醫(yī)療用品與設(shè)備：COVID-19矯形外科專家會議要點

1、Equity ResearchAmericas | United StatesCredit SuisseMedical Supplies and DevicesCOVID-19 Ortho Surgery Expert Call: Current Elective Volume and Capacity Trends - TranscriptMedical Supplies & Devices | Conference CallResearch AnalystsMatt Miksic212 325 4381Christoph Gretler41 44 333 79 44Vik Chopra21

2、2 325 1749Research AnalystsMatt Miksic212 325 4381Christoph Gretler41 44 333 79 44Vik Chopra212 325 1749Whafs New?： We hosted a conference call with Dr. Kipling Sharpe, orthopaedic surgeon at OrthoArizona in Phoenix, Arizona, to discuss his views on recovering Ortho surgery trends with the impact of

3、 COVID-19, as well as the timeline and protocol for rescheduling patients, and expectations for delay in deferrable procedures.We have included the full, unedited transcript of the call in this document.Replay Details： Domestic: (855) 859-2056/lnternational: (404) 537-3406; ConferenceID:2678577DISCL

4、OSURE APPENDIX AT THE BACK OF THIS REPORT CONTAINS IMPORTANT DISCLOSURES, ANALYST CERTIFICATIONS, LEGAL ENTITY DISCLOSURE AND THE STATUS OF NON-US ANALYSTS. US Disclosure: Credit Suisse does and seeks to do business with companies covered in its research reports. As a result, investors should be awa

5、re that the Firm may have a conflict of interest that couldon. Sweden has probably reached heard immunity so they should be in good shape.Christ Gretler:1 think no doubt still a bit off but definitely nobody likes them to come to holidays also at the moment over here.Kipling Sharpe:Yes.Christ Gretle

6、r:Switching gears now to patient behavior. Actually, 1 guess there will be (inaudible) push out by some of these more vulnerable patients at the moment. Is this now something you observe? Or how would you encourage those to come this site, (inaudible) fears they might have?Kipling Sharpe:My personal

7、ity is 1 never push anyone to surgery. What 1 do is elective surgery and so if people want to put it off, Im perfectly telling them to put it off. Or letting them put it off. So there are a certain number of patients who just decided that its not a good time for them to do it. But that/s a fairly sm

8、all number.Most of the patients who 1 have been taking care of leading up to COVID have reached their desperation point already, and so they were - they were ready and they were disappointed that we shut down more so than afraid to - afraid of getting something when were starting up.Were taking a lo

9、t of precautions. Our governor in allowing us to open up May 1, said that we have to test every patient for an elective surgery, so every patient is getting Q-tips shoved up their nose and tested. 1 have not had one patient yet that has tested positive and not been able to have surgery.But 1 think t

10、hats reassuring to the patients who were taking more precautions. Everybody entering the hospital, myself included, gets their temperature taken every time they walk in the door. We all have to wear masks the full time that were in the hospital. Doing the same thing at our office.Weve limited our -

11、and this goes back to a question that 1 didnt fully answer before as far as the office, we have limited the number of patients per hour we see. Well see four per hour, normally 1 would haveseen six to seven an hour and some of my partners who do hand and foot and ankle would have seen may 8 to 10 an

12、 hour.And so we - 1 think theyre allowed to see six an hour, but the idea is weve basically taped off two out of three chairs in our waiting room. We dont allow any family in unless theyre a caregiver and the patient is not able to get themselves in and out basically or they have mental capacity iss

13、ues where they need the caregiver or theyre a minor.So, weve really reduced that. We have added some telemedicine, so we can see a couple of telemedicine patients an hour in addition to the four per hour. So, that has reduced the office visits significantly. What Im finding interestingly is the pati

14、ents who are coming are much more likely to be ready for surgery.Typically in an office pre-COVID, 1 would schedule probably on average four or five patients per surgery, now its more like 6 to 10, and thats seeing less patients. And so, the percentage that are teed up and ready to go, theyve failed

