Until very recently, the majority of people diagnosed with heart failure (HF) would die within five years. Effective treatment options for this chronic and progressive ailment were limited for the estimated 22 million sufferers worldwide. Unlike most cardiovascular diseases, HF is sharply on the increase, with nearly a million new cases now being diagnosed annually. With populations in almost all developed countries ageing rapidly, treatment costs for HF are becoming prohibitive.
Despite a clear need for new and widely applicable devices, the cardiac rhythm management (CRM) market is one of the largest and most stable segments of the global medical device industry. Mattia Gilmartin, Senior Research Fellow at INSEAD's Healthcare Management Initiative and co-author Yann Lorido explain how one of the CRM industry's main players, Guidant Corp., is attempting to build the future of the industry around treating HF more effectively. The effort could hardly be more vital. Despite major recent advances in drug-based therapies, the survival rate for those hospitalised with HF for the first time is lower than for cancer.
Guidant has based much of its HF-related treatments around device-based Cardiac Resynchronization Therapies (CRT). A wealth of trial data now points to for a subset of HF sufferers; CRT devices used in conjunction with optimal pharmacological therapy can significantly reduce mortality. But bringing such devices successfully to market in such a mature and stable industry demands very careful evaluation and direct contact with physicians for such a revolutionary new treatment to win widespread acceptance.
The authors detail the recognition afforded Guidant as a pioneer in therapeutic technologies, particularly in its development of smaller, far more comfortable implantable devices. Moreover, Guidant's CRT system also includes several innovative diagnostic and therapeutic features than allow medical professionals to tailor therapy to a patient's specific needs more easily.
The case study describes how Guidant chose its initial launch markets in five Western European countries. The company's Therapy Development Team concentrated on identifying and building close relations with both GPs and cardiac specialists in an effort to engage them in a broader dialogue about the range of HF treatment options. At the same time, it also adopted a sophisticated conceptual approach to its marketing that required going beyond mere technical knowledge of the functions of CONTAK, the CRT system being introduced.
The third prong of Guidant's CRT general strategy focuses on altering physician referral patterns while cultivating a new client base of medical professionals. Unlike the electro-physiologists who implant CRT devices and have long formed the core of Guidant's clientele in this field, those who are responsible for managing the treatment of HF patients -- mostly GPS and cardiologists -- overwhelmingly speak a different language in terms of research traditions and evidence requirements. Gilmartin and Lorido explain how Guidant has systematically worked to provide top-rate education, training and service support for clinicians unfamiliar with the new device and related therapies.
The case concludes with a discussion of the future of CRT in Europe, particularly regarding what the authors see as the two main barriers inhibiting further widespread acceptance of CRT therapies. These are reaching the physicians treating HF victims, and the failure of many national health systems to offer adequate funding and reimbursement for CRT programmes.