real, individual cases. As a means of improving patient safety, AQI aims to use this data to educate those in the industry and identify emerging trends in anesthesia patient safety, including the introduction of new drugs or devices.

Anesthesia’s device market: Companies battle for market share
Between 2009 and 2010, the value of the U.S. anesthesia, respiratory and sleep-management device market increased 3.7 percent to more than $2.5 billion. Fueled by anesthesia information management system sales, the overall market is estimated to grow at a midlevel, single-digit rate, reaching $4 billion by 2017, according to iData Research’s May report, “U.S. Market for Anesthesia, Respiratory and Sleep Management Devices.”

But emptier wallets are driving providers to demand more cost-effective products. An increasing number of sicker patients are being admitted to the hospital, placing a greater strain on health care resources, according to Kelly Barritt, senior market analyst in clinical care for research group InMedica.

“Following from the economic recession, clinicians are starting to make more informed purchasing decisions to ensure they get the best return on investment; demand for anesthesia devices is expected to decrease as a consequence,” she explains.

The anesthesia delivery unit market, in particular, is also getting more competitive. Picis, GE Healthcare, Draeger, IMDsoft, Merge and Philips are now releasing low-cost, low-acuity models to compete with Mindray Medical International Ltd., MAQUET and Penlon and other firms that have recently entered the market. Unit sales are forecasted to increase through 2017 as a result of these lower cost devices coming out, adds iData’s report.
Across the industry and on a promotional level, OEMs are knocking down prices to levels never before seen, notes Ashish Dhammam, regional sales director for refurb company Soma Technology. But buying secondhand still remains a much cheaper option.

“In general, if you were to buy a new piece of equipment from us, you would save up to 60 percent — I’m talking list price savings,” he says.

Barritt notes that beyond cost, the big focus for most anesthesia device manufacturers is getting a complete solution in place for hospitals.
“Products that provide a total solution for anesthesia care, including integrated decision support, intelligent alarms, and enhanced monitoring and visualization systems are in most demand,” she explains.

AIMS: What’s driving the driver
Anesthesia information management systems, or AIMS, is the big talk in the sector today. The systems, which track vital information about anesthesia being delivered during surgery, are being increasingly recognized as a vital link in patient care. “They will help us by harnessing the computational power to better control care we deliver during surgery, much as advanced avionics systems make complex and safer aircraft possible,” says ASA president, Dr. Jerry Cohen.

This year, the AIMS market is predicted to skyrocket, growing by more than 50 percent. The growth can largely be attributed to U.S. legislation that requires hospitals to automate data collection in their anesthesia departments by 2015 as part of the implementation of electronic medical records, according to iData’s report.

AIMS are thought to help decrease malpractice claims by streamlining workflow. Yet, in a report last April, market research group KLAS found more optimism than actual adoption in the AIMS market. Between 2007 and 2010, the number of surgery departments using AIMS increased from 6 percent to 26 percent, with 63 percent of hospitals using only surgery systems stating they plan on purchasing an AIMS.

Vendors claiming the largest share of the AIMs market include Cerner, Draeger, GE, Philips and Picis, according to KLAS’ report.

Hospitals using AIMS designed for the perioperative market realized big savings. The average hospital saved $584,000 a year using such systems, and the hospital’s three-year investment of $1.3 million generated a positive ROI in 8 months, according to a 2008 white paper by financial research firm Hobson & Co.

For the anesthesia sector in particular, meaningful use requirements highlight the need for improved connectivity between the various devices in the patient care environment, including those in the OR, according to Risto Rossi, global anesthesia segment leader, premium life care solutions, for GE Healthcare’s Helsinki branch.

In the next five years, as sophisticated AIMS and EMR technology drives the market, equipment must keep up, as well as offer cost saving advantages and time efficiency. Devices such as MAQUET Medical System USA's Flow-i Anesthesia Delivery System — which received FDA 510(k) clearance in June of 2011 and is the newest anesthesia system on the market — are designed with this in mind, including a communication port for remote diagnostic and repair services. Nancy Werfel, MAQUET’s marketing manager for anesthesia, notes that Flow-i’s comprehensive service, availability of parts and reduced downtime are important components.



Low-flow anesthesia: Another cost-effective route
Back in 1996, a European Journal of Anesthesiology paper noted that the reduction in fresh gas flow offered opportunities for significant cost savings and reduced workplace environmental impacts. Rossi notes that this observation is probably even timelier right now as providers are constantly tasked to provide high quality care while simultaneously lowering costs.

“We in GE Healthcare have definitely seen an increased awareness among anesthesiologists for low-flow anesthesia,” Rossi says. “Globally, we have seen our customers responding positively to our low-flow enabled anesthesia systems and Advanced Breathing System platform products—Aisys, Avance and AespireView.”