15、 their conservative care already and theyve got significant pathology.Its interesting how many more are coming in ready and people who have, 1 think, more minor issues either because theyve had to wait and those things have just kind of self-resolved on their own, or theyve said, you know its just n

16、ot that bad that 1 want to go risk going into a doctors office and having to have my temperature taken and wear a mask and be around people who might have something that 1 dont want. 1 mean maybe thats why were seeing less minor arthritis and minor knee problems, see more of the severe stuff.So, int

17、eresting the way that is. Im speculating on the causes, and only based on my observation. And 1 forgot which question 1 was actually answering because 1 went off on a tangent, so Im sorry.Chris Gretler:Oh, OK, that one was around patient behavior, but youre spot on. And then basically another questi

18、on 1 had both on the new product launches, so if you basically look at the industry kind of - and Im sure they have a lot of new products they want to test and bring to you.So when do you think actually your profession is ready again to look at a new product coming up from the industry? 1 understand

19、 you already have previously scheduled in fall, so is it basically the earliest you would look at something new towards the end of the year, or how should we think about that?Kipling Sharpe:Yes, thats hard to answer across the board, because 1 think physicians are very different on that. There are e

20、arly adopters, and have tended to be an early adopter, 1 do have some consulting relationships, and there is a new medication that was just approved by the FDA during COVID that Im a consultant for that company, and theyre struggling to figure out how to get in front physicians, because its hard to

21、get into offices.Restaurants just opened up here a couple weeks ago, so now theyre - can we do dinners, they show people the product or talk to them. So thats - 1 think there are multiple issues around that. One is, what is a physicians willingness to look at it; and two is, how do you get in front

22、of the physician with the product. And one of those ways has always been meetings.One of the things 1 like about going to meetings is actually seeing whats new in the industry and what new products 1 may or may not be interested in. We havent had any meetings now for a few months. The academy meetin

23、g, which is our biggest meeting in March was cancelled, and it is scheduled again for in-person in, 1 believe its March of next year - its usually in March in San Diego.The American Association of Hip and Knee Surgeons, which is my favorite meeting, 1 think its the best arthroplasty meeting, and Ive

24、 attended arthroplasty meetings around the world, and 1 think its the best one in the world.World Arthroplasty Congress is a good one as well, but the AAHKS is much bigger and it is scheduled to happen in person in November at its normal time. And Im looking forward to going to that one in person an

25、d 1 dont know - the registration for that just opened up Monday, so 1 have no idea what thats going to be like. They have a contingency plan to do it virtually if needed, but the hope is that it w川 be an in-person meeting, and 1 think a lot of physicians are looking forward to that.The two issues ar

26、e, how do you get in front of physicians and are physicians willingness change. My feeling is physicians willingness to look at new products probably is no different than it was before COVID. Either theyre somebody whose an early adopter or a midrange or a late adopter, and that personality componen

27、t probably hasn/t changed. Im involved in starting up the study on a drug for DVT prophylaxis.We have not yet - we just got it set up two days ago to be able to start doing it - Monday, four days ago, was the first day we could have enrolled and we havent enrolled anybody yet. One patient who was el

28、igible didnt want to do it because of the CO VID, so it may have some effect on patients willingness to enroll in studies.Their apprehension level may be just a little higher because theyre already having to do more testing - really, it isnt that much more, just getting their nose swabbed. But in th

29、eir mind, theyre having to do a lot more. So that was this persons reason for not wanting to be in the study, she otherwise said she would have been interested. So thats an N of one. I don/t have great sense there, but I think that may slow down some of the research end of things as far as enrolling

30、 people in studies.Another company I was supposed to start doing some implant trials with, that was - we were working towards that in March and its been radio silent now from them for two months.Another company Im working with on a new implant, the R&D process was moving along pretty well, and then

