The Geography of European Arrhythmology. Panos E. Vardas MD, PhD Heraklion,, Greece

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1 The Geography of European Arrhythmology. Panos E. Vardas MD, PhD Heraklion,, Greece

2 EUROPEAN ARRHYTHMOLOGY MAIN ISSUES Training in Pacing and Electrophysiology Facilities Usage Economics

3 EUROPE TRAINING IN PACING & ELECTROPHYSIOLOGY Training in Pacing and Electrophysiology is: Compulsory in 9 countries Non-compulsory in 27 countries Average training duration is 14 months Training duration ranges from 3 to 24 months National Sub-specialty Exams 6 countries have registered exams 31 countries have none yet

4 EUROPE TRAINING IN PACING & ELECTROPHYSIOLOGY OBSERVATIONS Exceptional variation exists concerning the level of expertise between the experts who practice electrophysiology in Europe. The ministries of health and the regulatory bodies show a minimum of interest in proof of proper training. Simulation is still in its infancy. The learning curve is based on mentoring or on the opinion dare and proceed

5 European Pacing Centres per million population Belgium Germany France Switzerland Italy Greece Netherlands Spain UK Slovakia Denmark Russia The highest The median The lowest

6 European Pacing Centres Questions Hyper or under usage Is there an unusually increased number of pacing centres or are there countries which have a lack of facilities? Could the Industry contribute to the development of new facilities?

7 Europe Facilities in pacing and electrophysiology Proposals A common European approach Guidelines - is necessary for the creation and function of electrophysiology and pacing centres It is obvious that a hierarchy is necessary for the possibilities and the license of each centre. The same applies for the investment in these. Centre distribution per country could be organised by the national scientific bodies, since a certain logic needs to be followed.

8 Implanted Pacemakers European Countries with the highest rates of implanted pacemakers per million population, in 2005 Belgium Germany Italy France Czech Republic Sweden

9 Implanted Pacemakers European Countries with the lowest rates of implanted pacemakers per million population, in 2005 Russia Latvia Slovakia Slovenia Croatia Lithuania

10 Macroeconomic Analysis* Market Management United States Canada Europe GDP (in billion US $) GDP Real Growth 2.4 % 3.2 % 0.9 % Total Population (in millions) Total Healthcare Spending (in billion US $) Health expenditure % of GDP Geriatric population (60 yrs and over) * based on 2004 statistics

11 Europe GDP / Health expenditure % Countries Switzerland Greece Germany Italy Netherlands Poland Spain UK France Ireland

12 Pacemaker Prices Country VVI DDD France Germany Greece Israel Lebanon * * *Prices are average. In certain countries final prices differ significantly following negotiation. Norway Russia Spain Sweden Switzerland Turkey UK These prices include neither VAT, nor lead cost.

13 Europe Revenue Forecasts

14 Revenue Forecasts World Cardiac Rhythm Management Market Cumulative Average Growth Rate ( ) Europe USA Asia 15.9 % 19.3 % 23.5 %

15 Market share

16 Product Forecast

17 Forecast analysis Europe Cardiac Rhythm management Market (World), 2004 The European CRM Market generated an estimated $ million in The market is expected to grow at a CAGR of 15.9 % through It is expected to reach $ million in Cardiac resynchronization therapy and MADIT II are driving ICD growth in Europe.

18 Pacemaker Market- Europe Cardiac Rhythm Management Market (World), 2004 Year CAGR Revenue ($ $ million) , , , ,123.5 Growth 8.0 % 3.6% 3.1% 3.8% 3.9% 3.2% 3.5%

19 Pacemakers Revenue ($ million) Europe CRT-P 14,6 16,7 22,8 27,7 31,4 39,9 43,5 Pacemakers ,7 956,4 981, ,5 1080

20 ICD Market- Europe Cardiac Rhythm Management (World), 2004 Year CAGR Revenue $ million , , , ,976.6 Growth 102.8% 39.6% 42.7% 26.7% 22.2% 20.0% 29.9%

21 ICD Revenue ($ million) Europe CRT-D 51,1 145,7 240,5 386,5 521,7 652,2 782,6 ICD 21,1 388,1 504,6 676,8 825,

22 Pacemaker and ICD Market Trends and Forecast Analysis Europe The European pacemaker market generated an estimate $945.4 million in 2003 and is expected to reach $ million in The market is expected to grow at a CAGR of 3.5 % through The European ICD market is expected to reach $ million in The total ICD market in Europe is rapidly developing and is expected to grow at a CAGR of 29.9 % through 2008.

23 Conclusions European arrhythmology is characterized by significant heterogeneity and is in need of orchestration. It is required of EHRA to play a vital role not only in creating scientific initiatives, but also to support national scientific bodies in the field. Industry will continue to enjoy satisfactory revenue as the use of ICD/CRT devices increases accordingly.

24 Ευχαριστώ πολύ Thank you Tack Tesekkόr ederim Kφszφnφm Merci Kiitos Blagodarya Aciu / de'koju Takk Grazie Danke Tak Dank u Tδnan / Aitδh Multumesk Hvala Gracias Grΰcies Obrigado Dziakuj Dziekuje Dκkuji vαm Dβkujem vαm Djakujo Dziekuje