Although low-flow anesthesia is currently used more frequently in Europe, more and more U.S. clinicians are administering flows close to 2L and below, according to Werfel. Products like the Flow-I system have the capability to support low-flow anesthesia with settings as low as 0.3L.

“I think that there are definite advantages to low-flow anesthesia, such as less pollution, less patient heat loss, and fewer anesthetics used,” says Dr. Ashley Ryan, an anesthesiologist at Oconee Regional Medical Center in Milledgeville, Ga.

Low-flow gasses are especially useful because they release less exhaled volatile anesthetic into the atmosphere, which reduces the environmental imprint anesthesiologists make as they care for their surgical patients.

“In addition, low flow uses less anesthetic, thereby saving cost without compromising safety,” Cohen says.

In demand: Products, features and new technologies everyone’s talking about
On the used market side, some dealers are reporting that buyers now want newer models. Historically, 10- to 20-year-old Ohmeda Excel 110 Anesthesia Machines and Draeger Narkomed 2A and 2B anesthesia systems were in demand, according to Dhammam, a dealer. But today, GE’s Aestiva/5 and Aespire systems, and Draeger’s Fabius products, are probably the most popular anesthesia machines in the U.S., he adds.

“I attribute that to obsoletion of equipment,” says Dhammam. “Many hospitals switch to a different product every time a manufacturer decides to stop supporting equipment with parts, even if their equipment still has a lot of life left in it.”

Aside from reassurance that the technology they purchase will not become prematurely obsolete, hospitals prefer equipment that is compatible with other vital equipment and electronic medical records. Because of this trend, new equipment offers regular software updates and enhanced features via USB.

In addition, the patient population’s continuous trend towards sicker, older, younger or more morbidly obese patients undergoing surgical procedures is also having an effect on the anesthesia market.

“There is a greater need for advanced ventilation capabilities to support the ventilatory challenges of these patients,” Werfel says.

Ryan, who uses MAQUET’s Servo-i ICU ventilator, the company’s Kion-i anesthesia machine and the new Flow-i anesthesia machine, notes that the biggest trends include regional anesthesia, as well as implementing transthoracic echocardiography into the practice of the general anesthesiologist, video laryngoscopy, and continuous CO2 monitoring for all patients, including sedation cases. He believes that the market has a lot of room for improvement.

“I think that the market for anesthesia where we will potentially see quite a bit of advancement will be in the improvement and implementation of noninvasive cardiac output measurements as well as the continued development in the electronic charting programs for anesthesia providers,” Ryan says.

Ryan also believes China may flex its manufacturing muscle, flooding the market with products that may be “average to below average anesthesia machines and other products, but [nonetheless] appealing because of the difference in cost.”

The global anesthesia market will continue growing and demanding new solutions to address issues such as cost pressures, care quality focus and affordable, accessible solutions, according to Rossi.

“It seems that the anesthesia market will see faster growth in the developing world as buying power increases,” he says. “Developed markets will focus on ensuring that information in their systems is put to good use, by continuing to link devices to each other and the electronic medical record.”

DOTmed Registered 2012 - Anesthesia Companies

Names in boldface are Premium Listings.
Domestic
Arthur Zenian, enBio, Corp., CA
Tim Sullivan, Universal Vaporizer Support, CA
Rafael Bolivar, SOMA Technology, CT
Sam Joshi, MAQUET Medical Systems USA, NJ
Julie Gutterman, PULSE Consultants, OH
Lisa Vanasco, Ready Medical, CA
James Ruggerio, Mercury Medical, FL
Monte Montain, Alternative Source Medical, GA
DOTmed Certified
Stojan Bozinovski, Keeboshop, IL
Bob Gaw, PRN, MA
DOTmed Certified
Aaron Frye, Doctors Depot, Inc., FL
DOTmed Certified
DOTmed 100
Clinton Courson, Quest Medical Supply, Inc., FL
DOTmed Certified
DOTmed 100
Dave Wayne, SE Medical Systems, GA
Brad Rumph, Heartland Medical, KY
Alda Clemmey, Saffire Medical, MA
DOTmed Certified
DOTmed 100
Jacqueline Michaud, Medical Service Solutions, LLC, MD
DOTmed Certified
Thomas Green, Paragon Service, MI
Lawrence Maroney, Integris Equipment, NY
DOTmed Certified

International
Patrick Chapus, AGITO Medical, France
DOTmed 100
Jose Morillo, J Morillo Sistemas Biomedicos, Venezuela
Welshen Gao, Dododo Medical Equipment, China