1. Drug-eluting coronary stent market overview
Zach Eddy, Category Advisor

2. What are drug-eluting coronary stents?
Design
Expandable wire mesh tube
Coated with an antiproliferative drug
Pre-mounted on a balloon catheter delivery system
Function
Inserted into a coronary artery, typically during or immediately after angioplasty
Helps prevent the coronary artery from becoming blocked again (restenosis)
Drug is slowly released over time to help prevent scar tissue growth

3. Primary differentiating attributes
Stent material
Cobalt-chromium, platinum-chromium, and cobalt alloys
Antiproliferative drug
Everolimus, zotarolimus, sirolimus, or ridaforo­limus
Polymer component
Permanent or bioabsorbable
Stent diameter and length
Stent strut thickness
Delivery mechanism

4. Evidence summary
No drug-eluting coronary stent has demonstrated superior clinical or operational outcomes
The XIENCE (Abbott), Promus (Boston Scientific), and Resolute (Medtronic) product families have been extensively studied with published data up to five years after implantation, and all have demonstrated equivalence in clinical and operational outcomes
Existing evidence suggests that the Synergy (Boston Scientific) and Orsiro (Biotronik) stents with bioabsorbable polymer coatings have similar clinical and operational outcomes as permanent polymer stents
The EluNIR (Cordis) stent has the smallest body of evidence and has demonstrated similar clinical outcomes compared to the Resolute family with one year of published data
Source: Lumere analysis of peer-reviewed literature and clinical trials; more information available at app.Lumere.com

5. Recent market activity
Abbott halted sales of their fully absorbable drug-eluting stent (Absorb)
Medtronic gained FDA approval for the Resolute Onyx 2mm
Boston Scientific gained FDA approval for the Promus ELITE
September 2017
November 2017
February 2018
May 2018
September 2018
February 2019
Cordis gained FDA approval for the EluNIR
Abbott gained FDA approval for the XIENCE Sierra
Biotronik gained FDA approval for the Orsiro

6. After peaking in mid-2017, Boston Scientific has steadily lost market share to other vendors
Drug-eluting coronary stent vendor market share (by unit)
Source: Lumere client base
Vendor released new drug-eluting coronary stent

7. Increased competition has resulted in significant pricing pressure
Average drug-eluting coronary stent price (by year)
Source: Lumere client base from 1/1/2016 to 6/30/2019 (does not include rebates)

8. Sourcing strategy 1: consolidate vendors
Approach
Consolidate drug-eluting coronary stent purchases to a single vendor and leverage the increased share to negotiate lower prices
Benefits
Opportunity to achieve lowest market prices
Requirements
Strong physician engagement
Monitor physician compliance
Risks
Physician migration if preferred vendor is not selected

9. Sourcing strategy 2: capitate pricing
Approach
Set a capitated price for all drug-eluting coronary stents purchased within your organization
Benefits
Physicians have access to a variety of vendors and products
Requirements
Strong alignment between physicians and administration
Monitor vendor compliance
Risks
Select vendors may not participate

10. Optimal length of dual antiplatelet therapy will be a major focus over the next three years
Several clinical trials are evaluating one month of dual antiplatelet therapy after drug-eluting coronary stent implantation in patients at high risk of bleeding
Boston Scientific’s POEM trial will complete in 2019
Abbott’s XIENCE 28 trial will complete in 2020
Medtronic’s Onyx ONE Clear trial will complete in 2021
Medtronic and Boston Scientific are planning to release iterations of their leading drug-eluting coronary stent lines
New vendors may attempt to bring their drug-eluting stents to the US market, but timing is currently unclear
MicroPort’s bioresorbable polymer metallic stent (FireHawk)
Reva Medical’s fully bioresorbable polymer stent (Fantom Encore)

11. Thank you
Questions?