Factors affecting the selection of orthopaedic implant brands and their perceptual mapping

Medical Devices Industry

• Economics-based factors
• Unmet clinical needs due to technology mismatch and existing economy
• Regulatory environment
• Reimbursement policies
• Healthcare providers
• Local market sentiments

Conditions requiring implant surgeries

There is an increase in prevalence of osteoarthritis which leads to more demand of arthroplasty . Osteoarthritis is a degenerative disease caused due to increase in age, genetic disorders, nutritional factors or trauma. It also occurs due to obesity. Estimates suggest that 27 million adults in USA suffer from arthritis (Montserrat Nunez, 2010). Treatment with medication like NSAIDs, exercise and physiotherapy are suggested to patients at an initial stage, but most of them have to opt for joint replacement. Obesity is another disorder which may lead an individual to orthopaedic surgery. Accidents resulting in trauma to the bones require surgical intervention to help the union of bones. Bone problems like scoliosis also require surgery to help the spine regain its original shape. Musculoskeletal conditions are the most common cause of chronic disability. It is also seen that conditions like infective arthritis, rheumatoid arthritis, hip fracture, back problems, dislocations, etc. know no age bounds and hence, can affect patients of any age (Executive Summary - The Orthopedic Industry Annual Report, 2013).

Challenges faced by Indian orthopaedic implant market Despite a growth-oriented market with huge potential, this industry also has to face many challenges.

1. Willingness to opt for surgery: Patients hesitate to opt for surgery due to many reasons such as prolonged recovery period, availability of non-surgical options like yoga, physiotherapy, medication and also due to the fear of infection or failure of implants(Tara Shelton, 2014).

2. Low awareness amongst Indian patients: Surveys conducted in urban areas show that only 10% of the population is actually aware about the detection and prevention of joint problems like osteoporosis (Tara Shelton, 2014).

3. Affordability: The American Academy of Orthopedic Surgeons (AAOS) believes that the cost of implant must be balanced between the outcomes and the affordability for the patient. In other words, higher priced implants must establish superior outcome to justify the additional cost to the patient. This aspect is very c riti cal when it comes to developing and underdeveloped countries (A AOS Position statement).

4. Improper regulatory environment: Orthopaedic implants in India are considered as 'drugs' under the Drug and Cosmetic Act of 1940 which obviously is not favourable to the existing implant industry. The cost of orthopaedic implants is very high since most of them are imported (Mukherjee, 2015).

5. Reluctance to try indigenous products: Orthopaedic surgeons are reluctant to try indigenous brands of implants. In fact, around 75% of medical devices are imported. Following are some other challenges faced by the industry: • Inadequate quality standards hamper the image of Indian-made products. • High import dependency • Lack of tax incentives to promote indigenous products • Inadequacy of skill / talent required in this precision industry

Current strategies used to promote implants include tying up with health insurance firms, focusing on bulk buying hospitals and improving supply chain capabilities for faster deliveries with least costs (Dinesh Peter, Infosys Consulting, 2015).