31、they had to stop that in March. And they actually - I think they switched some of their stuff to making PPE temporarily, some of their engineers face shields, or something - I dont know what exactly they were - 3D printing some kind of PPE. So that kind of put a slowdown on that project which was mo

32、ving along pretty quickly, actually.I dont know how its affected things with the FDA, as I say, the one that Im working with the company on that did get approval from the FDA during COVID, which was a horrible time for them to launch a product.Things that are - devices that are in the telemedicine w

33、orld, thats where 1 think the big growth is going to be right now.Obviously, weve all gone to using some sort of telehealth, but things that are maybe in the therapy realm that can be done by telehealth to give patients - that company 1 invested in is expecting great growth in their particular produ

34、ct in that portion of the market and 1 think that*s going to grow. And 1 think theres been a lot wider acceptance that we (see) in our society, that we can do a lot more stuff remotely than what weve dont in the past; obviously thats not the case with surgery.Chris Gretler:Yes, no doubt. Definitely

35、some limitations there. OK, thank you for your comment. Maybe now we ask (Norma) here, the operator to give the opportunity for opening the lines to the audience for questions, and also well take some from the e-mail queue, in case you have any questions you want to mail, just mail it to MattMiksicC

36、redit- Suisse or .With that now maybe, (Norma), could you make a quick (callout)?Operator:Thank you. As a reminder, to ask a question, youll need to press star one on your telephone. To withdraw your question, please press the pound key. Please stand by while we compile the Q&A roster.And 1 have a q

37、uestion from (Stephen Kai) from State Street. Your line is open.(Stephen Kai):Hi, appreciate your time. Maybe just a quick question on implant vendors, who you use, what drove that preference, and then as kind of a follow up, just robotics, if youre using robotics, if you/ve evaluated the different

38、robots, the pros and cons, compare and contrast, that would be great.Kipling Sharpe:OK, so 1 have been primarily a Stryker user for my career. Im a really big fan of the anatomic dual mobility hip, which Stryker makes. And that has not caught on here in the country, in the U.S. 1 know dual mobility

39、has gained a lot of traction in Europe, it gained a rather limited traction in the U.S. 1 do a mini posterior approach on my hips, Ive tried thedirect anterior, I didnt like it. My patients recovered just as fast as my partners who do the direct anterior.But the dual mobility hips is more challengin

40、g to put in through that direct anterior and its longer incision and longer surgery and more blood loss than the direct anterior.For knees, I have been a Stryker user, I was an Howmedica user before that, Stryker bough Howmedica. Ive been using the Triathlon knee, I was a consultant with Stryker whe

41、n they came out with the Triathlon Knee, and I was involved in the development. And Im involved in a 10- years study on the Cementless Triathlon Knee called the Triathlon Tritanium. And that has been the bulk of the knees I have done.More recently, I have started trying some other knees and Ive put

42、in Smith Nephew. And I use Smith Nephew for my metal allergy patients still. Ive used the DePuy Cementless Knee. Ive used the Exactech cementless knee. And Ive done some Lima Knees.And Ive been using more recently a significant increase in Conformis knees. Im a pretty big fan now of the Conformis te

43、chnology, the custom knee. The only added cost is the C.T. scan. And of course, if youre using - for the people using robotics, a lot of them are doing C.T. scans or MRIs anyway. So CTs are cheaper than MRIs, so its not a huge added cost.The implant cost at my facility is the same as the implant cos

44、t with an off-the-shelf implant. Its got a six-week delay to make it, but my schedule is backed up six to eight weeks.I have - years ago, I took the Mako training before Stryker bought it. And I was not - excuse me, I was not all that thrilled with it. I never did a Mako case.More recently, my Stryk

45、er rep has been pushing me hard to look at Mako. And I went and I looked at it again. I think its improved a lot but Im still not interested. The main barrier for me is that neither hospital that I do my patients at has any interest on spending $1 million on a robot.It doesnt bring anything to the h

46、ospital other than maybe some marketing. But that hasnt - 1 mean, were all working at capacity basically anyway. So we dont see it as a big value-add. Plus, most of my partners do not use Stryker knees so - because its a single knee platform or a single company platform, it doesnt do anything except

47、 for the one or two guys who do Stryker knees.Ive not looked at any of the other robotics systems so 1 cant really comment on them. 1 know theyre out there but 1 really dont have any exposure to them. Did 1 answer all your questions with that?Chris Gretler:You did. Thank you very much.Operator:Thank

48、 you.Matt Miksic:Doctor - oh, do we have another, (Norma)?Operator:1 have no other callers in the queue at this time.Matt Miksic:OK. Well, everyone, please feel free to queue back up if anyone does have an audio question. And as K ri st off e mentioned, feel free to shoot additional questions in by

49、e-mail.1 have a couple on e-mail but 1 just had a couple of follow-ups on your comments on both Conformis and the robot. So on Conformis, Im curious, to what degree - some of the benefits as we understand it is that it does kind of kit down your knee inventory. So in a - in a center, a smaller cente

50、r, or an ASC or a center where youre trying to be more efficient with your space, youre not - youre not lugging around as much inventory, not as many sets, everything is self-contained in those kits. Theres that benefit if, 1 dont know if you agree or disagree with, and then theres the prospect of b

51、etter outcomes.Kipling Sharpe:Yes.Matt Miksic:1 guess how do you - how do you find the attraction, and maybe how do you find the reaction of patients to that particular need, just curious?Kipling Sharpe:So, the first question is what attracts me to it, the main attraction to me is the chance for a b

52、etter outcome. We know that 25 to 30 percent of our total knee patients arent happy even though we, as surgeons, arehappy over 90 to 95 percent of the time, and so there/s a big disconnect.So, trying to find that knee that makes the patient happier is the holy grail, and 1 havent done enough of them

53、 to know that that is the case, but my early, and Ive used them initially very sparingly, now more frequently over the last two years, and my gut feeling is that Km getting a lot closer to that holy grail of the patients actually liking the knee like they like hips.So, that for me is the number one

54、attraction. The attraction in the facility, you certainly hit spot on, that theres a lot less inventory storage space and facilities is limited. Our position on hospitals, four of our hospitals, not very big and theres not a lot of storage room, and youve got one surgeon using Stryker and another su

55、rgeon using DePuy and another surgeon using Zimmer, shelf space does get pretty limited when youve got to have two of every size and two rights and two lefts of every size and thats a lot.And then youve got CS and PR - PS and CR and youve got all kinds of different variations on the theme.Matt Miksi

56、c:Right, right.Kipling Sharpe:So that is a lot of inventory and the Conformis knees comes in in a small box and one tray, so 1 think the hospitals like - 1 know the scrub techs love setting up for a Conformis knee, and 1 think Conformis is going to be a lot more attractive when its cementless.So, Co

57、nformis has a bright future. 1 am on the scientific advisory board for Conformis, so 1 do have to give that disclosure there that 1 believe in it, so.Matt Miksic:OK, thats helpful. And then on the robot, 1 get your point about putting it before the orthopedic hospital and physician-owned center that

58、 you mentioned, for example, or maybe even the community hospital, Im just like well, what does it get us. Is this a matter of, and Ive had this conversation with other centers and other docs over the years, and is this a matter of were already getting about every knee and hip that we can get in the

59、 surrounding area.And so the robot doesnt move the needle for us, whereas maybe if you were one of three or four and trying to punch back against an academic center and saw this as an opportunity to share gain - gain share, then you could look at it and say well, if we plunk this in, we get 100, 200

60、 more news a year, maybe its worth it.But because youre in the first scenario, it just does - 1 understand your other points also, but is that the return decision there in terms of having additional volume?Kipling Sharpe:Yes, so, hospitals are concerned about volume and dollars, right, 1 mean they c